The question has been posed to me many times, and every so often I ask myself the same thing: how can I possibly say anything about medical practice and education—let alone write a book about it—if I am not a clinician myself ? The question is fair enough, and (most of the time) I appreciate when people are direct enough to ask me it. My response usually takes one of two forms. Sometimes I respond by emphasizing my insider knowledge, pointing to my experience taking care of my mom or explaining how I went to graduate school at an academic medical center where I learned from medical ethicists and doctors, rounded in hospitals, and spent time with patients—and where the majority of my peers and closest friends were medical students. These were friends I watched fumble and prevail in a shockingly imperfect educational system and stayed up late with having the conversations they weren’t having in school about death and suffering and poverty, about Board scores and career decisions and the pains of being a twenty-something, about whether and how they could possibly survive it all. I then explain that I currently work at a hospital and medical school where my job is to teach, mentor, and support medical students and residents and help establish a culture that reconnects students, residents, and doctors to why they went into medicine in the first place. And I tell how I share my life and my home with a new doctor, whom I try to love and support the best way I can as I watch him struggle to offer compassionate care in a dispassionate healthcare system.
Other times, I respond by simply embracing my role as an outsider. As I discuss later in this book, medical culture does a particularly fine job of enculturating newcomers into its rituals and norms—almost all adopt the values, assume the behaviors, and embrace the ideals of medicine, for better or for worse and without even knowing it. It is hard to see the norms of a culture when one is so entrenched in that culture. Thus, as an outsider with an admittedly privileged view from the nearby margins, I am at times able to recognize and speak to issues that others simply cannot see. Or, as Peter Cahn said in a recent issue of Academic Medicine: “Outsiders are particularly well positioned to notice unspoken assumptions because they bring a different set of perceptions against which to contrast the prevailing model. People steeped in the predominant metaphors can rarely articulate the underlying conceptual system because it has become naturalized to them.”1 It is for this reason that I find working in medicine as a nonclinician to be a virtue; offering a different view for my colleagues, friends, and loved ones in medicine is sometimes exactly what is needed. And yet the point that an outsider cannot possibly understand the lived experience of a doctor is not lost on me. I will never know what it is like to stay up all night on a labor and delivery shift, make a life-or-death decision for a stranger, or face the consequences of a serious medical mistake. So, even as I lament the stigma that surrounds the Ph.D. in an M.D.’s world while recognizing the value of my unique standpoint, I also acknowledge and accept the limitations of my perspective.
Outside, inside, or in between, those of us who are concerned about medicine and medical education focus on problems that are, quite honestly, not particularly new. For years, scholars, clinicians, and patients alike have pointed to the ways in which patients’ encounters with physicians have left them feeling dehumanized and misunderstood. I have lost count of the times when people I have just met—after I explain to them briefly what it is that people like me “do” in the medical humanities—exclaim, “Well, doctors certainly need that kind of thing, so keep it up!” What I think most people are referring to when they say their doctors “need” something is that, as patients, they feel their illness experiences and an essential part of themselves are overlooked in the clinical encounter—some aspects of their suffering are deemed invalid or simply rendered invisible. As physician Eric Cassell observed over thirty years ago, “Patients and their friends and families do not make a distinction between physical and nonphysical sources of suffering in the same way that doctors do.”2
The idea that medicine is concerned only with particular kinds of suffering, specifically those physically manifested on or within the corporeal body, helps to explain why even patients who do not appear to be suffering profoundly might feel as though they are not “seen” by their doctors. Because suffering ensues when people perceive a threat to their “intactness”—when they perceive a potential destruction of their identities, routines, futures, relationships, roles, and so forth—the sources of suffering are multifarious and intricate, and the “remedies” usually involve finding, restoring, or making new meaning.3 It is true that some conditions, like a broken arm or a minor infection, can be treated successfully through technical interventions alone; yet, even patients with minor or straightforward complaints come to the doctor because they are experiencing a perceived disruption in their normal way of life. Thus, the lived experience of patients who are ill or injured—even those who are not acutely vulnerable or suffering profoundly—includes more than biological breakdown. Patients seek the help of the doctor because they desire a restoration of their way of being-in-the-world. And when they are facing serious illness, even if not terminal, the experience can rip them out of their relations of meaning and being, shatter their worlds, and bring on intense “existential suffering”4 as they struggle to find meaning, security, or connectedness.5
