Filosofisk poliklinikk – diagnosing medicine

Education with no human depth

As a 26-year-old intern in Namsos and Kautokeino, I felt uneasy in the doctor's role. The concept of moral stress did not exist at the time, but in retrospect, I have understood that my growing cynicism towards patients and their families, and thoughts of finding a different path, stemmed from a sense of meaningless and powerlessness in relation to my profession. I remember the feeling of indifference that came over me as I flicked through the procedure manual to find the treatment algorithm for a young patient with an acute, severe illness. 'Why am I doing this, anyone can look up a user manual.' The patient died, no doctor spoke to the family and no colleague spoke to me about what had happened.

My medical studies had provided me with education without self-formation. Proficiency meant memorising differential diagnoses and assessment procedures so that the patient's problem could be labelled, and treated according to a formula

My medical studies had provided me with education without self-formation. Proficiency meant memorising differential diagnoses and assessment procedures so that the patient's problem could be labelled, and treated according to a formula. When that did not work, and the symptoms did not disappear and patients could not be reassured, I felt helpless and frustrated. I frowned on patients who came to my doctor's office with 'the wrong expectations'. Slowly I began to understand that it was my own competence as a doctor, approved by medical school, which did not correspond to reality. In frustration, I wrote the article entitled Medisin og hjernevask. Hvordan legers virkelighetsoppfatning formes slik at den blir til skade for dem selv og folks helse [Medicine and brainwashing. How doctors' perception of reality is shaped in ways that harm both themselves and people's health] (3). A deluge of positive reactions from colleagues showed that I was not alone.

I gathered a handful of young colleagues for evening chats in order to air our experiences from clinical work. A felt security in the group allowed us to share uncomfortable acknowledgements of inadequacy in the profession. We saw that problems and frustrations that we had interpreted as personal weaknesses – 'There's something wrong with me' – were caused by blind spots in our medical education. We had learned nothing about communication, ethics, psychology, or the theory of science. We did not know that a patient's illness is interwoven with their life history. We did not understand that evidence-based knowledge is founded on statistics, and, as such, carries inherent uncertainty for individuals. We had not reflected on the power of medicine, natural science, and the pharmaceutical industry in our secular society. We had not learned to think of the mind and body as interconnected. And above all, we had not been told that 'doctor' is a cultural symbol of security and hope, and can therefore have an immediate impact on patients' well-being and physiology – if the doctor understands their own role as a healer and sees the whole person, not just the diagnosis (4, 5). The title of doctor covered up the fact that we were moulded into technicians and bureaucrats, not healers.

In 1998, we adopted the name Filosofisk poliklinikk, booked the big central auditorium at Haukeland University Hospital and arranged a debate with the title Fundamentalisme i hvitt. Om makt og autoritetsunderkastelse i medisin og helsefag [Fundamentalism in white coats: Power and submission to authority in medicine and healthcare] (6). Around a hundred medical students, a handful of doctors, and dozens of curious members of the public, many with experience as patients, showed up. That was the start of a series of meetings and an institution, the think tank, that has existed for 25 years. It has been easy to find inspiring topics for a series of meetings held over many years, which incidentally can be found on YouTube (2). It has also resulted in several international seminars such as 'Dignity and Dialogue. Exploring Medicine's Relational Foundations' and 'The core of medicine: Identifying goals and methods for professional identity development in medical education'.

A main premise for the work has been our belief that medicine as a subject, despite all its success, embraces assumptions and traditions that create problems for patients, health personnel and society, and is in need of reflection and renewal. Let me give a key example: