1.1 - Healing Medicine with Farr Curlin

[Intro music]

Hi and welcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic Society. In the podcast, we aim to reflect on deeper questions in medicine, all with the aim of rediscovering the ideals that brought us to medicine in the first place in order to better serve our patients and colleagues.

John Rhee

Thank you for joining us and we look forward to engaging with you through this podcast.

Michael Egan

Hi and welcome to the Hippocratic Society Podcast where we aim to help physicians and trainees thrive by giving them the tools to pursue and practice good medicine.

Michael Egan

My name is Michael Egan and I am joined today by Dr. John Rhee and Dr. Farr Curlin.

Michael Egan

Dr. Rhee is a board certified neurologist, neuro-oncologist, and palliative care specialist at Dana-Farber Cancer Institute and instructor of Neurology at Harvard Medical School.

Michael Egan

He is a young member of the Pontifical Academy of Life and co founded the Hippocratic Society as well as serving as its Vice Chair and Executive Director.

Michael Egan

Farr Curlin is a Josiah Trent Professor of Medical Humanities in the Trent Center for Bioethics, Humanities and History of Medicine and co Director of the Theology, Medicine and Culture Initiative at Duke University.

Michael Egan

Dr. Curlin is co author with Chris Tollefsen of the Way of Medicine, Ethics and the Healing Profession, as well as more than 150 articles and book chapters addressing the moral and spiritual dimensions of the medical practice.

Michael Egan

He co founded the Hippocratic Society with Dr. Rhee and serves as the Chairman of the Board and President.

Michael Egan

Thank you very much both for joining us on the show today. It is an honor and pleasure to have you here and I'm very excited for the discussion today.

John Rhee

Thanks, Michael.

Michael Egan

Great. So the title of our episode today is Healing Medicine, and I think it would be helpful to frame that in the context of a story. And Dr. Curlin, I understand you have a story along these lines.

Farr Curlin

Well, sort of a story, Michael. I think what comes to mind is the fact that I went through four years of medical school, three years of residency,

Farr Curlin

and not once, to my recollection was I or my colleagues invited to consider a question that seems pretty basic. Namely, what is medicine for?

Farr Curlin

What is its purpose? What is its goal? And I will say, teaching for the past decade here at Duke University,

Farr Curlin

where I offer the course on clinical medical ethics,

Farr Curlin

I find that likewise, today's students have never been asked to consider what medicine is for, what it is that they've committed themselves to and they've professed to be medical practitioners.

Michael Egan

Wow. So clearly a very big question that's not being asked.

Michael Egan

And so, using that question as a frame of reference, we'd like to talk about some seeming issues in the medical field today,

Michael Egan

as I'm sure most of our listeners have heard or from popular news media or colleagues. Burnout is a widespread problem in medicine, and a recent survey from the American Medical association showed that 48.2% of physicians reported experience experiencing at least one symptom of burnout in 2023.

Michael Egan

Other studies have shown that large numbers plan to leave the profession in the next couple of years. And the idealism that drives people to medicine starts to fade, even in medical school.

Michael Egan

And I can imagine plenty of people in the medical field have felt the effects of such an environment. And even in my own very, very limited experience of working in a hospital, I got the sense of something being wrong or burdensome in the way that medicine was being practiced.

Michael Egan

So clearly there is a problem. But how does this problem actually present itself in the hospital, in your experiences? And what does burnout and this loss of idealism look like?

Michael Egan

Basically, what are the. What are the symptoms of this disease, if we could call it in medicine?

Farr Curlin

Well, I just last week met with some students who are in their first year of medical school, and this was a Hippocratic Society kind of inaugural meeting. And we were talking about hope.

Farr Curlin

And I asked the students, what do you hope for? And what have you observed that the medical practitioners you have seen hope for?

Farr Curlin

And immediately the conversation turned to the fact that these students, pretty consistently, insofar as they had shadowed physicians prior to entering medical school,

Farr Curlin

had picked up that the physicians thought it was not a good idea to go into medical training,

Farr Curlin

that if they had it to do over again, they would not become physicians.

