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examines the evidence with an open mind, however, I believe that one has to conclude that in the field of
medicine, at least, there is no inherent contradiction between the scientific and the compassionate.
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Technology and science are here to serve us. In the words of Albert Einstein, «The concern for man and his
destiny must always be the chief interest of all technical effort». The much maligned and expensive CT
scan, the example of medical technology par excellence, has not dehumanized medicine. On the contrary, it
has been a tool of unparalleled compassion. Its use has spared patients many more difficult, painful, and
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dangerous procedures. Technology is just a means to an end. In a perverse manner of speaking, compassion
too is just a means to an end. In the field of medicine, both technology and compassion have as a goal
healing the
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patient; we can ignore either only at the peril of producing poor medicine. We need physicians who are
both compassionate and competent. Short-sighted persons who, in their enthusiasm for the human and the
community approach, think that they can select students, teach medicine, and produce compassionate
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physicians by downgrading science, as is being attempted in a number of universities in the world, are
sadly mistaken. At best they will end up with compassionate ignoramuses, and at worst they will simply
produce ignoramuses — often without even the redeeming value of compassion.
75 6.Another commonly held view is that lack of compassion in physicians is the result of the ever-
increasing narrowness of the physician's education. We are told that if the students entering medical school
were also versed in the humanities, in music, art, and philosophy, we would see emerging at graduation the
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sage and compassionate physician. This theory sounds reasonable because of our association of refinement
and culture with civilization and because of our confusion of the quality of humanity with the study of the
humanities. Unfortunately, the association often observed between humanity as a quality and the
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humanities as a study is probably not one of cause and effect; culture is not necessarily related to compas-
sion. Think for a moment of the highly cultured intern who leaves a desperately ill patient to listen to his or
her favorite concert violinist, while a musically ignorant but more conscientious and compassionate
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colleague stays with the patient. One must not confuse ethics with esthetics, or compassion with culture. In
our own generation, the emergence of the most inhumane regime in history from the acme of Western
culture and the figure of Adolf Eichmann watching the crematoria to the strains of Haydn should lay to rest
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the notion that we can look to the humanities for the humanization of medicine or society.
7. third explanation for the failings of modern physicians, and one widely held by physicians
100 themselves, is the dehumanizing effect of the long and arduous training period, with its long hours and
continual physical and emotional strain. It would be foolish to deny that overwork and emotional strain can
reduce even the most humane person to an irritable wretch, yet it is worth noting that the arduousness of
105 the physicians's training has in fact decreased remarkably during the past 50 years—a period
contemporaneous with the alleged decline of the physician's humane qualities. If hard work were indeed to
blame for physicians' failings, we should have an improvement rather than a deterioration during the past
110 few decades. Medical students and physicians-in-training in the past were treated in a far more
condescending manner than are their modern counterparts, who are consulted and included in faculty
decision making almost as equals. Physicians' working hours have declined, and conditions during the
115 postgraduate period have also improved remarkably. Almost forgotten too is the expectation of years gone
by that the medical practitioner would be available 24 hours a day, seven days a week. And yet the more
gently treated student and resident has seemingly developed into the less compassionate physician. A para-
dox indeed!
120 8. If the preceding hypotheses do not provide an adequate explanation for our problem, where then shall
we look for solutions to this vexing situation?
9.
I contend that the fundamental problems lie for the most part outside the medical establishment,
125 within society as a whole. The physician is largely a reflection of society. Most schools of psychology
agree that the basic human character traits are well developed by the time a student enters medical school.
The student's basic motivations, goals, code of ethics and concern for others are already established when
130 medical studies begin, and the medical school must work within these major constraints. Unfortunately,
medical training can disillusion and render cynical even some quite decent students, but rarely can it
convert a basically self-centered and egoistic person into a humanitarian. Such a goal would strain almost
135 any educational system.
10.
Let us examine what has happened to society's overall attitudes toward life and the implication of
these changes for medicine. Most Western societies have changed from religious societies into secular
140 ones. Most Western religious societies put a greater value on humanitarian and societal concerns than on