Thoreau Method

Recently, I have acquired a preceptor who is classically trained, and like many doctors of “the old school,” he was very pleased to learn that I had studied Latin and Philosophy as an undergraduate. His words were something along the lines of “oh, you mean you have a real education!”

I was glad of the abbreviated chat we had after this moment, because it suddenly reminded me of how much I missed philosophy. It was always my plan B for if the med school thing fell through, but now I think that I was secretly hoping that I would end up wearing tweed forever. But somewhere in my General Surgery, Psychiatry, Obstetrics & Gynecology, and now my Internal medicine rotation, I sort of forgot about this, being overwhelmed by third year clerkship.

As well, medicine has altered over the centuries. There’s not much of natural philosophy left in clinical science; I think that the much-maligned and neglected Arts and Humanities in Health and Health sciences disciplines are a new sprout next to an old tree, and (if I may exhaust the metaphor) I’m not convinced that they will develop beyond sapling. This means that medicine has become more and more technical, and the people who apply to it are coming from more and more technical fields. And so we have a generation that the old school complains about, saying that we have lost much of the art in medicine.

I have to agree. I have noticed that, going through my training program, my creative aspect is atrophying. I don’t think about ramifications from basic premises: I worry about the dry meaning that can be read out of an arterial blood gas. I am losing the part of me that makes me interesting-and me!

So I have been incensed since Monday afternoon.

I went home after the teaching session, did the usual thing. Ate. Read. Tried not to fall asleep. Started grumbling when I couldn’t stay awake enough to read. Decided to go to bed. And then, in the midst of brushing my teeth, a little thought skipped through my mind.

Why not approach ethics from the aspect of epistemology?

I brushed my teeth for a good five minutes. After having a hard thought, I concluded that right and wrong did not objectively exist, as I could not deduce them from premises. I then decided that normative claims, then, had a pretty shaky foundation, and that was interesting. Then I spat out the remaining toothpaste and went to bed.

It was extremely refreshing. Not only did I feel pure, logical thought come rushing back, but I was evening thinking about ethics, which I honestly find pretty dull. But having my mind move in this way is something that I have missed for months, and it is refreshing and energizing to have it back.And now that I’ve been reminded of this kind of thing, I have also remembered a fairly good Thoreau quote, which I, as a person rotating through Internal Medicine, find a solace:

“To know that we know what we know, and that we do not know what we do not know, that is true knowledge.”

Anyone who has done or is doing Internal Medicine, I hope this comforts you too!

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