6.1 - Medical Wisdom with Kristin Collier

What is the place of wisdom in medicine? What are the consequences of a medicine without wisdom? How to we appreciate the importance of medical wisdom both on an individual and institutional level? Join us as we discuss with Dr. Kristin Collier the place of medical wisdom in healthcare today and why we need the humanities to bring flourishing to medicine.

48 minutes • Published Mar 10, 2025 • Download • Transcript

Recommended readings

Practical wisdom in medicine through the eyes of medical students and physicians, Lauris C Kaldjian, John Yoon, Tavinder K Ark, Laura Shinkunas, Fabrice Jotterand
What is medicine for?, Kristin Collier
The Rock, T.S. Eliot
The Sabbath: Its Meaning for Modern Man, Abraham Heschel
Why Conscience Matters: A Defense of Conscientious Objection in Healthcare, Xavier Symons

Transcript

[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.

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

Hi and welcome to the Hippocratic Society Podcast. My name is Michael Egan and I'm joined today by Dr. John Rhee and Dr. Kristin Collier.

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

He co founded the Hippocratic Society and serves as its executive director.

Dr. Kristin Collier is an Associate professor of Internal Medicine at the University of Michigan where she serves as the director of the Program on Health, Spirituality and Religion.

She's been widely published in both medical and humanities journals, and most importantly, she is a wife and mother of four boys.

Thank you both very much for joining us today on the show. It is an honor to have you here.

Thanks, Michael.

Kristin Collier

Thanks, Michael. Great.

So given Dr. Collier's expertise in the intersection between health and the humanities, we wanted to discuss today a topic that's vital to practicing medicine well, but probably not talked about enough,

and that is medical wisdom and its relation to the humanities.

And so to help digest this huge topic, I thought we could frame it in three parts.

First, what is medical wisdom?

Second, why do we care? And then finally, how do we live this today?

So why don't we just start right at the beginning? What is medical wisdom and how does it differ from simply clinical experience or expertise?

Kristin Collier

Thanks for that question, Michael.

Kristin Collier

Clinical reasoning, I think, is what we primarily learn how to do in medical education.

Kristin Collier

I call it the what's going on here skill.

Kristin Collier

I think we start to learn it early on in medical education during our clinical reasoning courses. And we have courses at our medical school here called the Doctoring course, which is a clinical reasoning course and our chief concern course.

Kristin Collier

And this involves learning illness scripts,

Kristin Collier

cultivating differential diagnoses for common chief concerns, and understanding how things present both common presentations of common and uncommon conditions and also uncommon presentations of common conditions. And I think this is never done.

Kristin Collier

We, of course, are always honing clinical reasoning skills. We continue to do it in graduate medical, patient and as an attending.

Kristin Collier

But I think again, it deals primarily with the clinical complexities of diseases and conditions where we use our medical knowledge and our Expertise to arrive at like a solution.

Kristin Collier

And I think, you know, we always tell our students it's where you take what the patient tells you subjectively from the history,

Kristin Collier

combine that with what you see objectively on your exam, and then figure out what's going on. And this process obviously is very structured, analytical,

Kristin Collier

requires logic and evidence in sort of a step by step manner. I think wisdom is different. Right. So wisdom, I would say, you know, is often defined as the ability to make sound decisions where,

Kristin Collier

you know, you need the intellectual understanding of disease, but you also need other things.

Kristin Collier

Emotional, ethical maturity, I would say a capacity for self reflection.

Kristin Collier

And what's great about wisdom is also a lifetime of cultivation and it encompasses many different qualities, I would say, like humility and empathy and patience and the ability to navigate ambiguity.

Kristin Collier

I often, when I'm talking with, you know, learners about this, I think wisdom to me also is like this ability to read between the lines,

Kristin Collier

so to speak, and relies on intuition.

Kristin Collier

And oftentimes, I think in medical education at first, especially sometimes in the pre clinical space or the scientific trunk, there are very clear answers to questions. But as we get into real clinical medicine,

Kristin Collier

clinical reasoning alone often doesn't suffice because there are many different pathways that are probably pretty reasonable to pursue. And there's a lot of ethically complex or nuanced or gray areas that we need wisdom to be able to discern what's due.

Kristin Collier

I think lastly around wisdom, you know, maybe this is a little controversial, but I think wisdom should be also teleologically oriented.