The failure of medicine to address these complex realities of illness and the kinds of suffering that extend beyond the workings of the biological body is a long-lived and persistent problem, one that has often been traced back to the ways doctors are trained. In the 1960s, philosophers, theologians, and practitioners began to draw attention to how medical care that privileged exactitude and certainty was failing to address the lived experiences of patients. These early medical humanists (though they did not yet refer to themselves as such) expressed concerns about “the way medical students of the rising generation were being trained and, in particular, [about] what was lacking in their education.”6 Daniel Fox, who offers a historical account of the political origins of the medical humanities, observes that groups concerned with medical education during this time focused primarily on three issues: depersonalization in medicine, the centrality of molecular biology in medical education, and the teaching of “mechanistic medicine.” They believed that the best way to deal with these issues was to infuse “human values” into formal medical education—even though their presumption that human values could be identified, measured, and judged, and value deficits remedied by a “dose of the humanities” might have been mistaken.7
The argument that a simple dose of humanities will never remedy the problems in medical education is not uncommon.8 Incorporating the humanities post hoc into a curriculum that scholars claim is so deeply entrenched within a culture of detachment and within an epistemology of science and certainty can do very little to change how students engage with patients and how they conceive of what it means to care. Not surprisingly, then, much of the recent scholarship concerning medical education indicates that the problems early medical humanists faced nearly fifty years ago are still present with us today. And not only are they still present, but they are also reinforced and perpetuated both within medical culture and within the contemporary medical school curriculum—a curriculum still preoccupied with identifying and treating biological disease states, potentially encouraging students to see themselves as mere technical problem solvers.9 Most would agree that, despite efforts to incorporate studies of the humanities, communication workshops, and empathy training into medical schools, we find ourselves not far from where we were five decades ago.
Due in part to the persistence of these issues, attention has been paid more recently to professionalism or professional identity formation in medical education—that is, to whether and how medical education fosters values such as compassion, altruism, honesty, integrity, and respect. Although professionalism standards, charters, and credos have become ubiquitous, many scholars have argued that there exists a considerable disconnect between the professional values and ideals espoused within the professionalism movement and the implicit values that are communicated to students on the wards through their interactions with peers and mentors—what they learn from the “hidden curriculum.” Unfortunately, with its emphasis on efficiency, compliance, and the acquisition of scientific or technical knowledge and its tendency to focus on biological disease processes and technical cures, this hidden curriculum undermines the espoused values of professionalism and leaves little room to focus on what kind of person the doctor should be.10
Over the past decade or so, much scholarship has emerged focusing on the harmful consequences of the hidden curriculum and suggesting remedies. These almost always include quality mentoring of students by their attending physicians and residents, given that these mentors have such a profound effect on students’ development.11 As physician Thomas Inui argues, the hidden curriculum of medical education “constitutes the most powerful influence on students’ understanding of professionalism in medicine.”12 Yet, even though discourse about the hidden curriculum has found its way into the literature and suggestions have been offered for addressing it, less attention has been paid to why the disconnect between espoused values and the ways students and mentors actually behave on the wards exists and persists. It is unlikely that this disconnect is simply a result of unprofessional physicians who engage in unethical decision making within a morally vacuous profession. Rather, as literary scholar and medical educator Kathryn Montgomery has pointed out, this hidden curriculum is likely a result of the fact that students and physicians are trained within a culture that views medicine as the direct application of science in the clinical setting, rather than a science-using practice imbued with uncertainty and ambiguity.13
Because of this view, the hidden curriculum of medical education sends a very clear and persistent message to students: medicine is a science concerned with the biological body and the efficient amelioration of disease states; doctors are therefore not required to attend to existential suffering. Claiming that medicine is akin to a kind of “impartial” natural science, Montgomery argues, bolsters clinical detachment and perpetuates what she calls the “the professional façade” that distances clinicians from the reality of illness, pain, and death.14 Like Montgomery, philosopher and clinician Jeffrey Bishop claims that the education and training future doctors receive obscure how suffering extends beyond the biological body; students are “seduced by the efficient and effective manipulation of bodies and psyches as the most important response to suffering.”15 Thus, as medical students progress through their training, tending to the body becomes paramount, and other sources of suffering fall from view.