Farr Curlin

And the students were perplexed by that and hoping that they would avoid that fate.

Farr Curlin

But it was a very dominant signal that they received from physicians. They shadowed that, asking them questions like, are you sure you want to go into this field?

Farr Curlin

So that's one of the things that it looks like is right out of the box, people getting the message from people who are practicing medicine that they are not particularly happy in their work and they kind of wish they were doing something else.

John Rhee

Yeah, I think that's a great, great, great reflection, Farr. And the other thing that we were also reflecting on here at our local chapter of the Hippocratic Society was this idea of who is going into medicine in the first place.

John Rhee

And what I mean by that is there was a huge rise in the number of applicants to medical school after Covid. And one could reflect on what's driving that and I think one of the things main drivers is that people actually saw that there was a sense in which those who were in the front lines,

John Rhee

nurses, doctors, were risking their lives for the care of other vulnerable people. And there was something very deeply inspiring, I think about that.

John Rhee

And so whenever I give these talks about the Hippocratic Society, the return to ideals in medicine, there's a sense in which when I do one of those word clouds where I ask people why they came into medicine in the first place, the largest word consistently is always service or a desire to serve others.

John Rhee

And so I think that idealism still exists in the start of medical school or when people enter medicine. But there seems to be something that happens in medical school or medical training, right, that where people start to leave those ideals in search of other things.

John Rhee

And this was what we were talking about last week in our Hippocratic Society dinner as well, where there was a sense in which people were reflecting on are we choosing the wrong people for medical school?

John Rhee

And are we choosing people who are actually not interested in clinical medicine? Like, are they actually interested in other things, whether that be research or going into consulting or whatever that other thing might be?

John Rhee

And my personal viewpoint as well as I think the viewpoint that's shared in the Hippocratic Society is a more optimistic viewpoint. This idea of hope that you're talking about, Farr, where the sense is that it is not that people are coming into medicine with a sense of pessimism, rather there seems to be small decisions that are made along the way,

John Rhee

along the way of training, whether that's in medical school or residency, where people are encouraged perhaps to choose away from those ideals that brought them into medicine in the first place.

John Rhee

And oftentimes they're small decisions, whether they're kind of decisions made out of perhaps a sense of anxiety around loans or things that people feel like they have to pay back or and therefore have to perhaps choose a more lucrative career.

John Rhee

But I think also the pressures in medicine of what medicine is implicitly considering what it means to be a good doctor. The good doctor today is not a doctor that is an expert clinician.

John Rhee

The good doctor today is perhaps somebody who is doing a mixture of clinical, but research, maybe also doing some advocacy in the national level. I mean, all of these things that I think people have come to think as what it means to be a good doctor.

John Rhee

And the reality is that that is not necessarily in line with perhaps the original end of medicine. Right? The idea of like what we're going into medicine in the first place and within this context of a barrage of responsibilities that have come down on the doctor, there's a sense in which perhaps that's impossible to fulfill,

John Rhee

that. That there is a sense in which people are even at loss of what they're doing in this field in the first place.

John Rhee

But I think that there. The thing that I want to really emphasize, because, Farr, you're the expert in this area, you've written a book about it. So I'd love to hear more of your reflections on that part.

John Rhee

But the part that I just want to emphasize is this hope, this optimism that people are still coming into medicine for the right reasons. I think. I think they're still coming in with a desire to serve others.

John Rhee

And what we have to do as physicians in practice is to help keep that alive. And not just keep it alive, but to help grow those ideals. Because ideals, I think the beautiful thing about them is that they're infinite, that there is a sense in which there's no ceiling.

John Rhee

There's a sense in which we could always grow in those ideals and deeper in those ideals as we care for other, other vulnerable human beings.

Farr Curlin

Yeah, I certainly do not think that the problem is we're selecting the wrong students.

Farr Curlin

I mean, that may be a minor part of the problem, but the fact that these first year medical students heard from seasoned clinicians.

Farr Curlin

Are you sure you want to go into this field? Indicates that what people have called burnout or moral injury, the kind of demoralization in the profession runs across cohorts. It's a problem from seasoned clinicians to students.

