A medical mind is precious and fragile: hard to create, easy to corrupt. Doctors invest over 10,000 hours learning how to diagnose and treat. The medical mind exists to help patients and should serve no other purpose. But it is easily corrupted, distracted from its main purpose.
If patient care matters, we must protect the medical mind from service to popular, non-medical ends.
Hard to Create
Medical students submit to a 4-year shaping program: an immersion in a peculiar thought process. Residency continues the formation for another 2, 4, or even 12 years.
The medical mind continues to develop, in practice. Ultimately, patient care adds the fine and necessary texture.
Forming a medical mind is more than taking courses and learning techniques. You cannot become a doctor by memorizing Google Scholar or watching a video.
A mind is more than information. It is an information processing tool, created at great cost.
How Medical Minds Work
With one hand, doctors reach backwards and hang onto medical knowledge. With the other, they grope forwards for new ideas and solutions.
Medical knowledge is not monolithic; it always changes. But neither it is a clean wipe of the medical hard drive to start fresh with a blank mind every Monday.
Given this two-handed approach of past-plus-progress, a medical mind must remain open.
The fact of new information makes some of what we think we know wrong, by definition. The history of medicine is full of attempts to treat using tools which caused obvious harm in hindsight.
Thus, a medical mind must adopt the scientist’s “pride in his/her humility.” Doctors must promote the limits of our knowledge because what we think we know might not be so tomorrow.
Easy to Colonize and Corrupt
The medical mind could remain protected, hidden inside the institution of medicine. But the town comes in, as it should. Doctors serve real people, who live outside.
Inevitably, social ideas colonize medicine. Medical knowledge adopts features and norms from the society it aims to serve. This is a good thing, if the ideas add knowledge. But patients suffer if society reshapes the medical mind and how doctors process information.
If society changes the way doctors think, not just what they think, then patients lose the only unique thing doctors have to offer. If doctors become nothing but dispensaries of information, patients might as well use Dr. Google and get the information themselves.
Shared Vision
This process of society shaping the medical mind is not new. It did not cause major problems when society showed a basic deference to debate, data, and civil discourse. We can call this basic deference the ‘Fukuyama vision.’
Francis Fukuyama, political philosopher, wrote a best-seller in 1992 called, The End of History and the Last Man. Fukuyama argued that the fall of Soviet Communism meant the end of history.
Soviet decision making was wrong. Western decisions were right. The best way to organize society was now clear. Research mattered. Truth mattered.
Western experts told the truth, even if it did not help the political dreams of those in government.
This Fukuyama vision (classical liberalism) existed alongside the medical mind, with broad overlap in approach and assumptions.
Society inevitably shaped the medical mind. But it worked reasonably well, because similarities were strong. Doctors grew more humane and relatable, without compromise to medical decision making.
The overlap worked until the Fukuyama vision failed.
End of a Shared Vision
During the Cold War, Soviet social policy served a lighthouse function. It showed Western democracies what to avoid.
After 70 years of aiming to do what Russia did not, the end of the Cold War removed any reason to keep the Fukuyama vision. It turns out Fukuyama had identified the end of the lighthouse, not the End of History.
During the cold war years, doctors shared the same basic mindset as the rest of Western society, so much so physicians forgot what makes a medical mind different. Doctors had become nothing but citizens, who knew lots about medicine.
A Conflict of Visions
Today, modern social policy no longer follows the old vision of debate, data, and civil discourse.
Current social policy rests on ideas about groups and power structures, not the slow process of scientific discovery. A renewed Marxism animates society. We call it “progressivism”, “anti-racism”, and “wokeism.” We must focus on groups, not individuals.
Modern cultural leaders consider many appeals to historical research to be impolite, at best, often profoundly insensitive, and even potentially hateful. We would best forget what lies behind and reach forward with enthusiasm to what lies before.
Medical Minds if Patient Care Matters
Modern popular thought means the end of the medical mind. Medicine cannot continue an uncritical embrace of popular social policy.
Evidence must matter, especially when it does not align with social dogma. Research must happen, especially when it questions what society deems acceptable.
Physicians have always been part of a medical guild, in parallel but apart from society. Doctors need space to ask unsociable questions and pursue impolite propositions.
If patient care matters, doctors must rediscover the roots of their medical mind, before it is lost entirely.
bravo
Thanks!
Yes Shawn,yes.
I watched in horror over the last 2 yrs how many ‘top docs’,’experts’,and typical physicians lost their critical thinking,regressed to the mean and society suffered as a result.
Me too, Ram.
It’s been hard to know how to engage. If someone rejects reason, logic, evidence, civil discussion, and many of the other essentials, how can we practice medicine?
The longer the majority stays quiet, the harder it will be to speak out. And when we do, it may come out clumsy and insensitive. This will only make everything worse. People will point to clumsiness as evidence of what they believe needs to be expunged. Civil debate is a perishable skill.