To me, the work of scholars like Montgomery and Bishop speaks to a “way of knowing” that German philosopher Martin Heidegger (borrowing from Aristotle) deemed “calculative thinking,” a kind of thinking that is associated with the natural sciences and their methodologies, one set over and against the world and its objects in order to discover “correct” answers.16 Although calculative thinking is appropriate for medicine in many ways and certainly leads to valuable technical knowledge, the danger lies in the propensity of modern medicine to conceive of calculative thinking as the only proper way of knowing anything at all. Indeed, Heidegger warns that “calculative thinking may someday come to be accepted and practiced as the only way of thinking.”17 Unsurprisingly, it is science and, by extension, medicine that have most tenaciously championed this way of knowing. “Science,” argue biologist Linda Wiener and philosopher Ramsey Eric Ramsey, “represents itself not simply as a particular kind of methodology, but as the only method that can produce universally replicable descriptions of the world. It is from this point of view that the objectified body of anatomy and physiology, for example, becomes the only body that we are capable of acknowledging as valid.”18 When scientific methodologies are seen as the best or only way to think through medical problems, addressing the needs of the tangible, physical, measurable body can appear to be the doctor’s only task at hand.
Although the scientific methodologies that constitute much of medicine’s predominant approach to care are not inherently problematic, the perception that scientific interpretations of the world are more real or reliable than any others can narrow the kind of care that medicine considers within its purview. In other words, the professed telos of medicine—which is often conceived of as the good of the patient and the alleviation of human suffering—is narrowed significantly by a medical practice that is single-mindedly concerned with the physical body.19 Educated within a system that almost exclusively embraces calculative thinking, which does not, indeed cannot, account for the lived, phenomenological experience of either patients or practitioners, medical students are ill prepared to address the kind of human suffering they will inevitably encounter.
Some of the scholarly work mentioned above has made the important argument that medicine is grounded within a normalized and rarely acknowledged epistemology that privileges scientific, objective, and verifiable truth, and that this accepted epistemology significantly influences patient care. Less work, however, has focused on why this kind of thinking—especially within medicine where human suffering and death are so prevalent—is so seductive.20 Therefore, one point of the present work is to draw attention to the taken-for-granted assumptions of medical epistemology and pedagogy and to efforts toward “giving up the science claim,” as Montgomery says, which requires us to consider the way medical education and practice personally shapes those who participate in it.21 But the scope of the present work extends beyond an acknowledgment of the taken-for-granted, normalized culture, epistemology, and pedagogy of medicine and imagining ways of changing it. Afflicted aims to understand why it is that students, practitioners, educators, and patients so readily subscribe to and perpetuate calculative thinking. With the aid primarily of existential and phenomenological philosophy, I argue that the propensity to ground medicine within a scientific, objective, and anatomo-biological worldview is, in fact, a manifestation of a fundamental and ontological or existential desire to turn away from our shared vulnerability of being human. Rather than encouraging introspection and authentic engagement with others, the pedagogy and epistemology of modern medicine perpetuate this flight from the ontological reality of illness, suffering, loneliness, and death. In other words, I contend that depersonalization in medicine is not primarily an epistemological but an ontological problem—that is, it is related to who we are as finite, mortal beings and our beliefs about what it means to live and to be. The epistemology of medicine, or rather the privileging of this epistemology and the pedagogy it gives rise to, is a manifestation of our shared ontological or existential struggle to authentically face the realities of death and meaningless suffering. This does not mean that the way medicine is practiced and taught is consciously intended to conceal suffering, loss, and vulnerability, but rather that it is imperceptibly, yet substantially, molded by deep existential qualms about the human condition.