Farr Curlin

And I think a really helpful way to consider that is that people go in with, as John suggested with respect to Covid, with a sense that they're entering a noble adventure that will require a lot of them, might even require them to put their lives on the line, but doing so is good.

Farr Curlin

It's the sort of thing humans are made for. We're wired for adventure, good adventure, the quest of something worthwhile. And I think that's why people have wanted to be doctors, you know, for forever.

Farr Curlin

Not just because it was a good income and, you know, brought other external benefits, but because of the intrinsic rewards of the work that we were in pursuit of something very good in real relationship with other people,

Farr Curlin

becoming the kinds of people who are trusted and trustworthy and serving them. Well, John mentioned the word service. People long to serve. It's part of how humans are wired.

Farr Curlin

That's how we come alive, is to give ourselves away. And then what happens is people get into medicine and they're just A lot of powers and forces and dynamics that conspire not because anyone's acting in bad faith, but conspire together to make it really hard to experience that you are achieving something good and working towards something good with the bulk of your time that you appear to be working.

Farr Curlin

And so we'll talk about that more. But I think that is the character of the problem. If,

Farr Curlin

if we don't know what good we're after in medicine, if we don't know what purpose we're trying to fulfill, or if the purpose that we end up pursuing is one that we don't think is particularly good,

Farr Curlin

then of course going to lose our morale,

Farr Curlin

we are going to lose interest and lose love for the work. And I think that clearly is happening across the profession.

Michael Egan

Wow. So clearly a very complex and multifaceted problem.

Michael Egan

At the same time, it seems somewhat dire that seasoned clinicians are passing on this problem to young medical students. But as John was saying,

Michael Egan

very hopeful as well, with people still entering with idealism and the spirit of service.

Michael Egan

And as you were both mentioning, it seems that the root of this is somewhat at the identity of medicine itself and the identity of the physician and who we consider them to be and what their work is.

Michael Egan

So I wanted to dive a little deeper into that. How did the situation come to this and what's truly at the root of this disease?

Farr Curlin

So,

Farr Curlin

in my opinion, we are experiencing late effects of cultural dynamics that have been at work for centuries, and particularly in the last century,

Farr Curlin

in which we have, in kind of modern liberalism,

Farr Curlin

an elevation of each individual being able to live life according to their own choices and to live on their own terms, so to speak.

Farr Curlin

And we have had a steady growing skepticism about whether there is anything good in itself that calls us to pursue it. That kind of commands our allegiance and commands our pursuit versus things which we just happen to desire and choose.

Farr Curlin

And therefore, since we desire and choose them,

Farr Curlin

they are to be treated as good.

Farr Curlin

And this dynamic has had consequences across cultures and across professions. But within the profession of medicine, it cashes out, I think, in what my colleague Chris Tollefsen and I call the provider of services model,

Farr Curlin

which is this notion that ultimately a medical practitioner's job is to provide healthcare services, so called technological interventions, that are possible, given the science of the day,

Farr Curlin

to pursue a kind of vague and subjective notion of well being, where ultimately that devolves to whatever it is that the individual patient says is good for him or her.

Farr Curlin

And there's. It's understandable that people would desire this for cultural reasons and because it is generally good that we live lives according to what we believe is worthwhile.

Farr Curlin

But this has developed to such an extent that it. The corollary is that it treats the medical practitioner as if he or she is almost an obstacle to the patient's good.

Farr Curlin

Their judgment is not really to be trusted. And then when you pair that up with a bureaucratic industrial system which is driven by its own logic that is not really well aligned with healing and solidarity and the patient work of attending to those who are sick, you end up with medical practitioners experiencing themselves as being a kind of cog in the machine,

Farr Curlin

driven by these external forces, either the third party or the patient's wishes.

Farr Curlin

And then they start to realize if that's true, it's no longer if that's true, it's no longer true that they are part of a grand adventure and pursuing something good.

Farr Curlin

But in fact, they are just a worker in a system that doesn't seem to be well ordered and their judgment is almost out of place. And I think all of that contributes to morale.

