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The Moral Education of Physicians—Why It Matters to All of Us

“Modern medicine is one of those extraordinary works of reason: an elaborate system of specialized knowledge, technical procedures, and rules of behavior,” explains Paul Starr. “By no means are these all purely rational: Our conception of disease and responses to it unquestionably show the imprint of our particular culture, especially its individualist and activist therapeutic mentality. Yet, whatever its biases and probably because of them, modern science has succeeded in liberating humanity from much of the burden of disease.”

In The Social Transformation of American Medicine, Starr documents the amazing revolutions in medical practice that have forever changed the face of medicine. As he recognizes, these transformations are largely dependent on scientific expertise and technology.

“Few cultural relativists, suffering from a bad fever or a broken arm, would go so far to prove a point as to trade a modern physician for a traditional healer,” he argues. “They recognize, in behavior if not always in argument, that in medicine the dream of reason has partially come true.”

Now, Philip Overby, a fellow in pediatric neurology at Johns Hopkins University, worries that this “dream of reason” may have changed medicine for the worse. In “The Moral Education of Doctors,” published in the Fall 2005 issue of The New Atlantis, Dr. Overby takes careful note of the great gap of scientific expertise and knowledge that separates the ancient physicians from their modern counterparts. He wonders “what, if anything, still abides in the medical vocation from previous eras?”

In all likelihood, most persons give scant attention to the education of physicians. Those outside the medical profession simply trust that a doctor, having graduated from an accredited medical school, passed medical examinations, and fulfilled an internship and residency, should be fully qualified to practice medicine at an acceptable level of excellence and expertise. Nevertheless, the education of physicians should be a matter of concern to all of us, patients and physicians, for the physicians who will treat us in the future are being shaped by the culture of the education they now receive.

Overby has a specific concern in mind–the metamorphosis of medicine into science. “Are physicians the same as scientists?” he asks.

Clearly, an extraordinary grounding in science is a prerequisite for success in medical practice. No one gains entry to an accredited medical school in the United States without a thorough grounding in scientific knowledge. Still, the physician must be more than a scientist.

As Overby sees it, the main distinction between scientists and physicians is that physicians treat patients. “They aim to heal the afflicted, not simply to discover the truths of nature.” Nevertheless, Overby notes that “the close relationship between modern medicine and modern science has made many doctors think and act like scientists.” This may be inevitable, given the scientific knowledge basic to the profession. “But the transformation of doctoring in the image of science may also obscure, in important ways, the real character of the medical vocation,” Overby observes.

Why? “If we educate doctors solely or largely as mechanics of the body, we may leave them unprepared for the human encounter with the sick and desperate, the brave and dying, the healed and grateful. And even if we equip them with the best medical tools of the age, we may leave the physician partially naked on the wards.”

How are doctors made? Overby advises that the process of medical education for doctors still maintains a distinction between physicians and scientists. Medical education is defined by action, Overby insists. That action takes concrete form in the taking of an oath, usually some version of the Hippocratic Oath, with its honored commandment, “first, do no harm.” Thus, the medical doctor is reminded that the practice of medicine “involves high stakes,” Overby explains. “In the practice of medicine, doctors assume responsibility for the well-being of another,” he explains. “Scientists are not asked to take an oath before beginning their work.”

In his article, Dr. Overby provides a fascinating and insightful review of just how doctors are made. After medical school, the new M.D. must complete an internship. This affirms “that action and experience are essential to the very definition of a doctor as a credentialed professional.”

Overby provides a powerful metaphor for his explanation of the transformation of an M.D. into a doctor. “Being a new intern is similar to being a new parent,” he explains. The new doctor is deprived of sleep and finds surrender in tending first to the needs of another–just like a parent. “With each passing night of inadequate sleep, the mother and father give up their lives, their vanity, and their grip on the way things were in favor of life with their new child–acting on the vulnerable baby’s behalf, putting the child’s needs before their own,” Overby suggests.

