By Marcos-Serna R, M.D.
Since the apparition of man on earth´s lit, disease has accompanied us and so has people that try to relieve our suffering, whatsoever its cause. Diseases are, in many cases, older than man but may be newer, emerging along man modifies and changes environment because of technical development and its wastes or just because of emerging of new species of bacteria or viruses. No matter the cause of disease it originates pain, sorrow, anguish, anger, bad drams, insomnia, family and financial problems and many other issues related to the loss of the ability of achieving daily life needs.
Disease, a term coined in the 14th Century, probably after words des- and -ease, refers to
a condition of the living animal or plant body or of one of its parts that impairs normal functioning (…).
[1] Some have called it an insult, an offense, evilness, wickedness, each of this adjectives referring to the damage of the body. Body is a sanctuary in which mind –or soul resides along with all its functions and capacities. For cultures whom cosmogony includes an immortal spirit for each human, body requires care and caregivers are people that devotes them time and efforts to give relieve of this suffering.
Perhaps since apparition of
hominia family about 2.4 and 3 mya, some individuals of the species were in charge of the wounded, the ill, of the old. For sure these individuals had not skills in “healing” the others but in alleviating pain. These species passed through an evolutionary process letting behind all families between
Australopithecus africanus and
Homo neardenthalensis, becoming
Homo sapiens (Linnaeus, 1758) around 150 tya, surviving where its nearest relatives,
Homo neardenthalensis and
Homo Floresiensis disappeared 12 tya.
[2]
Human development gave rise to specialization of work. Previously hunter-gathering creatures, mankind found that the soil was indeed able to feed them so became agricultural societies and established shantytowns in which conjugated recollection and growing of food. Perhaps the agricultural revolution improved the feeding needs of a by the minute larger populations, but carried itself the rising of new diseases related to overcrowding. And aside to disease, again, people who try to relieve it. Medicine has many faces and ways to be made according to the traditions of the culture in which it develops and the idiosyncracy of the people that shapes that culture. There is an excellent literary work referring to the medicine in different cultures, and should be known by all physicians to understand the thinking of our patients.
[3]
Disease is, by definition, an altered condition of the physical body so it´s clear why the individual dedicated to treat with disease is called physician. Coined in the 13th century, word Physician refers to
a person skilled in the art of healing or one exerting remedial or salutary influence.
[4] Nowadays the physician is someone that has the studies, training, experience and license to make healing procedures, independently of the nature of those that may be surgical, pharmacological or medical in origin; that person may be called physician or doctor and, in Spanish spoken countries,
médico, synonymous of
doctor.
Doctor means, in Latin, who teaches as it derivates from
docere, to teach. One can question: Do we teach so we deserve the academic qualification of doctor? In the ancient cultures, physicians were educated in a quite different way we are educated in medicine nowadays. Today, a medicine student goes to school for five years and once has accomplished scholastic education faces, at least in México, two years of treating patients, one in the internship, a year in which we´re not even doctors nor students but learn how medicine is made and, after that, the social service, another year in which we made
medicine based on existences instead of evidences, treating a undefined number of patients in a country town that hardly has electric power. Then, if the student is lucky –and a good student, may aspire to made a residence, specialization course to become a Ph. D.
In past years, medicine was taught in a very different way, usually involving the reasoning of disease and the patient and the relation between them and the environment. This is reflected in the words of Thomas Addis, an Irish physician dedicated to the study of blood clotting, who wrote:
The physician will use scientific methods, will sometime dismember to his patient, but in the ending, should resume all that parts in his diagnosis which is his whole conception of the existing relations between the patient as a person, disease as a part of the patient and this as part of the world in which lives.[5]
As seen, the understanding of disease was not only the accurate description of signs and symptoms, nor the merely listing of them, not even the relation of disease and time, climate o region in which it happens, but the integration of all these topics to understand the patient.
This is where the PH. D. degree came to light.
Ph. D., PhD or
Philosophiae doctor degree was first used to designate a physician because it is supposed that we understand the whole patient, undestanding that philosophy means the like for thinking.
Anyhow, these days medical education has nothing to do with philosophy. One can argue that is unnecessary to philosophy the disease or the patient or the place it occurs because we have technical means to precisely point the origin of the patient illness. If we pass the pages of any medical book today will found things as:
in the computed tomography scan we´ll find… or
molecular techniques reveal… or even
the search of kryptonite in cerebral-spinal fluid shows… instead the description of what the hell the disease is or how the patient got it.
In my practice of anesthesiology residence I have the fortune to teach 5th year medical students. This boys and girls (each month I found the more and more young) have the misfortune to know nothing about the medicine I learned at school and hospitals in which we smelled, touched, listened to the patients. These young are been teach to diagnose and treat magnetic resonances, EKG´s, laboratory reports, X ray slides, not patients. Worse of this is that they do not read anything but medicine.
Indeed, they are victims of their time as said by Jean-Jaques Rousseau. Global communications, internet access, TV and things like these are drifting apart these doctors from medicine practice. It´s just the way it´s been made now, but this does not mean it is the better way.
I think genuinely that doctors are among the most ignorant professionals today contrary to the past years in which physicians were respected and admired not ´cause to their academic degree but their knowledge. May be it is time to reconsider the way we are teaching medicine in order to doctors achieve the status of Ph. D. they deserve not only for their personal satisfaction but to treat patients that, obviously worth it.
When I finished my internship the Academic Chairman of my hospital made for me the doubtful favor to choose me for the closure speech. I´d made it one night before the timeline and the only thing I can recall was worth it was that I´d say, talking to my former teachers:
It´s your responsibility to teach well to whom will follow us. Remember that, the day of your death, a doctor will be beside you.
[1] Merriam-Webster Dictionary and Thesaurus Online, http://www.merriam-webster.com/dictionary
[2] Cracaft, J, Donoghue MJ, Assembling the Tree of Life, Oxford University Press, New York, 2004
[3] Selin H, Medicine across cultures, history and practice of medicine in non.western cultures, in collection Science across cultures: the history of non-western science, Kluwer Academic Publishers, New York, 2003
[4] Merriam-Webster, Op. Cit.
[5] I´m ashamed to say I do not have the reference of this statement cause I´d get it as an epigraph in a coagulation book.