Farr Curlin

The hopeful thing is that almost the problem is also,

Farr Curlin

in a way, a hint toward sources of renewal, because this problem of overemphasizing individual choice is just a distortion of something really true, which is that to be fully human and to really flourish, and this includes clinicians, we need to be moral agents.

Farr Curlin

We need to be living and acting and practicing according to our best judgment about what is genuinely good for our patients and genuinely caring for them. And people long to do that.

Farr Curlin

I think that's why the Hippocratic Society is receiving enthusiastic uptake. Where it started is people genuinely long to serve their fellow persons, to serve their patients according to their best judgment.

Farr Curlin

And if there's a context where they can join with others who share that longing and share that commitment and seek to recover that vision and nurture those practices and develop as those healers who pursue their patients good, their genuine good, with integrity and with patience over the long term,

Farr Curlin

that the joy of medicine,

Farr Curlin

the experience of the good of medical practice,

Farr Curlin

comes back. And it doesn't just come back, you know, 20 years later. I've seen that when people start to reason together in this way, it's like eyes are popping open again, like a veil has been removed and people are taking a deep sigh and thinking, yes, this is reminding me why I went into medicine in the first place.

John Rhee

Thanks so much for sharing that, Farr. And yeah, I don't have too much to add other than this idea that we also need this moral courage to talk about these issues.

John Rhee

As physicians as well, and especially as attendings in this apprenticeship model of medicine, where a lot of the trainees are depending on us to reflect on these questions in a deeper way.

John Rhee

I think that there's an ambiguity these days where we equate morality with certain words that don't really have clear definitions. And I guess, especially in medical school, I think about the word professionalism, where sometimes it's used as a way to perhaps set limits on what people think should or should not be done without using,

John Rhee

really the word morality.

John Rhee

And at its core, morality comes down to the question of. Yeah, a bigger question of perhaps anthropology, like, what it means to be human. And in our current society and culture at large, as Farr was talking about, there is a sense in which the superior, or the best way to approach these types of questions in a pluralistic society is by saying that you have your own truth,

John Rhee

I have my own truth, we all have our own truths. And therefore, as long as you follow your individual truth, that's okay. The problem with this approach is that actually at its center, it doesn't allow for dialogue.

John Rhee

Because if you just believe everybody has their own individual truth, then in a certain sense, what is the point of the dialogue? Right. If I'm not trying to convince you, you're not trying to convince me.

John Rhee

And so then we lose a sense of dialogue. And when we lose a sense of dialogue, we reach a point where we actually can't even discuss whether there is truly a truth of what it means to be a good physician.

John Rhee

Like, is there something that we all agree on of what a good physician means? And I think that those types of things are also what we're trying to reflect on here together as a community of physicians, that perhaps there is a good physician, that we all agree on, that there is perhaps a moral truth there of what it means to be good.

John Rhee

And perhaps at the core of that is something that is very deeply human, which is just our ability to. And willingness to. Or the acceptance to be vulnerable and depend on one another.

John Rhee

I had a beautiful experience this past week in clinic. It was like a crazy clinic day full of patients.

John Rhee

And I was just super touched because, like, at one of the visits, this guy, like, brought in his wife because he really just wanted me to meet him, meet, Meet her.

John Rhee

Sorry. Because of the fact that I just called him out of the blue two weeks ago, just being like, how have you been? I was thinking about you wanted to check in.

John Rhee

And he found that really, really moving. And then later that afternoon, I came back to my desk to see A bouquet of flowers from a patient's family, just out of kind of gratefulness.

John Rhee

And then after a long clinic day, I knew that there's one of my patients on the inpatient setting is kind of nearing the end of life. And I kind of ran over there just to provide some comfort to his wife.

John Rhee

She's trying to navigate this. And none of these things were demanded on me. In fact, none of them. All of them are, in a certain sense, kind of outside of what's typically, perhaps professionally expected of me.

