February 9, 2010

People-minded pre-meds

The pre-med curriculum should include training in human dignity

When people think of the essence of medicine, the Hippocratic Oath leaps to mind. Yet, despite its enduring tenets, some phrases may seem old-fashioned. For example, the oath says, “Into whatever houses I may enter, I will come for the benefit of the sick.” The promise to respect any household the doctor enters seems anachronistic in the age of hospitals and doctor’s offices. But Leon Kass, in his article “Is There a Medical Ethic?” makes the intriguing observation that respect for the household is rooted in the great privilege—and great burden—doctors have: to see humanity at its most vulnerable. He says a doctor sees “without illusion the darker side of the human condition, and sees humanity, unprotected and stripped of pretense, struggling gamely to preserve itself.”

Now, when I read this article for class, many of my fellow students objected to it. After all, the oath may not have been written by Hippocrates. Other Hippocratic treatises describe practices that do not follow the oath. Some people simply objected to Kass himself, because of his controversial personal viewpoints about stem-cell research. Despite these objections, his point still stands. A physician is privileged and burdened to see a person at his or her most vulnerable.

How much does the pre-medical curriculum prepare students for this type of responsibility?

In my observation, there are two types of pre-meds: those who are scientifically-minded and those who are people-minded. The first type is fascinated with the human body as an organism, with disease as a puzzle to solve. The relational part, though important, is secondary. The other type’s primary focus is to heal others. The scientific way to go about it is simply a means to an end. Of course, there is a large overlap between the two groups, but those are the general trends.

The modern pre-med curriculum is designed to take these two groups and weed people out, so that only people who are truly dedicated to medicine survive. It is a rigorous range of classes designed to teach hard science: chemistry, organic chemistry, mathematics, biology. It takes sacrifice: fewer electives, lower GPA, difficulty in studying abroad. In the end, the scientifically-minded types persist. The humanity-oriented pre-meds decide to go into professions more conducive to treating people relationally, such as social work, psychology, or education. “If the pre-med curriculum were more people-friendly,” a friend told me the other day, “I would still be pre-med.” He facetiously added, “The pre-med classes turn people into tiny little hermits.” I have known so many people who would have made incredible doctors who gave up because of the hard-science focus.

Do we want hospitals full of doctors only concerned with people as puzzles? In some cases, yes. We want the puzzle of our illness to be solved. But don’t we also want doctors whose primary focus is to heal us as human beings and who recognize that sympathy and understanding may be just as powerful as any drug? The combination of the two different focuses is crucial for the practice of modern medicine.

I recently spoke with a family friend, who is an internist on the faculty of Northwestern Medical School. I was interested in the psychological aspect of medicine, and asked him how much he needed psychology. “It’s 70 percent of my job,” he said. People are much more likely to discuss their emotional or mental struggles with their doctors, he said, because they distrust psychologists as quacks. He went on to say that he had received little preparation in psychology in either college or medical school. He had to learn the art of counseling on the job. Counseling is a puzzle, but a different type of puzzle than how to defeat cancer.

What if we make psychology classes part of being pre-med? What if training in human dignity is simply part of being a well-rounded pre-medical student, just as important as organic chemistry? We would have doctors who understand, just as the ancient Hippocratics did, that a doctor interacts with people when they are most vulnerable. Only the recognition of that burden, as well as thorough training in how to solve the medical problem itself, will make doctors into the healers they set out to be.

— Hannah Koch is a second-year in the College.