Thanks for posting a comment!
Woke activists have infiltrated medical schools and we are beginning to see the unfortunate results.
Having penetrated Medical schools they are now aiming to produce the most woke and equitable doctors possible , not the most skilled and most capable, an infiltration that will lead to a negative woke feedback loop.
The careers of professors have already been placed at risk …if they state that a man is a man and a woman is a woman the activists have a fit , if the medical dangers of obesity are pointed out , the activists become apoplectic accusing the teacher of being fat phobic .
The old virtues of individuality and merit are now being condemned , the medical ethics handed down to us over the last 2500+ years from Asclepius and Hippocrates ,are being rejected by the ideologically driven , equity focused , pronoun obsessed , medical social Justice warriors.
Woke medicine is already here seeing racism ( really pigmentism) everywhere their obnoxious jargon omnipresent….we should refuse to recognize their language, their definition of words, their Newspeak, their alternative facts.
Judging by the actions of our supposedly representative professional bodies, it’s too late.
I agree, Andris. I also agree that it is probably too late.
There have been times before when heterodoxy was treated as heresy. We found ways to regain sanity — as you said, medicine has been around for several millennia. I don’t know enough history to give examples of when medicine had to survive by hiding its essential counter-cultural nature. I think medical Latin served (in part) the need to be esoteric.
Thanks for taking time to share a comment!
Glad to receive another thought provoking note. I believe the medical mind has taken a real blow during the last 21/2 years. The treatment of patients by doctors with a medical mind has disappeared. It has been taken over by physicians that have never treated “a” patient but by doctors that treat groups of patients. They talk about science and evidence based medicine but don’t really understand it. the Politicians certainly don’t have a medical mind. Debate has been curtailed and doctors that don’t follow the “party line” have been fired on occasion (more in the US). In my opinion the most egregious behaviour by our Colleges and non medical minds was preventing the use of Ivermectin a safe fully approved drug with proven antiviral effect that should have been allowed (off label) when nothing else was working. There is pretty good evidence now it is actually effective. I agree the medical mind is unique and progressive and being lost.
Certainly COVID revealed how politicized medicine has become…in the past one could have a healthy debate with studies dissected and redissected about how to treat Diabetes or Hypertension without being cancelled or having the college appearing from left field to rap one on the knuckles.
Some of our colleagues have been reprimanded / condemned for simply forwarding , to each other, studies from Denmark or elsewhere concerning COVID that contradicted the official line…I can’t recall such occurrences in the last 50 years.
Great comments, Andris. We’ve lost our ability to discuss evidence. Thanks again!
Really interesting comments, Graeme. Thank you.
Therapeutics have become politicized. We used to be able to have a discussion — for or against — a particular therapy. No one took it personally. For example, I would share my thoughts on statin medications (Crestor, Lipitor, etc.). The other party would share theirs. We would learn from each other.
Today, particular medications are heralded as saviour or Satan. It has become impossible to discuss Ivermectin: one side insists it is a miracle cure, the other says it’s a nefarious plot to deny science. Since this post isn’t about particular therapeutics, I won’t take up the offer to debate it. I disagree with your comments about efficacy, but that is all I will say about it here. It would take this blog post down a very long rabbit hole.
Thanks again for posting.
Cheers
Other than the deaths obviously, the worst thing about the Pandemic for me was to see public health and medical therapies dictated by the politics of those advocating for or against it.
Politics before patients … 😉
Absolutely. The blatancy during Pandemic was utterly disgusting.
Andris
“Woke activists have infiltrated medical schools and we are beginning to see the unfortunate results.
Having penetrated Medical schools they are now aiming to produce the most woke and equitable doctors possible , not the most skilled and most capable, an infiltration that will lead to a negative woke feedback loop.”
Graeme Barber
“I agree the medical mind is unique and progressive and being lost.”
Shawn Whatley
“We’ve lost our ability to discuss evidence.”
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What is interesting about all three of your comments is that both my children (ages 23 and 21) very deliberately avoided going into medicine because of the “wokeism” inherent in current medical practice. My children would read the OMA journal and the CMAJ in their mid teens and simply shake their heads at the attempted political correctness.
My 21 year old went so far as to apply and be accepted at Peking University in Beijing. It’s a combined program with Queens. Say what you will about the Chinese, they don’t do woke. I would compare her courses to surgical residency in the 70’s and 80’s. Perform or leave. Or as was reiterated to me by a previous surgical chief, don’t tell me how rough the seas are, just bring the ship home. She loves it and thinks her education is far superior to anything she could acquire in Canada. Also, there’s the benefit of having to learn and be fluent in Mandarin in order to graduate.
My 23 year old works for a military contractor in IT. We can debate my ethical concerns regarding that, but again, they don’t do woke. It is simply not tolerated. Being woke and having security clearances simply don’t go together.