It is important to address these issues not only because they affect the kind of care patients receive, but also because they have real consequences for those who are exposed to patients’ unacknowledged suffering. The moral conflicts that can and do arise in medicine often point to clinicians’ own personal struggles to find some meaning or purpose in the face of death and tragedy.22 As Michele Carter and Sally Robinson put it, “by submerging and denying these personal conflicts instead of realizing they are part of the human condition, practitioners may find themselves harboring significant negative emotions of anger, despair, or helplessness, which in turn can impede their professional judgments.”23
Avoiding or trivializing personal responses to human suffering can have significant and tangible consequences in the clinical setting, but, just as important, these personal responses are not unique to those who work in healthcare—they are “part of the human condition.” With that clearly in mind, Afflicted argues that it is too simple to conclude that doctors simply lack compassion, empathy, or the desire to help. Rather, like their patients, doctors share in the human desire to avoid suffering and the existential anxiety it produces. But this desire poses a particular problem for doctors and other healthcare professionals. Even though the medical profession requires practitioners to extend care to others, medicine’s epistemological stance (grounded in calculative thinking) offers them an all-too-easy means of turning away from vulnerability—and thus also from providing care in the fullest sense—by comporting themselves as technicians. That is to say, the primary curative ethos of medicine, which emphasizes a “medical doing something,” perpetuates a calculative understanding of care that, however unintentionally, encourages physicians to turn away from the suffering of their patients.
In my view, then, the preoccupation with cure over care, pervasive clinical detachment, poor or nonexistent communication between clinicians and patients, compassion fatigue and burnout, and even “coping strategies” like gallows humor are symptoms of deeper issues underlying medical education and practice—symptoms that will persist until we address the existential issues that give rise to them.24 As such, readers looking for a “handbook” or “roadmap” for effective communication interventions need read no further, for I believe such interventions fail to address the core of medicine’s inability to adequately deal with vulnerability and existential suffering. And though I see the present work as practical and applied, especially in relation to the changes I suggest for premedical and medical education, it offers no specific behavioral or communication interventions. From my own experience researching and developing medical and premedical curricula and teaching medical students and residents, it is clear to me that many communication interventions, as well as research and pedagogy in interpersonal communication in medicine, are grounded in the assumption that communication is transactional in nature. So, rather than teaching future clinicians how to authentically engage with patients, to be present with the dying, or to bear witness to suffering, we have them memorize checklists and mnemonics to assist with difficult clinical interactions and with “delivering” information to patients. To “break bad news,” for instance, many medical students are taught the SPIKES (Set the stage, Perception, Inform, Knowledge, Empathy, and Summarize) method, memorizing the mnemonic in preparation for giving a patient-actor a terminal diagnosis.25 Although methods like SPIKES might offer some guidance for novices who have little or no experience addressing existential suffering and mortality, it is unlikely that they will offer much help in navigating a complex, all-too-human situation fraught with uncertainty, fear, and vulnerability.
Yet the appeal of communication and educational interventions in healthcare, even those which are reductionistic and formulaic, remains: they seem practical, relevant, and expedient, thus perfectly suited for the rational, fast-paced culture of medicine. Communication training, though absolutely necessary for future clinicians, is woefully insufficient in and of itself, and any attempt I might make to offer an efficient and practical roadmap to improve clinical communication would require me to engage in the kinds of efforts Afflicted intends to critique. Indeed, relying too heavily on such downstream efforts is one of the reasons why medicine has for decades made little progress in encouraging authentic engagement between clinicians and patients.26 To explain why these “how to” efforts continue to fail, I will explore the deeper philosophical and psychological reasons why medical practitioners avoid vulnerability, how this avoidance both influences and is perpetuated by medical epistemology and pedagogy, and why handbooks and checklists regarding competencies and behaviors will not change medical culture in any substantive way until we address the deeper issues that manifest in practitioners’ poor communication, burnout, and inappropriate coping.
