This April marked the 10th anniversary of the founding of in the formationand we invited all members of the in the formation family to contribute articles and other artistic works to celebrate our first decade as the premier peer-reviewed online publication by and for the medical student community.
Apshara Ravichandran, Class of 2022 at Saint Louis University School of Medicine, contributes to this article as in the formation writer and featured author in in training: 2020 in our words.
“If you want to understand what a science is, you should look…not at its theories or its findings, and certainly not at what its apologists say about it; you should look at what the practitioners are doing.
–Clifford Geertz, The interpretation of cultures
During my dedicated Stage 1 study period, I remember looking at these visual comparisons of an early version of First Aid and the most recent edition and feeling righteous indignation bubbling in me. The first was thin and worn and ragged while the second was thick, heavy, solid. Hundreds of pages longer, the latest edition seemed inscrutable and impossible to memorize, growing larger each year with new minutiae to examine.
But that’s medicine, isn’t it? The constant search for explanations, the absolute belief that the next randomized controlled trial might make sense of it all. If we did not believe that all of these tiny little kernels of repeatable truth, unearthed across the world in New York, China, Australia and elsewhere, were fitting pieces into the larger puzzle, it would be too overwhelming to keep digging them out. That’s what we like to think science is: the relentless pursuit of truth.
The truth, at least the truth we learn for multiple-choice tests, is gathered from numbers, a physical exam, and a full history, all tied into what we call clinical judgment. This is the part they say you can’t learn from a Google search, how these things dance together and tell us the truth. These are the results of acidotic blood gases on the computer screen when combined with the appearance of a gelatinous little baby with arms like toothpicks and a face obscured by tape and tubes .
But there are other things, other than clinical judgment, that we can’t learn from a Google search. There is the contempt one can feel when the mother of this baby only comes to see them once in the week since their premature birth, after having received no prenatal care. What about when you learn that this mother is an undocumented immigrant fleeing her home country? What about when you find out that they also used substances throughout their pregnancy? To be honest, I’ve never been able to properly differentiate between 1+ and 2+ edema, but I’ve been able to sit with moms like this, and have been there when providers talk about them , and I’ve seen people be clinically judged as if they hadn’t lived through decades of life and suffering and triumph that their doctors knew nothing about.
Medical humanity recognizes that we have always looked at more than numbers, and that we don’t always do so gracefully or intentionally. And vice versa is realizing that doctors are not blank surfaces, but people who carry their own stories, wounds and biases into their work. In anthropology, they call it reflexivity: realizing that the truths we pursue are altered, sometimes in the smallest ways, by who we are and how we interact with them. places like in the formation let doctors-in-training reflect openly on the experience of doing this job, beyond the act of interpreting labs and ordering chest X-rays. The field of medical humanities forces us to look at the subjectivity of this career and recognize that we are not detached, unbiased data processors working in a clinical vacuum.
We will always need researchers, people who keep asking questions about gene transcription and who feel at home in a wet laboratory with pipettes. People who understand numbers and speak the same language as computers that model disease processes. But we also need people who look at a patient and see a story, who look at objective data and see subjectivity, who not only do the work of a doctor but who reflect and study the social, economic, personal, emotions of our work. And we need opportunities – publications like in the formation, lectures, lectures on medical education, process groups such as those routine in psychiatric training – to center these implications. The medical humanities are essential to maintaining the culture of humane medicine, for both patients and clinicians.
Image Credit: Joanna Watterson, MD on Twitter