In the same way, the medical intern “learns quickly that life as he knew it is over.” Losing control of his time and self-concern, he finds fulfillment in taking care of others. “In this way, the ideals that brought the eager medical student to the profession are inculcated as moral virtues,” Overby explains. “The intern is broken down, and day after day his responsibilities are internalized until it becomes second nature to place his patients’ needs above his own. The intern is placed in the often charged, always difficult, impossibly sad center of his patients’ lives, teaching him a thing or two about human nature and human frailty.”

This process turns scientifically-trained M.D.s into faithful, competent, and caring physicians. Moving through medical school, internships, and residency, the doctors learn to work together, to trust each other, and to aspire to fulfill the highest ambitions and aspirations of their profession.

Without embarrassment, Overby suggests that doctors are often motivated by a quest for honor and glory.

“This is largely a good thing,” he argues. Nevertheless, honor can come mainly from one’s peers, and the level of expertise and knowledge required to evaluate physicians, especially in today’s highly specialized field of medicine, means that as doctors advance toward excellence, “there is greater honor from fewer and fewer people.”

Glory is different. The medical profession is cloaked in an aura of glory that, Overby understands, emerges from “the hearts of fellow human beings.” As the ancients understood, glory can be a dangerous seduction.

Dr. Overby’s concern becomes more focused at this point. In our highly scientific age, the quest for glory is often focused on scientific advancement rather than the actual practice of medicine. Medical students are generally taught by academic physicians as opposed to physicians who spend most of their time treating patients. Thus, the culture of medical education is increasingly scientific and technological.

The problem with this transformation of medical education is, Overby suggests, a threat to the medical profession. In terms of moral virtue, the physician receives the most important education “at the bedside, not in the research laboratory.”

The physician must treat the human being as a whole person, not merely as a body. The scientific education of doctors tends to reduce medical concern to “the materiality of the person,” Overby warns. Treating human beings merely in terms of their materiality is a form of degradation.

The reduction of medical practice to science robs the medical profession of a concern for the patient’s spiritual character, Overby observes. The worldview of modern science simply ignores metaphysical questions and reduces all issues to material reality. All that remains is “material inquiry into objects that are subject to inquiry through material manipulation.” The mechanism for this manipulation is technology.

With a sense of urgency, Dr. Overby wants to save his cherished profession from a reduction to science and technology. Of course, he neither bemoans nor denies the positive contributions of medical science and technology. Nevertheless, he understands that the physician must be more than a scientist or technician.

He describes the role of the physician in poetic terms: “We see people at their best and worst, stoic and vulnerable, devastated and elated. And if we pay attention, we learn something in the process about being human. We recognize the brutality of disease, the blessings of health, and the courage required to endure pain and face death. We also gain the opportunity for glory, to reach beyond our own sources of honor, to participate in the drama of mortal man seeking meaning. In this way, the physician can transcend the medical profession, even as he participates in its more ancient traditions.”

Modern humanity faces threats on many fronts, and the transformation of modern medicine Dr. Overby describes is one of those threats. A merely scientific approach lacks the deep moral concern and insight that protects the medical profession from perversion and manipulation. Day by day, medical doctors face some of the most difficult and excruciating moral issues of our times, and we endanger humanity by robbing doctors of the moral preparation and expectations that keep human beings from being treated as nothing more than material objects, and medicine from becoming merely an extension of applied science.

Christians understand this threat with a particular cogency. Human beings are indeed embodied creatures, but we are more than mere bodies. Furthermore, the moral challenges faced in the practice of modern medicine require a far deeper level of moral commitments, based in an affirmation of human dignity, than would be required of most research scientists working in laboratories.

Along with Philip Overby, we should be concerned about the medical education of physicians. After all, we entrust our well-being to these committed professionals. Along with Dr. Overby, we must be concerned that a lack of moral education will leave our doctors “naked on the wards.”