White coat sanctimonies

We need to talk about medicine

Photo by Volodymyr Hryshchenko on Unsplash

By Anonymed (an anonymous Canadian Doctor)

We need to talk about medicine…

Long before medical school, I spent a summer as a research assistant for a slightly mawkish “professionalism initiative” for young physicians. Part of my job involved combing the archives of outdated TV medical dramas in search of ethical conundrums that might put participants on their heels. 

Whether the source was ER or Grey’s Anatomy, the moral was always the same - doctors treat patients according to individual need, full stop. Deviation from this principle was invariably portrayed as bad, even when the patient had a swastika tattooed on his belly (Grey’s Anatomy Season 4: Episode 10). We were not to be moral arbiters, and any suggestion that we might be was a perversion of the medical ethos. 

These scenarios are more than just bad television. Physicians are confronted with ethical litmus tests on a daily basis and, especially in certain parts of the world, the cases can be extreme.  Consider what it must be like to be an Israeli doctor (for example) when a failed suicide bomber arrives at your hospital. Should this person be treated like any other patient? Does it matter that they may have attempted to blow up a hospital, a place of worship, or a school your kids attend? Does it matter that if the circumstances were reversed they would surely let you die (if not actively kill you)? No. That’s the point. Medicine isn’t supposed to be about dispensing societal justice.

Alas, those were simpler times. The western “reckoning” of 2020 sent the profession into a tailspin, and in the process undermined its age-old commitment to neutrality and objectivity. Medical institutions denounced themselves en masse, begging forgiveness for everything from racism and colonialism to admission standards and dress codes. Articles denouncing medicine’s alleged “systemic” bigotry and calling for "antiracist" curricula sprung up all over Canadian medical media, from the comically woke Canadian Medical Association Journal (CMAJ) to the Canadian Federation of Medical Students (CFMS), which thought it necessary to remind its half dozen post pubescent followers that it would be fighting intractable prejudice with a bookclub. The end result was a politicized medical profession increasingly fixated on the health and wellbeing of competing identity groups to the exclusion of individual patients.

Unfortunately, much of this was coming like Christmas. Canadian medicine has long twiddled over what are known as the CanMEDs roles, a focus-grouped-to-death framework for the ideal physician (which are soon up for review and likely destined to become explicitly “antiracist” in nature). The most consequential role to date has been that of physician as Health Advocate, which includes bromides such as: "Physicians promote healthy communities and populations by influencing the system (or by supporting others who influence the system), both within and outside of their work environments." [emphasis mine] Duly noted. The problem of course lies in who gets to decide what we ought to advocate for and in what manner this is to be permitted. Is it possible, say, to advocate in the wrong direction? The answer, certainly for the last two years but well before, has been most especially yes. 

Medicine was also primed for postmodern implosion by its obsession with what are known as the "Social Determinants of Health" - the “lived experiences” that determine the extent of one’s healthiness - recited as though they were the Ten Commandments of a bureaucratic religion (which they are, and there are more than ten). A preceptor of mine once told me without a hint of irony that, just as physicians of the 80s and 90s had AIDS, and those currently in practice have had the scourge of diabetes, my generation’s task would be to address the oppressive social structures that are currently (but not previously?) the greatest threat to human health. Don’t get me wrong, retweeting a list of reasons why white people should be mass sterilized sounds easier than developing an antiretroviral, but is it not a special kind of hubris to declare that in addition to fixing your blood sugar or your viral load, we’re also going to fix…society?

It doesn’t take a PhD in Equity Studies to predict where this goes. Nowadays, physicians young and old (but mostly young) absolutely love to talk about "positive change", “breaking down barriers” and all the rest, but rarely seem to know much about what they're supporting, why, or what the probability might be that things actually change for the better. All they know is that all patient groups are not exactly the same (apparently a 2020 revelation for many), that’s “inequitable”, and they have a duty not only to tweet angrily about it, but also to denounce anyone who expresses an iota of skepticism about their revolutionary fervour.

