Two Doctors on their Profession

“It’s so infantilizing to be sick,” says Jerome Groopman. He speaks with authority, having been a hospital patient himself, and also a doctor who treats people with life-threatening diseases.

Of the patient’s attitude, he observes: “You look for a parent to sweep you up and make it all better.” But your physician cannot be that parent, he would add, if only because the doctor is not infallible.

Dr. Groopman recently spoke at a symposium in a new series co-sponsored by Boston College and the Atlantic Monthly. This first forum bore the title “The Challenge of Medical Knowledge” and also featured Sherwin Nuland, a surgeon from Yale University and author of “How We Die,” among other publications.

This initiative of the Jesuit university and the Boston-based periodical has taken its inspiration from Cardinal Carlo Martini, the archbishop of Milan. His public discussions in the cathedral of that city have attracted thousands of people, especially the young. Following that lead, the Boston symposium has taken the overall title, “Belief and Non-Belief in Modern American Culture.”

Here, rather than focusing on the faith issues directly, I will emphasize what these two well-known physicians said about the practice of medicine. Both were insistent on the need to change attitudes both in doctors themselves and in the patients who approach them.

“As a patient, it’s critical to understand the fallibility of the doctor,” Groopman said. Nuland want even further: “Doctors are not godlike; they require constant affirmation.” He confessed to feeling responsible when patients die: “I always think it’s my fault.”

Dr. Groopman sees the root cause of physician self-worship as what he called “this tremendous intoxication with power.”

To illustrate this mind-set he told an old joke that goes somewhat like this: The place is heaven’s gate where a lot of saintly people are waiting to get in. St. Peter is checking credentials. Then a guy with a white coat and a stethoscope walks right by and passes through the gate. “What gives?” asks someone disturbed at this sight. St. Peter answers, “Don’t worry, that’s God. He thinks he’s a doctor.”

Dr. Nuland uses a World War II reference to talk about the same phenomenon, calling it “the Spitfire pilot model,” a set of prideful attitudes that take hold even before a student enters medical school and continues, unless corrected. “We have to fight our own instincts,” he says.

Physicians need more introspection, he adds, quoting the poet Auden who said that doctors are the least introspective of professionals. Nuland says that they need to look themselves square in the eye and ask themselves what their motives really are.

Nuland also sees physician attitudes as rooted in their privileged place in society. About this he does not mince words: “We become much more conservative once we become doctors. We become narrowed. Most people in my generation were brought up to be bigots.”

On this last point, he advises doctors, “Recognize the bigot in yourself.”

If all of this sounds ominous, both physicians agree that things are getting better. Nuland attributes much of this change to the benefits of the women’s movement. “There isn’t a doctor who hasn’t learned from patients,” he observes.

And Groopman, drawing inspiration from his Jewish tradition, finds reinforcement from what that tradition says about idolatry as the worship of self.  The dangers of egoism loom large in some of the rabbinic literature.

These two prominent doctors convincingly make the case for continued change in their profession , making it more responsive to patient needs. Much of what they say clearly has the ring of truth.

However, it may be important to place their opinions in context. Both these doctors work in academic medical settings where they can presumably choose their own patients and find time for reflection. As writers, they also know how to use words effectively, a skill that sometimes leads them into rhetoric that does not ring true. What they say sounds awfully good, but does it express reality?

If you asked my primary care physician if she feels like God, I suspect her response would be laughter. Instead, working for an HMO and keeping up with a heavy patient load, she is too busy to act divine. The press of her daily schedule, the need to keep track of patient records, and the effort to stay in touch with new knowledge and other professional requirements must constantly remind her that she is no more than human.

Yes, physicians still rank among the most privileged people in American society. But they are often deeply disturbed about their own profession. Many of them chafe at  the red tape and bureaucratic interference which they have to endure these days. They often need and deserve more moral support than the system will ever give them.

These constraints, along with the awareness of limits in their ability to heal, make many doctors, if not most, only too conscious that they are not God.

Richard Griffin