In the chapters that follow, I draw on the ideas of Emmanuel Levinas, Mikhail Bakhtin, and Hans-Georg Gadamer to argue that, in turning away from suffering and vulnerability, practitioners not only diminish the care they offer patients, but also diminish their own being. Through a philosophical analysis of the patient-practitioner encounter as an encounter between two persons each of whose being is constituted by the other’s, I emphasize that the doctor, in escaping from authentic engagement with a patient who is profoundly suffering is, in fact, “escap[ing] from herself.”27 I argue that physicians who authentically respond to the call of suffering on the part of their patients approach not only their patients but also themselves: their subjectivity is deepened and expanded with the recognition of their own potential for suffering that is always already at hand. It is this understanding of the patient-practitioner relationship—an understanding that highlights the mutual giving and receiving within an encounter between two people who are both struggling to make meaning in the face of vulnerability and mortality—that will begin to orient us toward to a richer understanding of illness and suffering and will cultivate a more capacious understanding of care for healthcare professionals.
Finally, I suggest ways in which future physicians might be “brought back to themselves” through a pedagogy that values the cultivation of the self, openness and humility, and a fuller conception of what it means to be a healer. Following medical humanist Ronald Carson, I argue that the cultivation of new ways of understanding and interpreting the world and the lived experiences of others can be taught—not didactically but “maieutically”—that is, by “indirection,” the way we learn from reading literature and poetry, for example.28 Teaching by indirection helps cultivate the “moral imagination”—emotional and intellectual capacities that allow us to imagine something of what it might be like to be in the situation of someone else.29 And teaching by indirection, rather than didactically, with literature, art, poetry, and narrative can foster new ways of seeing and thinking and can open up spaces for dialogue and reflection in order to garner personal moral clarity, empathic understanding, and an appreciation for others and their experiences. This approach is similar to the one advocated by the existential philosopher Søren Kierkegaard, who himself adopted the Socratic ideal of “indirect communication,” an approach that was in no way dogmatic but rather guided his readers from behind to where they would make decisions for themselves based on interior reflection and introspection.30
As might be painfully obvious at this point, much of the present work is informed by a philosophical tradition shaped by a group of thinkers who share many things—including being very white and very male. And though this is true, much of Afflicted is also informed by postcolonial and feminist theory—which I hope will become apparent in later chapters. Specifically, my thoughts on pedagogical approaches are informed by a feminist ethics of care and by the ideas of feminist and activist writer bell hooks, who has helped me come to see the classroom and clinic as “radical space[s] of possibility,” where both students and educators learn about how to live in the world as “whole human beings.”31 And though I recognize and later discuss the intersections between Levinas’s philosophy and feminist approaches to ethics, especially in their shared emphasis on responsibility to others, I also point out that feminist theory is essential to medicine—where power hierarchies reign supreme—for it speaks to issues of oppression and subordination that too often taint the experiences of patients, learners, and nonphysician healthcare professionals alike.32 Yet, despite the presence of diffuse power, racism, sexism, sanism, ableism, and so forth, I remain cautiously optimistic that Alan Bleakley is right when he says, “Medical education need not act as a handmaiden to normative medicine, but can formulate resistance to, and critique of, the institutional norms of medicine [that are] unproductive to patient care, collaborative, interprofessional teamwork, and doctors’ self-care.”33 That is, of course, if we are truly committed to making real changes.
