We expect too much from medicine. We all wish that some body of knowledge would contain all answers to all our questions, provide a cure for all our ailments, an end to all our anxieties. Unhappily, medicine is inexact and incomplete. But this is easy to forget, just as it is easy to forget that the doctor is no neutral service provider: we are not cars or computers requiring standard servicing. Nor is health insurance a warranty over our body: it buys the right to have repairs, so to speak—whose effectiveness is unpredictable at best—but not to exchange damaged goods. New limbs can be ordered, new heart pumps, new kidneys, and even new cells. But these are only parts of a whole that is the self, which is a reality not always present to our conscious minds: we tend not to contemplate our bodily self from within but rather to expect knowledge of it to come from without. We objectify the body in order to make sense of it. So does the doctor.
Medical practice has thus become increasingly specialized. There is more and more to know about smaller and smaller dimensions of the body, as if our constitution as a human being were irrelevant to the understanding of what may just as well be a complex, selfless machine. Focused on measurable, microscopic realities, addressing specific targets at cellular and now genetic levels, our medical technologies allow for the invention of treatments more efficient and less invasive than ever, helping to ensure a longer lifespan throughout the populations of the developed world. But where is the concern for the embodied self? How do we, the individual patients, relate to the divisions of our anatomy into bits and pieces, to the charts and numbers on our medical records? Why should we believe that the knowledge of our digitized self has anything to do with our ailments and anxieties? And whatever happened to the warm, wise embrace of the compassionate physician?
Medicine was not always about cold data. The memory of the old-fashioned family doctor, allayer of discomfort and fear, is not entirely a fantasy. There was once world enough and time for such a figure. Some might still remember house calls, the devotion of one doctor to one family, and of a family to its doctor. But such availability is largely unimaginable today, especially in America. The economics of medical care don’t permit it. Technology and efficiency have won out over the old idea that medicine is primarily concerned with the treatment of patients. Technological progress allows for innovation and better treatment—from antibiotics to bypass surgery—but good medicine continues to require, preferably in equal measure, psychological awareness, intuition, sensitivity, and empathy. Even the most hard-nosed, scientifically informed patient expects some of those qualities in a doctor whose profession it is to make us feel better and presumably live longer.
Medicine was once a humanistic endeavor, an ars, an art or practical skill, as well as a scientia, or body of knowledge. Early Western doctors, who lived in Greece near the end of the fifth century BC and followed in the footsteps of Hippocrates, remembered as the founder of medicine, believed it was of paramount importance to establish a diagnosis and a prognosis before prescribing a therapy. All three parts were equally important in establishing the patient’s individual historia, and each one depended on the other. This was an empirical endeavor based on a new rationalism that informed also the first stirrings of philosophical wonder. Instead of appealing to gods to understand nature or to cure bodies and souls, rationalist doctors, like the first philosophers, used reason and observation in order to understand nature on its own terms, identifying natural causes and recommending treatments on the basis of what they saw.
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