If patient care matters, we must protect the medical mind from service to popular, non-medical ends.
Medical students submit to a four-year shaping program: an immersion in a peculiar thought process. Residency continues the formation for another two, four, 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.
With one hand, doctors reach backwards and hang onto medical knowledge. With the other, they grope forward for new ideas and solutions.
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Medical knowledge is not monolithic; it always changes. But neither is it 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.
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.
Society attempting to shape the medical mind is not new. It did not cause significant problems when society showed basic deference to debate, data, and civil discourse. We can call this basic deference the ‘Fukuyama vision.’
Francis Fukuyama, a 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 compromising on medical decision-making.
The overlap worked until the Fukuyama vision failed.
Soviet social policy served a lighthouse function during the Cold War by showing 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.
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.
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.
Shawn Whatley is a physician, past president of the Ontario Medical Association, and a Munk senior fellow at Macdonald-Laurier Institute. He is the author of When Politics Comes Before Patients – Why and How Canadian Medicare is Failing.
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