John Rhee

But there is a sense in which when I enter into this relationship with the other, and they also allow for the vulnerability there. I also, as a physician, allow for the vulnerable, the vulnerability of, like, being open to entering into this relationship that is also deeply human, that there is something so much deeper there that is so meaningful and worthwhile.

John Rhee

And whether, you know, you as a listener are reflecting on kind of, oh, are there actually universal truths and goods? I think that these types of things are universal. I think that there's a sense in which when you hear those stories, you realize, like, yeah, that that is, like,

John Rhee

what it means to be a good physician in the sense that that's like, what I want. Like, I want those relationships with my patients because the relationships at its core are so deeply human.

John Rhee

And then that makes us reflect on, perhaps there are universal goods in which we all are in agreements, that these are goods, these are things that really unite us to one, one to another.

John Rhee

And the pursuit of this deeper sense of, like, what makes this life meaningful and what are we trying to pursue in this life that makes it meaningful.

Farr Curlin

Yeah, I would say, John, the.

Farr Curlin

The.

Farr Curlin

The cultural dynamics that lead young people to talk about pursuing my truth are, as you say, dynamics that prevent dialogue. Another way to put that is they really atomize us.

Farr Curlin

They separate us from one another, they alienate us from one another.

Farr Curlin

Because I, of course, have no access to your quote, unquote truth, and you have no access to mine.

Farr Curlin

The Hippocratic Society proceeds differently, with an ancient confidence that the world is real and that it is knowable. It's hard to know it well. And Hippocratic Society does not have prescriptions in answer to the questions of what is true.

Farr Curlin

But we are determined to discern what is true and together to seek it out. We believe that there are better and worse ways of practicing medicine. There are ways that, to greater and lesser extents, really correspond to the reality of what we would be doing if we're practicing medicine.

Farr Curlin

Well, we think there are people who are better exemplars of medicine than others. And we don't presume to say we are those people that we're determined insofar as we're able to become those people.

Farr Curlin

And Hippocratic Society effectively brings together practitioners who already share that longing. They want to do the good. They want to become the sorts of people who are characterized by doing what is good, by practicing medicine well.

Farr Curlin

And they don't come with the pretension of having all the answers, but they come with a longing to discern those answers insofar as they can be discerned and to live and practice according to them.

Farr Curlin

And so I think that is, that's a really essential part of Hippocratic societies purpose and mission and practice. I think it's why people find it so refreshing is because humans in their heart of hearts know it cannot be true that medicine is whatever we make it up to be.

Farr Curlin

It cannot be that our patient's good is just whatever the patient says it is or what we say it is. There has to be a reality that we're called to account by.

Farr Curlin

And to live well is to. Is to live in accordance with that. And so we're determined to do our best in that respect.

Michael Egan

Thank you both so much for that. That was very eye opening. And I really resonated Dr. Curlin with your point about losing that sense of adventure. It reminded me of a pre med I met, an undergraduate who was determined to pursue a very, very specific path, something like pediatric surgery,

Michael Egan

something very particular, where he clearly had a desire to go into this specific field to help these specific patients.

Michael Egan

And someone like that with such a drive, I can imagine any sort of loss of the sense of adventure for him would really destroy his motivation for the practice of medicine.

Michael Egan

And it's been like that, I can say with almost all the pre meds that I've spoken to and interacted with. And anyone who's really that I admire going into medicine truly does go in for the sense of the spirit of service, as John was saying before, and to become this good physician.

Michael Egan

And so even from outside of the medical field, I can absolutely see how devastating that loss of identity and adventure would be for the medical profession.

Farr Curlin

If I may, I'm going to just add one other story that I think conveys this importance of the moral adventure of medicine.

Farr Curlin

I was not yet in medical school when I was in Guatemala and was asked to serve as an interpreter for a plastic surgery clinic in the highlands of Guatemala. This clinic had already been booked up months in advance with a full slate of cases and a team from the University of Minnesota worked night and day all week doing surgeries to repair burn adhesions and cleft lip and palate.

Farr Curlin

And a man from 30 or 40 miles away somehow heard about the clinic and came to the clinic with severe cleft lip and palate and asked to be added on.

