Humility

Healers must learn to face the lapses and failures of knowledge and technology.

HEALERS HAVE ALWAYS CLAIMED more knowledge and skill than was warranted. They have rationalized the irrational and memorized the soon-to-be forgettable. Some doubters have always kept digging and some have brought new ways to the ever-imperfect art of healing. With each finding, healers begrudgingly surrendered the past, adopted the new, and resumed their boasting-proud of their new modernity.

Healers have always fretted that doubting might impair outcome, that treatment without conviction would suffer. But treatment without skepticism also suffers. A delicate balance between doubt and certainty requires a humbling respect for the many unknowns about sickness and health and the many events that can go wrong. Healers must learn to face the lapses and failures of knowledge and technology, not with fear, but with honesty and humility.

Sir William Osler told this-and more-to the Canadian Medical Association in Montreal, in 1902. His prescience is worth our attention in these disputatious and litigious days.

He began his "Chauvinism in Medicine" lecture with a bow to Hippocratic medicine for bringing "the spirit of criticism" to bear on "the arbitrary and superstitious views of the phenomenon of life" and for introducing "quiet methodical research...into the domain of (medicine's) Art." He paid tribute to "the remarkable solidarity" of our profession in its dedication to our ambitions, our methods, and our work." Our ambition? "To wrest from nature the secrets which have perplexed philosophers in all ages, to track to their sources the causes of disease, to correlate the vast stores of knowledge, that they may be quickly available for the prevention and cure of disease."

Our methods? Observation, experimentation, and reasoning "to be able to know the true from the false." Our work? Simply "to prevent disease, to relieve suffering and to heal the sick."

Our ambitions, methods, and work have tied us in an "unbroken-continuity" across national boundaries and different languages and cultures from our Grecian past through schools and systems that have flourished and fallen. "The philosophies of one age become the absurdities of the next, and the foolishness of yesterday...the wisdom of tomorrow."

"Based on science, medicine has followed and partaken of its fortunes" leading to "the great awakening (of) the nineteenth century," which gave medicine "a quickening impulse more powerful than at any period in its history." This led not only to "unraveling the causes of disease, the perfecting of methods of prevention, and the wholesale relief of suffering," but to "unloading of old formulae"-"the substitution of the scientific spirit of free inquiry for cast-iron dogmas."

Osler rejoiced over his recent half-century. "Search the scriptures of human achievement and you cannot find any to equal in beneficence the introduction of Anaesthesia, Sanitation, and...Asepsis.... The work of Walter Reed and his associates will probably make yellow fever as scarce in the Spanish Main as is typhus fever with us. There seems to be no limit to the possibilities of scientific medicine... Never has the outlook for the profession been brighter," Osler exulted, "Everywhere the physician is better trained and better equipped than he was twenty-five years ago. Disease is understood more thoroughly, studied more carefully and treated more skillfully.

"The average sum of human suffering has been reduced in a way to make angels rejoice. Diseases familiar to our fathers and grandfathers have disappeared, the death rate from others is falling to the vanishing point, and public health measures have lessened the sorrows and brightened the lives of millions."

Yet, Osler worried that, in the "vastness of medicine's progress...the parts might not fit together," and that "necrosis and degeneration" might produce "disfiguring and dangerous outgrowths on the body medical." Abraham Flexner's revolutionary expose of "Medical Education in the United States and Canada" came eight years later, in 1910! Today we again, or still, ask whether the parts fit!

What did Osler dread the most? "Perhaps," he said, "no sin so easily besets us as a sense of self-satisfied superiority to others." More than the "master sin" of pride "is an attitude of mind which either leads to bigotry and prejudice or to such a vaunting conceit in the truth of one's beliefs and position, that there is no room for tolerance of ways and thoughts which are not as ours are. To avoid some smirch of this vice is beyond human power; we are all dipped in it, some lightly, others deeply grained."

Unlike the "blatant loudness of Jingoism," Osler warned, "Chauvinism is a condition of the mind, an aspect of character much more subtle and dangerous.... Chauvinism is a great enemy of progress and of peace and concord among the units." He was not talking about the narrow chauvinism of contemporary male-female discourse, but the characteristic so well depicted by Chauvin that his name "has become a by-word, expressing a bigoted, intolerant spirit."

Osler named anaesthesia, sanitation, and asepsis as the greatest achievements of his millennium. Our list might differ, but we can benefit from his caution about self-conceit.

Science and technology give us Mars-landers, daily trips between Puerto Vallarta and Seattle, and organ transplants. They also provide the cost-cutting "systems" that cause the landers to crash or forget how to call home, that install jack screws which wear out and plunge commuters to their death, and allow "medical errors" arising from our muffled discourse with patients, their families and our co-workers-pharmacists, nurses and others involved in patient care.

The antidote may be humility.

Ed_Rudin@macnexus.org