In an attempt to catalyze such changes, Afflicted is unabashedly interdisciplinary and draws on different analytical methods and modes of thinking. Much of it involves the close reading of both philosophical works and contemporary scholarly literature in medicine and medical education and brings these works into conversation with one another in order to develop an analysis that is at once philosophically rigorous, practical, and relevant. Chapter 1 begins with a synopsis of the scholarly literature that discusses the epistemology and pedagogy of medicine and the effects these have on physician formation. It then shows how this perspective can be deepened and expanded by an understanding of calculative thinking, as explained by Heidegger, to offer a more comprehensive grounding for the discussion about the inherent problems of medical education and practice. It highlights that calculative thinking—the default and preferred way of thinking not only in medicine, but also in contemporary society more generally—is actually derived from our more primordial (what Heidegger calls “meditative”) way of thinking and being in the world. Privileging calculative thinking closes us off from other “truths,” truths that are unverifiable, unquantifiable, or intangible. A Heideggerian critique helps to illustrate medicine’s tendency toward a calculative understanding of illness that is defined by a hurried curiosity, as opposed to a meditative thinking that is slower, open to wonder, embraces ambiguity, and considers the ineffable and unquantifiable to be just as “true” or valid as things that might be scientifically “proven,”34 a point more fully explored in later chapters. Recognizing the dominance and seductiveness of calculative thinking within medicine is important, for it speaks to the human tendency to turn away from contingency, vulnerability, and death—a point clarified and expanded in chapter 2.
Because medicine and medical education focus on the “real” and the “scientific” (namely, assessing and treating biological disease), the phenomenological or lived experience of illness—including existential issues such as suffering, fear, and inescapable uncertainty—are left largely unaddressed. Thus practitioners trained within this environment, especially those who view themselves as scientists or technicians, may believe that they are not called to attend to these issues. Chapter 2 examines why calculative or technical thinking is pervasively privileged and particularly problematic in medical practice. It is not enough, however, to say that doctors turn away from answering this call to care simply because they have been trained within a medical culture that fails to acknowledge the lived experiences of patients that fall outside the bounds of calculative thinking and technical rationality.35 Turning away from the reality of vulnerability and mortality is, I argue, part of the shared condition of being human. Through an exploration of the philosophical work of Søren Kierkegaard, Martin Heidegger, Maurice Merleau-Ponty, and Friedrich Nietzsche, I attempt to show that medicine’s preoccupation with science, detachment, and scientific certainty is a manifestation of the basic human desire to turn away from the anxiety that emerges in the face of human suffering and the struggle to make meaning in the face of profound illness and death.
In chapter 3, with philosophical help from Heidegger, Levinas, Charles Taylor, and Bakhtin, I contend that, by turning away from patients’ suffering in the name of objectivity and “clinical detachment,” physicians not only compromise the care they offer their patients but also diminish both their own practice and their own being. What is more, I argue, only through responding to the call of the face of suffering can physicians become authentic or resolute. For it is through facing the reality of their own mortality and potential for suffering that physicians deepen their subjectivity and begin to recognize and respond to their patients’ call for care. In authentically responding to this call from the other, doctors come to see that they need their patients, not only to determine how to help them, but in a more fundamental way: they need their patients in order to heal, in order to be healers. As Heidegger would say, doctors need patients and their calls outward to them in order to become what they already are.36
Chapter 3 ends with a discussion about how clinicians might come to know how to respond to the suffering of their patients. With the help of hermeneutic phenomenology, particularly that of Hans-Georg Gadamer, Frederik Svenaeus, and S. Kay Toombs, I explore how physicians can come to a shared understanding with their patients about “what is the matter.” This discussion emphasizes the necessity of reflective discernment and practical wisdom (“phronesis”) within the clinical encounter. It is not enough to simply confront suffering; the physician as healer is called to respond to this suffering in a way that is appropriate for and meaningful to a particular patient.