The safest (and now only) way to advocate, on any topic, is to pick the most reactionary progressive position you can find and boast about your deference to it. In the bizarro world of emotional social media outbursts, if you find a well-trodden woke cliche and share it with nary an original thought, it’ll usually be sufficient to keep you in the club. When in doubt, everybody wants to stick it to whitey, so if you’re unsure, just support something that does that (it won’t be hard to find). 

As with all areas of our beleaguered society, hesitancy is heresy in medicine - “silence is violence”, questioning is “minimizing”, and thinking logically is something only a white supremacist would do. What you can especially never do, on pain of immediate professional censure, is suggest that the performative empathy in all those declarations of white privilege and systemic racism and colonial-gender-binary-genociding are perhaps paper thin, or worse, that those sharing their personal emotings, regardless of race, might have their facts backwards. Appeals to reasoned argument are themselves regarded as sinister, a denial of “lived experience", and an attempt to prop up “systems of oppression.” 

The pseudo-academics, six-figure diversity consultants, and cowardly administrators pushing all of this must know on some level that they are not fighting prejudice. By now it seems difficult to deny that they are perpetually stoking animus and grievance and bigotry. Regardless, whether by delusion or cynicism, the medical profession has imbibed the new orthodoxy such that it now openly comports itself according to a hierarchy based on group identity, with the “safety” of some tacitly (and often explicitly) deemed less worthy than others’. 

This might sound like justice to the apparatchiks in the Diversity, Inclusion and Equity department, but there are problems with doctors deciding that some groups of patients are more virtuous than others. Just off the top of my head, what happens when all those untouchables with “unacceptable views” have to go to the doctor? Will they feel safe seeking care? What about minority patients who reject the patronizing narrative about their all-encompassing oppression? What if patients are minorities within minority groups and have been persecuted by communities we doctors are now taught to view as homogeneous and pure? Why should they trust us? Will police officers feel safe talking to their physician about the stress of their job when that physician likely tweeted alongside every Twitter MD this side of the Mississippi denouncing them (without good evidence) as bigots and murderers?  Will those who were skeptical of COVID policies or the vaccine itself feel safe in the care of a medical profession that publicly called them idiots and rubes, white supremacists and even domestic terrorists? And though I resent speaking in racial terms, will any white person with an inkling of self-respect feel comfortable receiving care from the many medical professionals who routinely denounce them in the most bilious terms based on their skin colour?

If anyone in the medical profession thinks I’m exaggerating, please read the recent CMAJ article which explicitly calls for the abandonment of physician neutrality and for “antiracism” to be infused into all CanMEDS competencies. This is not a fringe position. And if you think this is in some way reasonable, some kind of course correction deserving of little more than a shrug of the shoulders, then we ought to at least have the good grace to admit that this is no longer medicine we’re practicing. Physicians need not stay mum on issues that matter to their patients. But the gross ideological double standard that now exists with respect to what can be said, about whom, and the manner in which it can be said is unbecoming of a great profession.

Despite years of progressive chiding, most medical schools in North America still see their graduates off with a traditional White Coat Ceremony. We don our new doctor duds, recite a version of the Hippocratic Oath (at least for now), and that’s that. The point is not to honour “dead white men” (we often should, just not because of their race) or celebrate our position as morally and culturally superior beings. These ceremonies are meant to affirm what by then should be baked into the cake - medicine first and foremost is about treating the patient as an individual according to his or her needs. It’s not about group identity. It’s not about politics. It’s not (dare I say) even about asking ourselves what Mao would do. 

As things stand, it might already be too late for my generation of physicians to do anything but parrot platitudes about equity and denounce as racist the freest and least bigoted societies on earth. But if there are to be even pieces for the next generation to pick up, this divisive nonsense must be resisted now.

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Thanks for reading. For more Woke Watch Canada commentary on medicine read Bad Medicine

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