For the past 40 years, I have worn many hats in medical education. It has been my passion. From mentoring first year medical students to overseeing all of the training programs in my subspecialty in the United States and Canada, I have immersed myself in the gamut of this arena. Surprising to many, my most enjoyable experience was not interacting with those at the tip of the spear in my profession, but teaching medical students early in their career, a job many of my colleagues were only too glad to hand off to someone else.
In a very real sense, the first 15 years or so of my involvement in medical education were refreshingly straight forward and uncomplicated. There was only the “science” to look at. In an earlier substack I revealed that my decision to follow a career in healthcare was based on my (as it turns out, naïve) assumption that I could follow the truth. For those early 15 years that was much of what I did. And I thoroughly enjoyed it!
But in the middle 1990’s, the winds changed. These changes were subtle at first. I gradually had to concern myself about more than just delivering the best care I could to my patients. Extraneous considerations forced their way into the picture. The temptation to compromise, with the best of intentions, became more and more persistent. Above all, the influence of power and money became increasingly more unmasked. Today they are no longer hidden, but even celebrated. Big Pharma, Big Tech and Big Medicine are by no means apologetic for wielding their power openly. The changing wind gradually became a storm, and finally the raging tempest in which we now find ourselves. Like the proverbial frog in the pot of water that is slowly increasing in temperature, we were complacent for too long and we now finally realize the imminence of the danger.
Many of my colleagues have trouble defining the difference between a male and a female, and what is really astounding, they don’t consider it a problem. “It depends” has replaced the once solid foundations of biology. Instead of treating patients with the same honest care, uninfluenced by their race, creed or sexual preference, it now has become a stated goal to treat patients fundamentally differently, all in the name of equity. There is no apology for delivering substandard care to some, as it is considered a means to correct the sins of the past. It is now lauded as a virtue to reverse the perceived unequal treatment of some in the past by imposing a new unequal protocol.
Critical thinking has become something to be rooted out, as conformity to consensus has become more important than a questioning mind. Intellectual honesty has taken a backseat to political correctness. Moral principles are ridiculed. A blight has entered the once tranquil and secure world in which I lived and worked.
But Tolkien?? How does that fit in to this story? It is reported that The Hobbit grew out of stories Tolkien told his children. He had begun thinking about his mythology out of his experiences during World War I to “express his feelings about good, evil, fair and foul”.
As a high school student, I read his works out of a sense of pure enjoyment. I had no concepts of some deeper meaning behind the stories, but just reveled in the word pictures he created. Now I am amazed at his prescient understanding of the world into which we have descended. Indeed, the Dark Lord of Mordor seems to be on the march!
Those seeking a career in the health professions are not unlike the inhabitants of Middle Earth, now facing a powerful and unforeseen force whose goal is one of complete destruction and domination. Danger, like the Orcs, is around every corner. Trusted institutions prove to be feckless. The North Star of truth is clouded….
Like the band of Hobbits, Elves, Dwarfs and Men who gathered together in their Fellowship of the Ring, in order to remain true to their goal, prospective physicians, nurses, dentists, health policy experts and researchers must create their own Fellowship so that truly patient-centered care may survive. They need to be supported in the fostering of critical thinking, courage, integrity and moral responsibility as they move ahead in a world determined to wring these qualities out of them.
Medical schools will not encourage the formation of such Fellowships. Indeed, they are a huge part of the problem. Nursing schools seem in some respects to be ahead of the curve, but my nursing colleagues tell me the same dangers are lurking in their field as well. Sadly, the few health professions who have held true to their oaths of care have been vilified and professionally “burned at the stake” as heretics.
Somehow, we must reach out to prospective health care students to mentor them and equip them with the tools with which to create their own Communities of Practice for learning and support into the future. They need to forge their own Fellowship of Health and Truth.
Complexity Science has taught me that, in a Complex Adaptive System (and healthcare education… indeed ALL of healthcare is a Complex Adaptive System!) a small amount of effort applied at an inflection point can have massive, nonlinear results.
Perhaps an educational institution with a reach into the undergraduate and secondary school levels will move forward and capitalize upon the realization that they can make that substantive difference. Perhaps private organizations and charitable foundations with credibility in the healthcare and broader business worlds will also take up the challenge.
But here is the confounding difficulty: Those who CAN make that substantive difference for these students are not on the journey WITH them! Those holding the power to make the necessary changes are, for the most part, insulated from the dangers of the quest of those in the infancy of their professional journey. They themselves are not subjected to the hardships. Many may have even bought into the lie of the new order of things.