Farr Curlin

And they had to tell him, we cannot add you on. The schedule is so full already, and it wouldn't be fair to our other patients. You have to wait until our next clinic, which might be a year from now.

Farr Curlin

That man slept on the stairs to the clinic and stayed there 24 hours a day for five days.

Farr Curlin

And finally, on the last day, as they're breaking down the ORs, the chief surgeon says, guys,

Farr Curlin

if I. I think I'm just gonna do this,

Farr Curlin

would you guys join me? And everybody said, absolutely. They go and tell this man who's quivering with excitement.

Farr Curlin

They end up doing both lip and palate at the same time at his. In response to his plea, which they didn't generally do. And the entire team of surgeons are in the OR together.

Farr Curlin

And they operated for two or three hours on this man and did a beautiful reconstruction of this defect. Defect.

Farr Curlin

And. And I was hooked. But when I saw that, I thought, what profoundly good work.

Farr Curlin

And to. To be able to serve people who have such great need.

Farr Curlin

And most medicine may be not that dramatic, but the goodness of the work is palpable so long as we're not just reduced to people inside the bureaucracy pursuing the goals from outside or just providing things because we're told to.

Farr Curlin

If we're genuinely pursuing healing, we can get back in touch with the joy of that kind of work. That even though these cost these. All these surgeons hours of extra time, made them also elevated and happy because they knew they'd done a very good thing.

Michael Egan

Wow. That's beautiful. Thank you very much for sharing that, Dr. Curlin. And so going on from there, how do we get back to that sense of adventure? How do we return the beauty of the practice of medicine to medicine?

Farr Curlin

I think the first thing is acknowledging the problem, acknowledging this dis. Ease, this enemy, this burnout, you might even call it, as my friend and colleague Brewer Eberly does, a kind of heartache within medicine and beginning to ask why is that there?

Farr Curlin

Which I think leads pretty quickly to questions about what medicine is for,

Farr Curlin

to back to questions about what is the purpose? What is the good that we're after?

Farr Curlin

Because if we've lost track of the good, no wonder we're losing morale.

Farr Curlin

And so I think it begins with recovering a Vision for the good. That is the good that makes medicine the practice it is. And in my view, and it's not, I don't think it's a very controversial view or it shouldn't be.

Farr Curlin

That good is the patient's health.

Farr Curlin

That's what it's been recognized to be by Plato and Aristotle and countless physicians and philosophers and observers of human life throughout the centuries, that the thing that makes medicine what it is is that it's a practice of pursuing healing for people who are injured or who are ill, who are sick.

Farr Curlin

That it is very good to attend to the sick and do what you can to make possible their healing is something I think people know in their bones long before they enter medicine.

Farr Curlin

But to enter medicine is to kick that recognition and commitment up a notch and really devote yourself to becoming skilled at,

Farr Curlin

reliable at,

Farr Curlin

consistent at, and trustworthy at attending to those who are sick or injured in pursuit of their health.

Farr Curlin

The dynamics we've talked about already leave doctors kind of bewildered. Where it seems like the goal of medicine is efficiency, it's RVUs, it's satisfying patients whatever their wishes are. It's providing healthcare services in pursuit of what the patient says is their wellbeing.

Farr Curlin

Whether or not that has to do with health. It's all these things that are not health. And so in my view, part of, part of the adventure and part of the work of recovery is recommitting to medicine's healing purposes.

John Rhee

The other thing that I just wanted to add there is the work that we're trying to do here in the Hippocratic Society as we're talking about this in this intro podcast,

John Rhee

is that a few days ago I was talking about the Hippocratic Society with a very senior surgeon at Mass General,

John Rhee

and he told me as he was hearing what we were doing, that despite having being in oncological surgery for like, many, many years, being one of the top surgeons there, he was like, I need this.

John Rhee

Like I need this so that I could grow and be a better doctor. And I think that that was really beautiful on his part, both in terms of his humility, but also the sense in which we come back to this idea of this dependency, because it is that we find strength from one another and that we can't do this on our own,

John Rhee

that there is a sense when we're taking on also this responsibility, this moral responsibility of caring for other human beings, that doing so in community is important because we can strengthen one another and recognize that we alone cannot do it.