Kristin Collier

Hopefully in medicine there's a goal that's in the purview of the physician. And I would say the goal is the good of the patient. And so cultivating wisdom, I think also requires that we have aligned ourselves with the moral structure of reality and then take the clinical reasoning and then apply it to the particularities of the patient who's in front of us,

Kristin Collier

who is an ill person, not just a sick body embedded in a social context and with again many possible paths in front of us. And lastly, when I think also too, when I speak with maybe more humanities sort of oriented folks,

Kristin Collier

I think of Aquinas, who has a great definition of wisdom thinking, sort of paring it down that you know, wisdom is the science of right choice. Right. It's like phronesis practical on the ground wisdom.

Kristin Collier

So that's how I differentiate those two terms.

Yeah, thanks so much, Kristin. And I think one of the really interesting things about what you mentioned there is, well one that it aligns so much with what we've been talking about, which is we talk often about the idea of practical wisdom or prudence being such a key virtue in the formation that we're providing here at the Hippocratic Society.

And in addition to the teleology of what the good is for the patient,

I just thought of one anecdote that I had recently, a personal experience where as a relatively new attending,

I was a few weeks ago going on a week long silent retreat just to kind of disconnect,

kind of go deeper and things that are important and also be able to reflect on the past couple months having started as an attending. And I had a patient that was hospitalized during that week who was progressing.

Her, her cancer was progressing. And so there were also like many, many emails, maybe like a hundred emails a day about this patient.

And one thing that I was reflecting on in this kind of retreat was this fact that there's a sense in which I was also unsure about how to best find this balance between caring for my patient, but also knowing how to balance how I personally didn't want her to be progressing,

or that I personally also was very emotionally involved because of all the things that we talk about in the Hippocratic Society.

Yet that was also affecting this aspect of where I needed to find this silence in order to also be like the best doctor that I could be for her.

And that it required this growth and experience by the end of that week, actually where I was reflecting on how I approached that week well and what I didn't do well, and that it's a process of also learning what it means to be a good physician so that I could be there for my patients also more constantly in a reflective way.

And the medical wisdom, I feel like both applies, it seems like, to the good of the patient and also the good of what the physician should be doing in terms of being able to therefore think about or reflect well on the good of the patient.

Kristin Collier

That's lovely. Thank you for sharing that. I think your points speak to.

Kristin Collier

I know what we'll get to later is how do we cultivate wisdom? And I like that you sort of focused on this importance of self reflection and taking time to reflect.

Kristin Collier

Oftentimes we're so busy doing in medicine that we don't make the time for that. But without that we are not going to be able to cultivate wisdom. And I appreciate you sharing that, John.

Kristin Collier

Thanks.

Yeah, thank you both for that. And that was a beautiful story, John.

And I think a common theme across both of your answers was this ability to make right decisions and like you were saying, John, it is a balance of how to be a good doctor while reflecting on your current attending status and the past couple months, and also how to currently treat your patient who needs you at this very moment.

And so with these types of decisions that doctors face all the time,

what is the current attitude or approach towards medical wisdom in healthcare or in general?

What sort of level is the general population in healthcare practicing this medical wisdom that you guys have experienced?

Kristin Collier

That's a good question. You know, I. I've recently just only become interested in this, this concept of wisdom. And I think for a long time I would have conflated that's two things.

Kristin Collier

Like wisdom is the same thing as clinical reason. I didn't understand the richness of wisdom.

Kristin Collier

And so just I wondered if I was alone in this. And so the past few years I've been asking various people at various institutions and various levels of medical training if they think wisdom is an important attribute for physicians to have.

Kristin Collier

And really, everyone uniformly agrees. And then I'll ask them,

Kristin Collier

well, how do you define wisdom? Or how is it cultivated in med ed? Or how did you learn to be wise?

Kristin Collier

And then silence falls across the room.

Kristin Collier

So I think when I see something like that as a medical educator, I think, wow, this is like an opportunity. This is an opportunity.

Kristin Collier

And thankfully, I think there is renewed interest in medical wisdom. And I think a lot of folks sense this opportunity. And I've seen more of our colleagues across the country working on med ed initiatives like this.

Kristin Collier

I just saw a piece published 2023 by people like Fabrice Jotterand in Wisconsin and John Yun in Chicago. And I know Lars Keljan, I think, was on that piece also in Iowa.