Chapter 4 explores how educators might help cultivate qualities such as humility, openness, and gratitude toward patients among doctors in training. It argues that medicine’s preoccupation with calculative thinking will persist until educators can cultivate within clinicians and clinicians in training the capacity to face the reality of existential anxiety through a pedagogy that values and fosters vulnerability and reflection. Although recent trends in the professionalism movement, including those in “professional identity formation,” have made progress toward these ends, by focusing on outcomes and assessments, they may actually serve to reinforce calculative thinking. This chapter looks critically at such trends in medical education and contends that ideas concerning professionalism can be enriched and expanded through an understanding of virtue ethics and the Aristotelian concept of phronesis, one that emphasizes personal development, experiential and habitual learning, and quality mentorship.
Chapter 5 discusses specific curricular interventions that can work toward getting students to think critically and to “reflect broadly and deeply on what it means to be human.”37 It highlights pedagogical approaches that allow students to see that the “real” scientific facts of biological disease cannot be separated from the existential reality of illness and that human beings always already dwell within their lived experiences, even before science and medicine inscribe their particular, abstract truths onto the body. Through exposure to patients’ stories—whether as narratives or in face-to-face encounters—and through reflective writing, dialogue, and quality mentorship, students may come to appreciate the lived experience of illness, to expand their moral imaginations, and to develop a more capacious sense of care grounded in a recognition of our shared humanness and potential for suffering. This kind of pedagogy does not result in a “professionalism” that can be measured, quantified, and assessed, but rather in a way of being in the world—a posture of openness toward others, an ability to face uncertainty, and the capacity to extend care to patients even when “nothing else can be done.”
In the epilogue, I conclude by synthesizing the broader themes of Afflicted, emphasizing the need to address the normalized and taken-for-granted epistemology of medicine and its preoccupation with calculative thinking and technical notions of care that (re)produce the perspective that only what can be empirically verified is true or real. I reiterate how the narrow focus of modern medicine serves to numb doctors to existential anxiety—their patients’ and their own—in the face of suffering and to deafen them to the call to authentically face the suffering other, and how acknowledging its dehumanizing effect on the care they provide reveals the need to offer doctors in training new, more expansive narratives about medicine that account for the lived experience of illness and suffering.
Taking seriously Bakhtin’s and Gadamer’s conviction that truth is shared and that it emerges within a polyphony of voices offered by multiple interlocutors, Afflicted is enriched and supported by the voices and stories of medical trainees who generously shared with me their experiences within medical education and practice. With approval from the Institutional Review Board at the University of Texas Medical Branch (UTMB), I interviewed ten medical trainees—nine third- or fourth-year medical students and one first-year resident—about what they thought of their medical training, their experiences with patients and mentors, and what they believed it means to become a doctor.38 The point of these interviews was not to gather and analyze “verifiable” or generalizable data (a project that would, no doubt, be guided by calculative thinking), but rather to inform my own perspective and guide my own (meditative) thinking, as well as elucidate for my readers the lived experience of medicine and medical education.
I spent years living and learning closely alongside my friends and loved ones while they endured medical school, and the opportunities I have had to teach and mentor premedical and medical students and residents have provided me invaluable insight into medical education. For this project in particular, I wanted to take the time to formally ask and document the questions that I have been exploring over the years. My hope is that the experiences of these medical trainees are reflected in the pages that follow and that this project itself can contribute to the important work being done toward creating educational environments that cultivate broader notions of care—for the sake of both future doctors and their patients. And it is my hope that such work can create an educational culture that begins to recognize and value the lived, embodied, phenomenological experience of illness, a culture that embraces what sociologist and medical educator Arthur Frank calls a “pedagogy of suffering”—the idea that “the ill offer others a truth,” especially those practitioners who authentically encounter them.39 I believe this is true not only for current and future physicians, but also for all who work or will work in other areas of healthcare, including nursing, occupational and physical therapy, and surgical, respiratory, and radiologic technology, to name a few. Witnessing and responding to the testimony of patients opens up the possibility for personal transformation; made aware of their own vulnerability and brokenness by entering into the suffering of others—either face-to-face or imaginatively through stories or art—those who offer care to patients may come to see that suffering is not merely a puzzle to be solved or controlled, but an undeniable part of the human condition.40