Preventive Medicine Column
Dr. David L. Katz
In medicine, we pledge: primum non nocere. First, do no harm. But before we can do no harm as doctors, we need to be doctors. And before we can be doctors, we need to be human beings. Being a doctor is a great privilege, but it is a subordinate privilege. Being human comes first.
I distinctly recall the time in my medical education when I realized I was becoming more medical and less human. The process of learning how to conduct a complete history and physical had so taken over my brain that I could no longer remember how to have a conversation with a patient. The structured interview offered benefits, of course, but the loss of spontaneous human interaction seemed a high price to pay.
Fortunately, this proved to be a symptom of immaturity, professional if not personal- and perhaps a bit of both. When I eventually knew the steps of the history and physical well enough to stop fixating on them, the human elements of interaction were once again accessible. I am pleased to say I have talked- really talked, and even listened!- to my patients ever since.
I spent many years involved in medical education, so I know I’m not alone. I have seen many good young people subordinate their good youthful and perfectly human capacity to communicate to the tyranny of the structured interview. Many can be taught to get past this. I’m not sure all can, however.
I think that education in the subtleties of human interaction, and communication in all its nuances, must start much earlier than medical school or residency training. I think we should be raised on it. Much of this is the work of family, but not all- for the human family is much larger, and more diverse.
It is in this context that a general decline in instruction in the humanities recently noted in the New York Times worries me, for such courses in the fundamentals of who we are reverberate with relevance to the course of human events.
I am by no means suggesting that every doctor, or members of any given profession, should all be humanities majors. But a general decline in our respect for and attention to the humanities may be at our collective peril. For whatever it is we do, we are, commonly, human first.
I was a humanities major, which of course did not obviate any of the standard pre-medical requirements; there was physics, and calculus, and organic chemistry as well. But I majored in French at Dartmouth, with a concentration in medieval literature, and took additional courses in the great works of literature, logic, history, Shakespeare, philosophy, eastern religion, romantic poetry and more. I never felt so educated, before or since. But more importantly, this exploration of century-spanning human thought and emotion situated any cogitation I was inclined to consider modern, or novel, within the grand expanse of human reflection.
Clearly there is no need to cite Voltaire to perform a competent vasectomy; no need to invoke Invictus to treat influenza. But the humanities are redolent with all we have in common. They are flush with the follies of history and the lessons attendant upon them. In a world where we find so many ways to disperse, so many reasons to denigrate, so many excuses to dissociate, they remind of the grand sum of our collective enterprise, even when the lens is the poignant intimacy of the private parts we each play.
The humanities matter because they transcend what we choose to do, and highlight what we ineluctably are. We are human, together. We are human first.
Dr. David L. Katz; www.davidkatzmd.com