Can medicine survive modern society?

David Hume, the Scottish philosopher, said reason is slave to the passions. Aristotle insisted knowledge required questions. If we cannot ask, ideas never improve. Policy becomes artifact. Then social media turns it into an endless siren of emotion: too often, doctors screeching at each other. Historians tell us we live at the end of an age, perhaps even the twilight of a civilization. The fabric required to practice medicine wears thin. Polybius (200-118 BC), a Greek historian, wrote that kings become tyrants, aristocrats become oligarchs, and members of democracies become mobs. A mob feels deeply, convinced of its own self-righteousness. Civility fades and barbarians emerge nasty and cruel, filled with anger and spite. As Western civilization declines and democracy becomes mob rule, medicine becomes an anachronism, an artifact from the Greek age of reason. By age and disposition, medicine seems more and more out of place in modern society. Medicine needs three things to survive: civility, logic and free speech. Read: Dr. Shawn Whatley: How to get Canada off the healthcare teeter-totter Civil traditions Civility is more than knowing the rules required to live in civil society. Social skill follows immersion in civil traditions. We develop a second nature of civility and become citizens. As Hannah Arendt wrote: “Every generation, civilization is invaded by barbarians—we call them ‘children. ’” We have lost the spirit of civil traditions as well as the traditions themselves. We cannot regain the traditions without knowing the spirit animating them. We cannot be Scottish by just donning kilt and pipes. To be a Scot means more than just doing Scottish things. We become Scots first, and Scottish things follow. A cowboy in a kilt with bagpipes on his saddle is not Scottish. Can people regain civility if they never knew the institution in the first place? Can those who were polite, simply because it was fashionable, learn to be polite when the fashion fades? Did public virtue come from reason, by fiat? Or did it emerge over centuries of strife—shaped, learned, and adjusted to enflesh an ideal? Logic Care requires critical thinking. But logic and reason will offend those who refuse to think clearly. Consider a few examples. The pursuit of equality pushes hospitals to hire people for jobs they cannot do. With the right disposition, burly men make the best security guards. But hospitals cannot hire big guards. They must also hire small, frail, old men and tiny women too. When journalists write about nurses rag dolled by 300-pound psychotic patients, they never mention the size and strength of the security guards on duty, only the need for more guards. Drug dosing requires mathematical skill and accuracy. Can we demand this of all clinicians? Or is this Euro-centric, as some insist? We teach clinicians how to stay safe with psychotic patients: Do not turn your back. Keep a path to the door. Though necessary, these survival tips are, by definition, prejudice—verboten in modern culture. Free speech Clinical care starts with questions: How can I help? Why did you stop your meds? Why did you take the whole bottle of Tylenol? Today, doctors must affirm a list of things society has decided to support. Doctors avoid questions about anything on the list, and they must avoid any non-verbals which might imply a lack of support. Cannabis? Yes, I know of a clinic close by. Euthanasia? Yes, here’s a referral. Doctors dare not ask about depression, loneliness, or poor pain control. (The most contentious issues are even too scary to mention in a blog.) Some things need to be said. It is not fat shaming to say someone is overweight. It is not insensitive to say a patient is not strong enough to throw hay bales all day. Doctors need to be able to question a patient’s decisions which might be animated by depression, even if they fall on the list of things we must affirm. Can medicine survive modern society? Society opposes many of the presuppositions required to provide care. People find it offensive that medicine requires any pre-thought at all. It seems close-minded. To be clear, presuppositions can fail. We need thoughtful change to improve. Medicine is an ancient tradition. It requires things that modern society will not tolerate. We will never modernize medicine enough to smooth all the hard edges. For now, physicians dance around the unseemly bits and pretend medicine can continue without them. How long can the pretense last? Shawn Whatley is a practising physician, the author of When Politics Comes Before Patients—Why and How Canadian Medicare is Failing, and a senior fellow with the Macdonald-Laurier Institute. He is also a past president of the Ontario Medical Association.

Can medicine survive modern society?

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