Chapter XVI: In Defense of Medicine
Fenigsen, Richard, Fenigsen, Ryszard, Issues in Law & Medicine
The Crisis. One of the principal causes of the current crisis in medicine is the profession's failure to control the invasion of basic sciences and technology, the inability to subordinate their contribution to medicine's human aims. Obviously, we shall never renounce the enormous benefits which science and technology bring to diagnostics and therapy. We must not allow science and technology to determine our goals or impose on us their value system. Unfortunately, this is precisely what is happening quite often today, the result of which is a medicine that is increasingly effective and less and less appreciated by people, does not satisfy the doctors themselves, becomes too expensive even for the richest nations, and is criticized from every quarter. For doctors, basic sciences and technology are only means and must remain so; they must not be used needlessly; the enormous contribution of the basic sciences must once again be subordinated to the thinking human being, the physician, and directed toward human goals. It is our task, and that of the next generation of physicians, to resolve the crisis in medicine; a difficult end to achieve, but the only possible solution.
Facing this task the profession stands divided. In the previous chapters I have already mentioned the increasing polarization into two types of physicians: the traditional clinicians and the "modern" doctors. They look almost indistinguishable and share most characteristics yet their ways and even goals are not the same.
The clinician is a doctor who tries to absorb new scientific achievements and master new technologies (life-long learning is the true tradition in medicine), but has never renounced the skills, the experience, and the spirit of clinical medicine. He knows how to reconcile a naturalist's objectivity with sincere involvement in his patients and emotional involvement in his own art. The medicine he practices is of a personal kind, his own contribution dominates the whole course of events. The diagnosis, discovering what's wrong with the patient, is for him a personal victory and a source of pride. The therapy which he adjusts to every individual patient, displaying resolve when needed and restraint when necessary, personally following the effects from one hour to the next, is for the clinician an opportunity to show what is best in his mind and character. As Marguerite Yourcenar so aptly noted, (107) for a clinician, a patient whom he has cured of a serious illness is l'oeuvre de sa vie, his masterpiece.
The "modern" physician lives in a very different professional climate, where the doctor's personal role is being belittled (and is, in fact, reduced), where diagnosis (or its fragments) arrive on scraps of paper from the laboratory, and the doctor will not even say "Madam, you've got this or that," but "the blood test has shown.... " where treatment is no longer the work of a doctor but of "a team" (that is, of no one); where further observation of the patient is left entirely to the nurses; where it is not thought that a doctor must devote the maximum of time, attention and effort to his patient, but only as much as is "reasonably" due; where lack of emotional involvement is praised as a virtue; where ultimately the doctor's dissatisfaction with his own role leads him to the melancholy view that all medical endeavors are meaningless. Not trained to rely on his own understanding, not accustomed to trust his own human reactions, a doctor who has received this sort of ill-balanced, inharmonious, "modern" education is inclined to extreme and unbalanced views. He is entirely serious in his belief that medicine is a science (whereas for the traditional doctor science was a tool of medicine). He tends to view the truth of medicine and his own diagnoses as scientific certainties, and may even believe in prognoses. Having taken on the value system of the "exact" sciences, he sees no proof that one should be kind or caring, or that human life has infinite value: these are, after all, nonscientific postulates. …