Many….but not all. Perhaps some are on their own dangerous quest….They may also be facing dismissal from their posts in academic healthcare if they object too strenuously to the CRT indoctrination. They too are under pressure to turn their backs on critical thinking and follow the consensus and not the science. Countless physicians, nurses, first responders and those in military service have lost their livelihood, their dream and are subject to continued professional censure. Many have acted with courage, ethics and moral responsibility. Unfortunately, some have not. But perhaps at least some of those would have, if only they had been given the support they needed.
We may not be a Gandalf, but it is imperative that we try to support the students the teachers, the mentors and the leaders in this effort, even if only as individuals in our limited influence arena.
Without the success of the healthcare students and practicing professionals of today to retain critical thinking, courage, ethics and moral responsibility, healthcare, and indeed all of society, will continue spiraling down an ever darkening path.
Maybe the message of Tolkien is to join these individual quests together! We should foster the development of a true Community of Practice composed of all the health professions integrated both horizontally and vertically, making it open and inviting to all.
Thank you for this column. I have been a registered nurse since 1963, I turn 80 in 2 days, and have worked clinically and in healthcare education for many years. Now retired, of course. I am dismayed at what has become of the practice of “medicine.” I was trained in patient centered care where each individual patient received the care needed for their condition. Now we have “evidenced based medicine” where a defined protocol is used for all patients. This protocol is determined by a group of physicians employed by the medical center and the rest of the physicians must abide by it. Critical thinking is out the window.
I saw the beginning of this when medical centers began buying independent medical practices. Physicians, who were independent contractors, became employees of the medical center and had to abide by their rules. I saw big Pharma controlling these medical centers and physicians with huge grants and financial rewards. Now we have them all, including medical journals, bought and paid for by big Pharma. I am dismayed.
I saw the lack of critical thinking by physicians when I was vaccine injured from the first dose of the Shingrix vaccine for shingles. I week after the shot I developed peripheral nerve pain that two physicians assured me was not caused by the vaccine. Eventually, the neurology group in the ER odetermined that I had developed Guillame-Barre Syndrome as a result of the Shingrix vaccine. I found it hard to believe that the trained physicians were unable to put together the shot with the vaccine when I saw it clearly. Even when I was insisting that this was the case. Needless to say, I rejected the COVID vaccine.
During the COVIDCRISIS we were lied to so many times. I knew from the beginning that it was being approached in the wrong way, no early treatment, lockdowns, no school for children. We needed to protect the elderly and those with comorbidities and let the rest go about their business. I am so sad that we have had to deal with this.
I hope that your ideas can be implemented so that we can again have critically thinking physicians who see the patient not the condition. I’m afraid it will be difficult because of the hijacking of our healthcare system by big Pharma.
To Tracy Bishop and JenM--Your email addresses do not show to me. I would contact you directly but can only hope that you see this and contact me: rsgonner@protonmail.com
Thank you for this column. I have been a registered nurse since 1963, I turn 80 in 2 days, and have worked clinically and in healthcare education for many years. Now retired, of course. I am dismayed at what has become of the practice of “medicine.” I was trained in patient centered care where each individual patient received the care needed for their condition. Now we have “evidenced based medicine” where a defined protocol is used for all patients. This protocol is determined by a group of physicians employed by the medical center and the rest of the physicians must abide by it. Critical thinking is out the window.
I saw the beginning of this when medical centers began buying independent medical practices. Physicians, who were independent contractors, became employees of the medical center and had to abide by their rules. I saw big Pharma controlling these medical centers and physicians with huge grants and financial rewards. Now we have them all, including medical journals, bought and paid for by big Pharma. I am dismayed.
I saw the lack of critical thinking by physicians when I was vaccine injured from the first dose of the Shingrix vaccine for shingles. I week after the shot I developed peripheral nerve pain that two physicians assured me was not caused by the vaccine. Eventually, the neurology group in the ER odetermined that I had developed Guillame-Barre Syndrome as a result of the Shingrix vaccine. I found it hard to believe that the trained physicians were unable to put together the shot with the vaccine when I saw it clearly. Even when I was insisting that this was the case. Needless to say, I rejected the COVID vaccine.
During the COVIDCRISIS we were lied to so many times. I knew from the beginning that it was being approached in the wrong way, no early treatment, lockdowns, no school for children. We needed to protect the elderly and those with comorbidities and let the rest go about their business. I am so sad that we have had to deal with this.
I hope that your ideas can be implemented so that we can again have critically thinking physicians who see the patient not the condition. I’m afraid it will be difficult because of the hijacking of our healthcare system by big Pharma.
To Tracy Bishop and JenM--Your email addresses do not show to me. I would contact you directly but can only hope that you see this and contact me: rsgonner@protonmail.com