Both my children-who could have easily undertaken medical careers- look upon the current governing medical structures with disdain. They are both of the opinion that “get woke, go broke” applies quite nicely to such bodies, and that they will eventually implode from within. As my daughter likes to say, when you are this many standard deviations away from the checks and balances that ensure that society continues to function, you have to come back to the mean. The problem is that you often don’t stop there but rather go a similar distance to the other side before coming back to neutral. Food for thought.
Wow! David, thank you so much for taking time to share this. Fantastic stories.
Everything you said was interesting. I only want to add to your “they don’t do woke” comments.
Wokeness is American. As usual, Canada has been colonized by American content, which we adopt and assume is our own. Apparently, Europe sees wokeness as an extreme form of Americanism. For example, Europeans do not topple statues.
It’s good to hear that performance still matters in security. Pretending merit and performance do not matter in medicine, because they are hard to measure, will end up breaking medicine from within. As you say, “get woke, go broke.”
Thanks again for taking time to share these personal stories. Fascinating!
Cheers
Wonder where your children obtained their moral fibre from?
Best wishes to the both of them….it will be particularly required in Communist China.
What a timely and insightful post, Shawn! Since I graduated 45 yr ago, the culture of medicine has changed at least as much as the rest of our culture. Of course medicine in the 1970’s was also a product of that culture, much more reflective of Modernity, that drive to debate right and wrong and find truth, than the current fear of offending anyone who identifies on the “right side of (the) history” you cited Fukuyama talking about. I do recall a fellow med student (Marxist-Leninist) warning me that the “wheels of history” would roll over (conservative aka reactionary) people like me. But my career mostly held to the premise that a “doctor” was one who had both the knowledge and that medical way of thinking you describe to think outside the box, while a technician followed procedural manuals and proficiently did tasks. In my experience in West Africa, apt mature students with grade 6 education were taught to follow algorithms to diagnose and treat most urgent medical presentations and perform surgical procedures, with the doctor on duty to follow up in the morning.
Learners today must pretend that they have no opinion other than the correct one presented by their school, must never question that a personality disorder isn’t really a disorder if involves identity, that personhood is defined by the ruling power rather than the reality you see and know.
Thanks for stimulating good thought and discussion. (I loved Andris’ “pigmentism”; will have to use it. might be easier for people to relate to than “melanin deficiency”)
/Phil W
Great comments, Phil!
I found this part especially juicy/provocative:
“In my experience in West Africa, apt mature students with grade 6 education were taught to follow algorithms to diagnose and treat most urgent medical presentations and perform surgical procedures, with the doctor on duty to follow up in the morning.”
We found the same thing with Emergency Triage. A bright high-school student could enter data into an app and assign triage codes more accurately than staff with years of training. I suspect we will find this more and more as AI expands (where it can) into medicine.
This begs, precisely, what it means to think like a doctor. If being a doctor is nothing but filtering symptoms and spitting out a diagnosis, then AI or a student with an app can do it. Medical training used to be about the formation of a medical mind. I suppose training is still about formation — the targeted end product has just changed.
Thanks again for sharing your experience. There’s simply no other way for us to capture observations over five decades. And there are those who prefer we would forget it all anyways.
https://atlantic.ctvnews.ca/cape-breton-doctor-removed-as-head-of-emergency-medicine-for-eastern-zone-1.5473738
Thanks Gerry
Chris’ story is unbelievable. I can’t imagine what he had to endure. He’s come through it strong and energized. I expect we will see big things from him soon.
Cheers
The CDC’s definition of “vaccine” also has changed: Last spring, CDC defined a vaccine as “a product that stimulates a person’s immune system to produce immunity to a specific disease, protecting the person from that disease.”
The definition of “vaccine” now reads: “A preparation that is used to stimulate the body’s immune response against diseases.”
Curiously no uproar, and everyone seems to be going along with the above…right out of Animal Farm and before our very eyes.
It’s almost as if we need new laws/constitutional statements such as – thou shalt not force anyone to take anything they do not want injected into them – or thou shall not force anyone to put a diaper on one’s face if they do not want a diaper on their face – I could go on but hey…
Thanks Rickk … I missed that. It almost sounds like IVIG might qualify under this new definition?
The CDC, WHO, federal public health, and many more institutions have lost legitimacy in the eyes of those they purport to lead.
I agree. We need clarity — perhaps new legislation — on the limits of public health. After SARS, we seem to have expanded its power and scope. Now, we’ve seen it went too far.
Thanks for taking time to post!
Very troubling actions…I wonder how many others will be struck off the register for other drugs used off-label
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Dr. Bernstein must not provide medical exemptions in relation to vaccines, mask requirements or diagnostic testing for COVID-19. Dr. Bernstein must not prescribe ivermectin or hydroxychloroquine. Further information may be found on the College of Physicians and Surgeons of Ontario website at http://www.cpso.on.ca