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Doctors have the reputation for thinking that they are gods. I am not sure we mean to project that image; some of us do, but for others, I think, the notion of divinity may exist more in the head of the patient than the doctor. The patient wants the doctor to be god, because then perhaps he could be strong enough to fight off nature - that nature which is causing illness.
Contrasting clinical practice with research, the late Dr. Lewis Thomas put it well: "Self-confidence is by general consent one of the essentials of the practice of medicine, for it breeds confidence, faith, and hope. Diffidence, by equally general consent, is an essential quality of investigation, for it builds inquiry. Here then are chief characteristics, each necessary in its own sphere, each unsuited to the other." I would make the same contrast between the practicing doctor and the writer.
As a doctor, I cannot and should not say whatever my personal feelings and doubts may be at any given time; I cannot and should not speak about myself except insofar as it helps my patient. As a writer, I am free to describe my feelings as I wish. Sometimes those personal feelings may not mesh with what patients believe or what I may have said in a treatment setting in a particular circumstance. Reading your doctor's inner thoughts is like reading the diary of your priest after confession: it can be disconcerting. Some writers give up clinical practice so that they can write freely: Kay Jamison did so after publishing her memoir about her own bipolar disorder.
Perhaps doctors can be allowed to write if we first manage to cast off the illusion of godhead, both our anger about it and our wish for it.
We all know - we doctors and patients - that doctors are not gods, yet, at some level, we are disappointed by that fact. We doctors would not mind being gods, if it were possible, I suppose; and patients would accept our divinity if it meant their restoration to health. But it does not work that way.
Psychoanalysts have a concept for all this: they call it "transference." The idea is that patients transfer feelings, from somewhere other than the real doctor-patient relationship, to their doctors. The doctor is overvalued, and becomes a god, or demeaned, and viewed as lower than swine. Often, the one precedes the other. Neither is true.
Like the Greek divinities, doctors who play god, or who are seen as gods, are seen to suffer one prime weakness: hubris. We doctors are arrogant; perhaps we are entitled, if, in our expertise, we excel; yet arrogance is arrogance, and it feels distasteful. Arrogance is an odd thing, though, for, as Benjamin Franklin described, one could even have pride in not being prideful. It is hard to be truly and knowingly humble.
I try, in my writings, more than in my actual discussion with patients, to freely express my doubts, my sense of error, my awareness of my mistakes - in short, my recognition that I am not a medical god. (Explorations of this idea include the recent work of the surgeon Atul Gawande). But, despite railing against the arrogance of doctors, patients want reassurance that the person treating them knows what he is doing. The problem is that medicine is not a science; it is an art, as William Osler said, based on science. As with any art - and even with science - there will be error. I try to be upfront about this aspect of our work with my patients, but one should not overstate the case. It is not as if we have no idea about what to do; if that were the case, years of medical school and governmental licensure would be irrelevant. But despite our specialized knowledge, our ability to know what is right is fuzzy; it reflects educated estimates, not exact facts.
So we doctors are not gods.
Nor should we wish to be. The concept of medical godhead reflects a mistaken notion of medicine, in my view; I call it Galenic, because it stems from the medical theory of Galen, which has seeped into our profession and our culture after two millennia of wide acceptance. This is the view that nature causes disease, and that the doctor fights nature to cure the disease. The doctor provides the cure: only a step is left to godhead.
The other view, long lost but deeply correct, I think, is the Hippocratic view of medicine: The idea here is that nature heals disease, as well as causes it, and the role of the doctor is to help nature in the healing process. The doctor is the not the central hero, but the handmaiden to nature. This does not mean that cure does not occur, but it occurs less than we think, and nature deserves the credit, not any human being. There is no room for doctor as god, and our purposes are more humble: to cure sometimes, to heal often, to console always.
Medicine is a complex affair; we frequently do not do justice to what our patients suffer and what they need. Pretending to know more than we do only makes matters worse. But being honest about what we do not know is not a sign of weakness.
Perhaps Anne Sexton, who herself committed suicide, captured it all best in her poem called "Doctors":
They work with herbs
and penicillin
They work with gentleness
and the scalpel.
They dig out the cancer,
close an incision
and say a prayer
to the poverty of the skin.
They are not Gods
though they would like to be;
they are only a human
trying to fix up a human.
Many humans die.
They die like the tender,
palpitating berries
in November.
But all along the doctors remember:
First do no harm.
They would kiss if it would heal.
It would not heal.
If the doctors cure
then the sun sees it.
If the doctors kill
then the earth hides it.
The doctors should fear arrogance
more than cardiac arrest.
If they are too proud,
and some are,
then they leave home on horseback
but God returns them on foot.