John Rhee

And the Hippocratic Society does that by Forming communities, local communities to support one another in their endeavor to be good physicians.

John Rhee

We also focus on the practical aspects of growth. Right. And so the story that you shared far, I thought that it was really beautiful because there are many, many themes and topics that we talk about in the Hippocratic Society, One being this mindful approach, this idea that the surgeon who was like,

John Rhee

hey, I am really tired, it's been a really tough couple days, but this person is in need and let's do this. Like, this is so important. There's a sense in which he had a meta view of.

John Rhee

Of what he was doing, the purpose for which he was doing it, and therefore was able to still kind of from within himself, find that deeper sense of purpose, of why, and therefore do it.

John Rhee

Right. The good in that case is also so clear that he had a clear view of, like, what is the good for this patient? The spirit of service or the ideals is also so present there.

John Rhee

But I think the things that we also talk about in the Hippocratic Society are the practical ways to grow in becoming a good physician. Also specifically in the virtues. Right?

John Rhee

And so in that story, I hear a lot of the virtue of generosity, the sense in which he places this patient in front of himself, the virtue of charity or love, and also the virtue of fortitude.

John Rhee

And a lot of the discussions that we have are what are these virtues that are especially important for a physician, you know, for a clinician to develop? And how can I develop those things in a very practical way too, in the hospital setting, but also in my own personal life,

John Rhee

knowing that living virtue is not something that's just isolated to my time in the hospital, but rather how I live virtue in my individual life, in the small things, how I treat my spouse, how I treat my children, how I treat those who are most in need in my own personal life and community.

John Rhee

Those are all things that impact the way that we also treat our patients. And that there's a continuity there within my personal and work life that's so important.

John Rhee

And so within community, we try to build these things together. Talking about these things, sharing experiences, and also especially from attendings who are able to reflect on places that they were able to live this well, but also places where they may have failed at times.

John Rhee

And in that openness of dialogue, again, that vulnerability, be able to be role models for the trainees who are coming in. But as this senior surgeon said, that there's also so much for the attendings to learn too, because there's a sense in which medical students who are coming in with these big ideals have in some sense a greater focus on why they're there and haven't yet lost that.

John Rhee

And so how to preserve that and how to grow that in attendings, I think is also a beautiful thing that I've personally witnessed in doing these Hippocratic Society dinner chapters.

Farr Curlin

Yeah. Medicine is a craft.

Farr Curlin

We train people to be medical professionals through apprenticeship. And for that reason, the Hippocratic Society with our medical chapters invites people from the beginning of medical school to, you know, people in the last third of their career as practicing clinicians or attendings to come together because there's in a real way the practice itself calls us all to account.

Farr Curlin

And we want that. I mean it's, it's good work that we know we never fully exhaust. We never get to the point where we don't have more to learn. We never get to the point where we don't have more to grow into as, as medical practitioners.

Farr Curlin

And I think I really appreciate, John, about the way that the Hippocratic Society doesn't just talk about what's wrong and doesn't just talk about ethical controversies, although we don't shy away from those.

Farr Curlin

And we, we do spend time considering how do we distinguish good medicine from that which is not so good.

Farr Curlin

But we also focus on becoming the sorts of people that we would admire if we saw them, the sorts of people we already long to be but recognize we were never quite fully that.

Farr Curlin

We always know we have more to grow into and in our own virtues and our own characteristics.

Farr Curlin

And that, that, that, because that never ends, it means that the senior physician can learn from a junior physician sometimes, or even a student and vice versa because we're all really part of the same human quest and the same professional quest.

John Rhee

Yeah, I think that's beautiful. And I think perhaps as we're ending and wrapping up this podcast, Farr, we've talked a little bit about the different aspects of what the Hippocratic Society does.

John Rhee

But maybe you could share with our listeners.

Farr Curlin

Yeah.

John Rhee

What is like the vision and mission of the Hippocratic Society and what are we trying to do with it?

