On the “Real” State of Medical History

Last week, I wrote an optimistic Thanksgiving reflection on the status of the history of (navy) medicine. Then, I received the latest newsletter from the American Association for the History of Medicine (AAHM). In the newsletter’s introductory presidential message , Professor Nancy Tomes paints a considerably more grim picture:

Why care about the history of medicine?
Readers of the AAHM newsletter have likely been asked some version of that question, couched in different degrees of disdain, many many times. We hear it from our students, our colleagues, and our Deans. In an era when universities, including academic medical centers, are struggling to reposition themselves in a difficult economic climate, history can easily seem irrelevant. We produce no patentable commodities. Our research attracts comparatively little private or public funding. Perhaps most damningly, we study a field associated with rapid and transformative change, where any minute some new development—it may be genomic medicine, or electronic medical records, or high tech prosthetic devices—will supposedly Change Everything. In a field such as health care where change occurs at a mind boggling rate, why should anyone care what happened a week ago, much less 500 years ago? [emphasis mine]

Professor Tomes’s “dependable if not particularly original set of answers” echoes my own: she invokes Santayana’s oft-quoted saw, “Those who cannot remember the past are condemned to repeat it”. Professor Tomes suggests that Santanyana quite easily passes muster among her colleagues in the “Arts and Sciences” faculty. It’s in the health sciences faculty that the history of medicine runs into trouble as it competes with “bioethics and  literature”. In the hospital and the clinic, Santayana’s formula falls on increasingly deaf ears.

But it’s in the clinic, I think, that Santayana, by invoking the notion of historical “retentiveness”, offers us at least a partial answer to our profession’s apparent historical deafness.  Our history constitutes a “base” upon which we build a more enlightened future. The research / scientific arm of medicine “gets” this – even if “history” is not explicitly credited – because any researcher worth his or her salt readily acknowledges that most scientific progress is based on work that has been done before. “We stand on the shoulders of our predecessors.”

So, how do we convince the everyday physician – the busy medical student, resident or practitioner – of the value of the hallowed history of the profession?

I tend to associate the halcyon days of medical history – when it was held in high regard within the medical profession – with a generation of medical doctors who were respected as doctors, and especially as historians, or promoters of the value of medical history. The famed and revered Owsei Temken and Henry Sigerist were among the former; the beloved William Osler, of the latter. While subsequent generations of professional historians indubitably have served “history” well, I believe that the disconnect between medical professionals and their history comes at least in part from the replacement of MDs by PhDs in the medical history “establishment”.

My “formula” is this: “doctors talking to doctors”. I submit that people of a “culture” (and “medicine” is most definitely a “culture”) will more readily listen to, and value, the words of others from the same “culture”.

It may well and regrettably be true that medical school teaching budgets – both of money and of time – are too tight to accommodate formal courses in medical history. Yet, a respected clinician who spices his or her bedside or didactic teaching with historical vignettes will plant the seed of appreciation in students whose minds are open to such information. I also think it’s incumbent upon physicians and their historical associates to bring history to medical school in small and inexpensive (free is best!) doses. For instance, I have found it relatively easy to convince the provost of a local medical school to grant me time for an occasional lunch hour history presentation. (Most recently, it was a “Research Thursday” lecture: I highlighted my historical research…) These talks are pretty well attended, and we don’t even offer pizza and Cokes. Inevitably, a few students will stay after – their curiosity about medical history piqued.

I also submit that we can encourage an interest in our professional history in a new generation by encouraging work by current students. To this end, the Society for the History of Navy Medicine (this blog’s original “sponsor”) offers travel grants to students whose papers are accepted for presentation at our annual papers panels, and we offer a research grant for work leading to publication in the area of naval or maritime medical history. Finally, we should bring history to the conferences that practitioners – the “history creators” – attend. Last year, the Society mounted two panels on naval medical history at the Naval Academy’s biannual History Symposium. And the year before, we mounted our panels at the annual meeting of the Association of Military Surgeons of the United States. Both of these sessions were very well attended.

There is interest among medical professionals in their history. The key to getting them to listen, I submit, is to bring their history conveniently to them rather than hoping they will take time from their incredibly busy schedules to come to the historical fountainhead.

©2012 Thomas L Snyder, MD

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