Class of 2016
Holistic care is making its way into medical school curricula. This is wonderful when we consider the plethora of information gathered from several disciplines. I see this in my own education, which combines undergraduate psychology, graduate-level theology, and, of course, medicine. These each affect the way we perceive life and personhood. Holistic care integrates our interdisciplinary knowledge and applies it well. It exhorts us to move away from labeling patients as “breast cancer in room 308” and towards valuing them as precious people.
Yet, despite our positive view of holistic care, there is a serious shortcoming in our provision of it. Despite our knowledge that caring for a person physically, mentally, emotionally, and spiritually is good for health, we do little in practice. Why? Sometimes, admittedly, we do not know what holistic care is, or how to go about it. My greatest fear? We simply do not care. We must backtrack to appreciate this.
Years ago, people understood the work they did as a vocation, or a calling. The origins of the term vocation are linked to early Christianity and the call of God to people. This was also reflected by the apostle Paul in his letter to the Corinthians as he reminded people that God had “called” (1 Cor 7:17, ESV) them to a certain life. Later, during the tumultuous Reformation, two theological giants, Martin Luther and John Calvin, followed this train of thought and emphasized the importance of any work as something that a person was called to by God.* Subsequently, there was an understanding of a person’s work – in our case, medicine – as a true calling.
There are two things that are helpful to consider. Firstly, the call to medicine was passive. People were drawn into it, likely to fill a need. Secondly, it suggested that there was a “caller.” The need for a task to be completed was established by another party that then called upon certain people. These characteristics of a calling meant that the emphasis on pursuing a career in medicine had less to do with personal fulfillment and more with responding to a need and being a contributor to the common good. The mindset was on “us” or “society” versus “me.” Speaking for my generation, I believe this view is largely lost today.
Amongst my colleagues, the conversations surrounding a career in medicine are self-centered. How much money will I make? How prestigious can I become? What sort of lifestyle will I have? Will I be fulfilled? Of course, some of these questions have real merit. What must be noted, however, is that the overwhelming subject is “me.” Before, medicine was a vehicle for helping people. Today, it is often a vehicle for money and reputation, and helping people is an early guise. This is linked to a wider sociological setting that emphasizes self-actualization and individual autonomy over collective well-being. Unfortunately, this pervasive mindset isolates us from one another and our shared humanity. We have lost, as John Winthrop said, appreciation for “our community as members of the same body." As a result of our amnesia, the late American sociologist Robert Bellah lamented in his book Habits of the Heart that “we have put our own good, as individuals… ahead of the common good.”
Again, this problem is especially poignant in medicine. We are not just caring for people’s finances or products. We are caring for people at a most vulnerable point in their lives. In addition, medicine is a place where both money and prestige are to be had. Medicine is an attractive place to seek self-gain, but it is an especially dangerous profession in which to do so as the repercussions of inappropriate care can devastate the vulnerable people served.
When we enter medicine solely for personal fulfillment, everything becomes a means to that end. Patients are welcome insofar as we can bill for them or insofar as they present us with cases that can further our academic careers. But when we are not paid more for dealing carefully with patients’ concerns, they become a nuisance. We usher them out because their questions do not benefit us. Unless some prestigious publication is attached to our caregiving, these patients are not worth our time. It upsets me to consider friends who have been poorly treated by the “best” or “most prestigious” physicians in a field. We do not see them as people in need of help, nor do we see ourselves as public servants. We see patients as secondary, or even as obstacles to our primary goals. If we think like this, we will be uncaring doctors.
When we return to why we fail at holistic care, I think it is in part because we do not care. The root of such uncaring may simply be our nurturing of self-obsession over the common good. But if we want a generation of physicians that truly cares, we must shift the culture of “medicine and me” to one of medicine, patients, and our role in helping. I wholeheartedly admit that I have been molded in this culture and that I, too, contribute to this problem. My aim is not to be harsh. I say this as a culpable member of the community who seeks to build our profession up for the better. As Bellah wisely said, we must return “to the idea of work as a contribution to the good of all and not merely as a means to one’s own advancement.” Let us reconsider today the why of medicine and hope that, in our heart of hearts, we find the truest desire to be there for our patients.
*Luther considered all work as vocations that acted as the means by which God worked providentially for people and the world (consider his exposition of Psalm 147 in Luther’s Works: Selected Psalms III, ed., J. Pelikan, vol. 14 (Concordia, 1958). As for Calvin, in his infamous Institutes of the Christian Religion he states that “in following your proper calling, no work, will be so mean and sordid as not to have a splendor and value in the eye of God” (III.10.6).
1. Robert N. Bellah, Richard Madsen, William M. Sullivan, Ann Swidler, and Steven M. Tipton, Habits of the Heart: Individualism and Commitment in American Life (Berkeley: University of California Press, 2008), 285.
2. Ibid., 285.
3. Ibid., 287-288.