The world of medicine, as is true of the world in general, is at the point of a crisis. This is a state that has been apparent to a few physicians for a long time; now it is becoming apparent to many. It is a part of the lack of basic training and philosophy, of the lack of a solid foundation of principle which must under-lie all basic training. In fact, there is a great difference of opinion between colleges, and even among members of the faculty in any one college, as to what subjects are essential, and why certain subjects are essential and others irrelevant. There is absent, therefore, in the training and education of the physician, those foundations of purposefulness, discipline and definiteness without which any other qualifications for medical practice are as nothing.
Now medical practice faces another crisis. We quote from the May 1943 number of the American Institute Journal, page 169:.
BENEVOLENT OLIGARCHY OR DEMOCRACY.
Which do you prefer?.
During the past several months we have written on topics of immediate importance. This month we pose the above question. You must make your decision now or have, at the end of this war, a benevolent oligarchy to contend with. Of course, you who think that such a state is good need not concern yourselves. Those desirous of seeing that for which we are supposed to be fighting live again, must decide a course of action against the future. The most recent socialistic trend that our Government has taken consists of the absorption, by the Government, of class A medical schools on July 1, 1943. From July (supposedly for the duration of the war) all medical students will be educated by the tax payer; that is, the tax payer will stand the expense.
All classmen are included in this plan. Each student will be paid 2.75 daily for maintenance. Upon matriculation the student will be classed as a private. When graduated he will be commissioned as a first lieutenant. The plan is apparently compulsory for all now enrolled regardless of their ability to pay. This is the plan we wrote about several months ago. It appears to be the opening wedge of the State into American medicine. Furthermore, a Social State, as we declared in March, will have been formed when this plan becomes a law, because of the close relationship that exists between medicine and industry. It is our opinion that there is nothing so permanent as that which is supposed to be temporary.
The crisis is nowhere more evident than in the training and education of the physician, and what effect this new trend will have upon medicine, and upon our world in general, we cannot envision. Our present crisis has materialized from the confusion which arises from lack of a basic security.
It is only upon basic solidarity that the edifice of a sound practice can arise, and in this fundamental position the place of discipline has been all but forgotten. It is not enough to force a form of discipline upon the medical student; the form does not suffice. It is necessary to establish the habit of self- discipline, and this must be done in early life, and continued through the critical years of medical training.
The primary and secondary schools, through the medical school, have no higher duty than to incorporate such training, for in this training rests the ability of the man to develop for himself the end purpose of principle: to learn to make his own decisions, based on principles, and to do his own thinking and to live freely and strongly because of his consciousness of his own foundation in principle.
What is true of the general medical school is doubly so of the so-called homoeopathic school, for here there is not only the same confusion and sense of crisis felt throughout the world to- day, but the desire to ape the allopathic school; and in its attempt to be all things, it has failed miserably to stand for anything well worth while.
Unless the student understands the foundation of homoeopathic principles and appreciates something of its history, its growth and development, he will remain an inadequately prepared physician, and hopelessly deficient in any qualifications for a homoeopathic physician. It is the appreciation of its principles that gives that to its possessor which will sustain him and give him an understanding of and stability in his practice. It has been the tendency to seek the easier way, to make a career of medicine for the sake of income, because of a lack of appreciation of principle and self- discipline, that is symptomatic of the country as a whole in every field of endeavor; and it is this lack of appreciation of values that will plunge us into a new barbarism unless this crisis can be met and the tendency curbed immediately.
Crisis have become almost commonplace in our day. It suggests a period of suspended judgment; we are unable to make decisions, until this period of crisis is upon us. Buchanan said, “It is the point at which a decision must be made, a judgment rendered. It is the point when issues are clear enough for understanding and for action”.
Crises can only happen to free men who approach the crisis unprejudiced, with an absolutely clear understanding, but grounded upon the long and sound training of self-discipline and principle. Crises are made possible only by liberty, which is an essential attribute of the human reason and will. We are now face to face with a crisis in medical practice, and because of our freedom it is a crisis in which decisive action is possible and must be taken.
We are suffering from insecure foundations; we must have firm foundations. Perhaps it is too late to build anew, for the resent generation, but we can certainly mend those we have built and see to it that the future will be built on sounder foundations. We, as members of the medical profession, must see to it that we reach the deeper foundations, those foundations laid down by the great minds and unprejudiced thinkers of an earlier day, and thus avoid the pitfalls of the popular appeasement methods.
It is a time for searching the great truths of homoeopathy that have existed without change for many years; and by intense study and practice we shall build the respect for unchanging principles that will enable us to go forward, to pass this time of uncertainty, and to carry on constructive work. There is present among a very large group of physicians the conviction that there is no such thing as a certitude, there is no stable position and there is a conclusion in their philosophy that there are no absolutes; this brings us to the conclusion that one system of medicine is as good as another.
One system of medicine is as good as another, surely, if there is an absolute standard for the basis of each, standards which are comparable in the light of truth. We not only have refused to accept an absolute standard, but we have permitted investigations, lawful in themselves, to be the standard of medical practice. We have not been willing to accept principle and to go forward from there. Because it had been proved worthy, in the eyes of some, it soon became outworn, and other and newer objects of interest must needs be investigated, not as evidence, but as standards in themselves.
Herbert Agar calls this day “a time for greatness,” and truly it is a time for greatness in our colleges. In the world about us this crisis, presents the picture of light and darkness, between war and blood on the one hand and hope and decency on the other.
There is nothing worth fighting for except an ideal, a principle, an absolute, for that alone can provide a sound basis for the future. Applying this to our system of therapeutics, we see that we must stand on our own solid foundations and shun all attempts at appeasement.
Walter Lippman, commenting upon modern, so-called scientific education, says:.
The concept of human nature is one in which desire is sovereign and reason is the instrument for serving and satisfying desire. This conception has become increasingly the accepted image of man in the modern world. It is upon this image of man that our secular education and training is based. Our world today is in the hands of masses of people who are found in this image and who regard it as indubitably the true and scientific conception of human nature. Yet the cultural traditions, and the great central institutions of the world, came down to us from men who would have regarded what is now the fashionable image of man as the image of an uncivilized barbarism.
This modern man is a being whose desires are limited, not by reason, which represents the universal order of things, but only by the difficulty of getting more and more satisfaction. The desires of the modern man are, as respects his own inner measures of control, illimitable desires. It follows that his desires are never satisfied and it is the anguish of unlimited, and therefore unstaple desires, which is the characteristic misery of our age.
Many of our great thinkers are in unison in decrying against these things in great schools of learning and it is certainly true in the medical profession. Alfred Noyes says it is only by the restoration of the basic truths that progress toward human reason can be rescued from chaos. Goethe said, “The deepest, nay, the unique theme of the history of the world, to which all themes are subordinate , is the conflict of faith and unbelief.”
Physicians wants something in which they can believe and it must be something beyond the test tube, beyond the demonstration of mathematics or beyond speculations on philosophy. They must work to develop the kind of character which will result, first, in the ability to understand what it is they wish to build from life in themselves and for their patients; and second, which will inspire in others the desire to press on to higher attainments.
It follows that those who teach constitute the most important problem. In selecting instructors we must require more than technical competence. We must insist upon character founded upon basic principles. Then more and more medical students will look to the dignity of their calling, and less and less to the opportunity for medicine as a career in which they can earn. Rather, the goal will be how much they can learn how best to live.