Dr William Osler was speaking to medical students at the University of Toronto in 1903 when he said, “[t]he practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.” In 2023, Daniel Marchalik raises the question, “How do we preserve the parts of medicine that inspire people to become physicians in the first place?” in a book review published in the Lancet. The hero of the book, Taffy Brodesser-Akner’s 2019 novel Fleishman is in Trouble, is Dr Fleishman, who is in the midst of a difficult divorce. The doctor hoped to raise their children on the “model of a person in a white coat giving solace and peace and healing to someone who needed it.” In contrast, his wife, a highly successful businessperson, was singularly focused on the financial security of her family. In the story, the doctor’s idealized version of medicine “exists in tension with the realities of modern health care—an anti-Oslerian transition from art to trade, from a calling to business.”
The book’s author is quoted in an interview as recognizing the disconnect between the idealized world envisioned by a medical student and the reality of medical practice. She said, “I wondered if there is any industry where you could live a whole lifetime without the ground shifting under your feet in a such a profound way.” The book’s reviewer agrees: “in a rapidly changing world no profession can be immune to shifts in technology and industrialization—a change that is only accelerating in medicine with the introduction of artificial intelligence, virtual medicine, and new treatments.”
Here we are today, with the likelihood of a new medical school opening under the aegis of Simon Fraser University; likely to be physically located in Surrey. What aspects of medicine that will inspire students who are responding to a “call” not a “business” must be preserved while developing the curriculum of a new medical school? The answer may be in the words of Ernst Wagner (1876–1928) a German physician, physicist, and extraordinary professor at the University of Munich, “we do not treat diseases but sick human beings.”
—George Szasz CM, MD
1. Osler W. Aequanimitas. Philadelphia, PA: P. Blakiston’s Son & Co; 1932.
2. Marchalik D. The expectations trap in medicine. Lancet 2023;402(10408):1125.
3. Pratt JH. The personality of the physician. N Engl J Med 1936;214:364-370.
Peabody FW. Landmark article March 19, 1927: The care of the patient. By Francis W. JAMA 1984;252:813-818.
This post has not been peer reviewed by the BCMJ Editorial Board.
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