Farr Curlin

So our vision, as was said earlier, is forming clinicians in the practice and pursuit of good medicine.

Farr Curlin

I think it's important to know that the Hippocratic Society is an association of clinicians for the good practice of medicine. This is not a top down venture of medical systems, medical powers, licensing bodies, the government, even medical educators altogether.

Farr Curlin

It's a, it's an association of clinicians who are already committed to becoming good physicians or good Clinicians who gather together toward that end.

Farr Curlin

And we meet together in two primary ways. The first is we have what we call Hippocratic Fora, that's our base practice. So in chapters at different academic medical centers, people meet together from the level of medical student again to attending,

Farr Curlin

usually on a monthly basis over food, and they take up a case that we have developed into a one or two pager to consider a virtue that we think is central to the good practice of medicine,

Farr Curlin

how that virtue is expressed in that case, how it could be developed further, what hinders it,

Farr Curlin

and then think together about practical steps that they can take in their context to grow in that virtue.

Farr Curlin

Or we take up a case that raises one or more central questions, perhaps ethical questions that clinicians today raise. And we consider together how we distinguish again good medicine from distortions of medicine which are always going to be present.

Farr Curlin

And you know, part of being a good medical practitioner is distinguishing those. So we seek to grow in our clinical discernment, which is what the ancients called phronesis, or practical wisdom in the clinical context.

Farr Curlin

So that's in the Hippocratic Fora, which is our base kind of practice for our chapters. We're also going to be developing soon, actually launching this year Hippocratic Symposia,

Farr Curlin

where chapters,

Farr Curlin

once or twice a year will invite in a guest speaker to address some issues, some question that we think is really important for medical practitioners today and engage in the kind of dialogue that we also engage in in the Hippocratic Fora, but on a larger scale and inviting the public and professional folks in their context to join into that conversation.

Farr Curlin

And so with these two together, we hope that we'll just be slowly but steadily growing as a community of happy warriors, so to speak, or happy practitioners,

Farr Curlin

staying in touch with the goodness of our work and encouraging each other and growing to become the people we already long to be. And we hope that our colleagues and our patients will notice the difference.

John Rhee

Yeah, thanks so much, Farr. And I think that the aspect of the Hippocratic Society that I found very moving is this grassroots energy, the sense in which people who are in medicine feel that this is really important and that for the future of medicine, we have to form the next generation of clinicians,

John Rhee

clinicians in training to think about these things. And that perhaps it is in some ways even better that it's coming from this ground up rather than a top down approach.

John Rhee

And so, yeah, we talked about a lot of things today and this was our just to just to also state our intro podcast to reflect a little bit more deeply about.

John Rhee

Yeah. What is medicine itself and how Hippocratic Society can be a way to address the some of the challenges that we're witnessing in the culture of medicine.

John Rhee

So this will be a series of podcasts where we'll reflect on some of these bigger questions in medicine and then have a part two to each podcast where we then speak about practical way to grow in one of those larger questions in medicine itself.

Michael Egan

Great. Thank you guys so much for all this about the medical field in general and then as well, introducing the Hippocratic Society.

Michael Egan

I'm very excited to get this podcast on the road to help reach people who may not have a chapter at their university or academic medical center.

Michael Egan

And as always, please reach out to the Hippocratic Society. You can find our website at hipsoc.org that's H I P S O C.org and there you can find more about us, our contact information, where we have chapters, and please feel free to reach out if you have any questions or are interested in starting a chapter at your institution.

Michael Egan

So once again, thank you so much, Dr. Curlin and Dr. Rhee, and we will see you all next time.

John Rhee

Thanks, Michael. Thank you.

John Rhee

Thank you very much for joining and reflecting with us today. Keep up with new episodes by subscribing to the Hippocratic Society podcast. For more information on the Hippocratic Society, visit us at hipsoc.org. The Hippocratic Society is a 501(c)(3) and depends on the generous support of its listeners.

John Rhee

And as always, we'll see you next time on the Hippocratic Society Podcast.

1.1 - Healing Medicine with Farr Curlin

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