Turning toward Suffering Together

In chapter three, the philosophical work of Heidegger, Levinas, Charles Taylor, and Mikhail Bakhtin is drawn together to illustrate that in turning away from vulnerability, illness, and death in the name of objectivity and “clinical detachment,” physicians not only offer compromised care to their patients but also diminish their own practice and their own being. What is more, the argument is made that it is only through a response to the call of the face of suffering that one can offer authentic care. For it is through facing the reality of their own finitude and potentiality-for-suffering that physicians’ subjectivity is deepened and that they begin to recognize and respond to the call for care issued forth by the patient. In authentically responding to this call from the other, the doctor comes to see that she needs the patient, not only to determine how to help him, but she also needs the patient in a more fundamental way: she needs the patient in order to heal, in order to be a healer. As Heidegger would say, she needs the patient and his call outward toward her in order to become who she already is.

The Formation of Medical “Professionals”

Chapter four explores how educators might help cultivate the capacity for authentic patient care among doctors-in-training, including a comportment of humility, openness, and gratitude for patients. The argument is made that the curative ethos of medicine and its preoccupation with calculative thinking will persist until educators can cultivate within clinicians and clinicians-in-training the capacity to face their vulnerability and the reality of existential anxiety. It is through a pedagogy that values and fosters vulnerability and reflexivity that this capacity can be cultivated. Although recent trends in the professionalism movement, including that of “professional identity formation,” have made progress toward these ends, these movements actually may serve to reinforce calculative thinking, due to their focus on outcomes and assessment. 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, which emphasize personal development, experiential and habitual learning, and quality mentorship.

Epilogue

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Exploring the Shortcomings of a “Scientific” Medical Education

Chapter one begins with a synopsis of the scholarly literature that discusses the epistemology and pedagogy of medicine and the effects they have on physician formation before arguing that this perspective can be deepened and expanded by an understanding of Heidegger’s explication of “calculative thinking.” An understanding of this mode of thinking offers a more comprehensive grounding for the discussion about the inherent problems of medical education and practice. Privileging calculative thinking closes one off to other truths, those 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 those things that might be scientifically “proven,” a point that will be more fully explored in later chapters. Recognizing the dominance and seductiveness of calculative thinking within medicine is important, as it speaks to the human tendency to turn away from the contingency, vulnerability, and death—a point that is clarified and expanded in chapter 2.

The Journey Back to Oneself: Reimagining Medical Education

Chapter five includes a discussion of specific curricular interventions that can work toward getting students to think critically and to reflect deeply and broadly on what it means to be human. 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 through narratives or face-to-face encounters—reflective writing, dialogue, and quality mentorship, students might come to appreciate the lived experience of illness, to expand their moral imaginations, and to develop a more capacious sense of care that is grounded within 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 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 all patients even when “nothing else can be done.”

The “Remainder” in Modern Medicine: The Lived Experience of Illness and Existential Anxiety

This chapter examines why privileging calculative or technical thinking is particularly problematic in medical practice. Because medicine and medical education focus on the “real” and the “scientific” (assessing and treating biological disease), the lived experience of illness—including existential issues such as suffering, fear, and inescapable uncertainty—are left largely unaddressed. Thus, some clinicians, especially those who view themselves as scientists or technicians, may believe that they are not called to attend to these issues. 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. Turning away from the reality of vulnerability and finitude is part of the shared condition of being human. Through an exploration of the philosophical work of Kierkegaard, Heidegger, Merleau-Ponty, and Nietzsche, this chapter shows that medicine’s preoccupation with science, detachment, and 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.