In his latest book, “The Finest Traditions of My Calling: One Physician’s Search for the Renewal of Medicine,” Abraham M. Nussbaum pleads with readers to help him find the best way to reimagine his role as a physician and remind him of why he sought out this profession in the first place. Director of the Adult Inpatient Psychiatry unit at Denver Health, Nussbaum joins the ranks of the growing number of physicians telling stories about the goings-on in their exam rooms. However, he takes his book a step further, extending its reach to comment on one of the larger questions for the profession in our time: how can we recharge medicine with the humanism it seems to have lost?
Nussbaum writes, “We need to see wisely … the solution for medicine’s ails is not rigid standardization, but the renewal of wisdom and the communities that cultivate wisdom.” Patients and doctors alike “want virtuous physicians” but the medical community “does not actively cultivate them.” Instead, physicians now are “encouraged to count something rather than see someone.” Nussbaum believes that “the best hope for medicine lies in physicians seeing patients as particular, unique individuals,” inspired by Abraham Verghese’s writing imploring physicians to approach patients almost as they would a text they needed to close-read, implementing the literary tools of narrative, character, and metaphor to better understand their patients.
Nussbaum writes chapter after chapter, drawing from an almost overwhelming (but necessary given the breadth of his book) number references to former and contemporary thinkers including Aristotle, Foucault, our own Arnold and Sandra Gold, Hildegard, and Osler to name just a few. Spurred by Gawande and Sweet’s likening of the physician to line-chef and gardener respectively, Nussbaum reimagines the role of the physician in other professions from artisan to witness as he searches for renewed inspiration.
One reimagining that Nussbaum is critical of is the physician-technician. He writes, “We often conceive of medicine as controlling the body, which is why analogies to industrial engineering, where a worker is responsible for the inanimate object he or she manipulates, carry such currency in contemporary medicine. We compare physicians to airplane pilots, implicitly likening our bodies to airplanes, machines controlled by physicians. An airplane pilot is responsible for flying a plane, but patients and practitioners have a mutual responsibility to care for a body.”
Perhaps a better analogy is physician as teacher, helping “patients make changes they could not achieve on their own” or a coach “motivating a patient to change.” However, Nussbaum recognizes the limitations of these analogies, and recognizes the unique place of the physician. “Coaches can use techniques like motivational interviewing to kindle and encourage patients and students, but profound illness incapacitates self-motivation.”
Nussbaum’s book is at once a humanist’s account of the state of healthcare today and a call to action for medical professionals to take up humanistic practice. Nussbaum leaves readers with his dream of what medicine could be, imagining “a medicine where physicians and other practitioners could get to know people intimately, bear witness to the social injustices they suffer, and accompany them to health and justice.”