Kristin Collier

So I think the attitude is positive, although I think people sometimes are quizzically like,

Kristin Collier

this sounds good, but tell me again what that means or how we can sort of be more intentional about cultivating wisdom. So I think hopefully there are opportunities ahead of us to sort of dive deeper into what it means and how we can sort of sew the garden a bit.

Yeah, I think the other thing that is interesting is this idea where perhaps in our culture we have maybe more in recent years,

kind of lost the importance of gained experience over time.

I guess what I mean by that is,

especially with AI and these large language models,

it seems like all knowledge perhaps is at the tip of our fingertips. And so it's kind of like we don't need the experience of older people.

I could answer all these questions myself,

and in a certain sense, because of that, there's been a devaluation perhaps of the elderly who carry this vast amount of an accumulation of experiences which I think is necessary to the development of wisdom because wisdom at its core also indicates this growth in the virtues which one needs through experience.

And I think the importance of also recognizing the value of those who are older, more experienced and rediscovering the richness of how they contribute something unique that is not just knowledge from text or knowledge of even clinical reasoning of standard of care or evidence based medicine, but that there is much more to experience and wisdom that's so important to gather from those who have that weight of many years of caring for patients.

Kristin Collier

Yeah, I totally agree with you. And I think it's this, you know, this, this idea that I do believe wisdom is distinctly human,

Kristin Collier

you know, contrasted to machines as an embodied virtue. I do not believe machines can be wise, which again, that is something I've disputed and argued with some folks around here and agree that this is something that is hard earned and is a virtue and develops over time and is embodied and is not the same as knowledge or information.

Kristin Collier

Which I think is important that you pointed out that, you know, as we think about the emerging enthusiasm for large language models and AI and medicine, I do not believe that machines have wisdom.

Well, it sounds like it's the perfect time for, as you were saying, Kristin, people to actually start caring about this topic and you know, more pieces to be written on this and it becoming a broader interest in the whole medical or the healthcare sector,

especially as AI is coming up, as we're having, maybe even continue to have a shortage of doctors, as some people have said.

I think of myself hopefully going into medicine in the future.

I don't know how AI will change the healthcare field, how it'll change my healthcare education,

but I can only imagine that it'll become more and more invaluable to have these sort of experiences and mentorship that is so vital to medical education.

And so given that, and given that it is becoming more a topic of concern across different sectors of healthcare,

why do we care about medical wisdom? Why is it so important?

And what are the consequences of a neglect of medical wisdom that may or may not have been happening in the past?

Kristin Collier

Yeah, the consequences of a neglect,

Kristin Collier

that's important. If we're going to say something is important, we should agree that if we don't have it, something bad will happen.

Kristin Collier

So I think maybe here, here I think maybe it's important to think about Aristotle and how just John, that you mentioned virtues and maybe thinking about the main intellectual virtues that he talked about and thinking about the techne and the episteme and the phronesis and phronesis for our discussion today.

Kristin Collier

Replying to practical wisdom.

Kristin Collier

So I think within medicine,

Kristin Collier

episteme, for listeners that maybe aren't familiar, are just the bare scientific knowledge and knowing what something is, the facts, right? And techne is concerned about how to do something which we're very versed in in our procedural subspecialties in medicine.

Kristin Collier

And there's so much technology in that space. And then as we've discussed this phronesis is this very different type of knowledge from the other two.

Kristin Collier

And what I would sort of equate with some type of wisdom.

Kristin Collier

And, you know, I would say that modern medicine is really excellent at episteme and techne, but I think the philosophical questions oftentimes found within phronesis are largely absent in the practice of modern medicine.

Kristin Collier

And I've thought about, like, why that is. And I think, you know, thinking about our,

Kristin Collier

I think scientific and empirical mindset that dominates academic medicine about our need to, you know, quantify everything, I think techne and episteme are just easier to measure, easier to put our minds around, right?

Kristin Collier

And it can be sort of standardized. Where wisdom is, I think, is more vague for people.

Kristin Collier

So I think of your question of the consequences when we neglect this. I think of T.S. eliot. I wrote a piece what Is Medicine For? In the British Medical Journal a couple years ago, and I quote Elliot, and he has this poem, right?

Kristin Collier

And in the poem he says, you know, where's the wisdom that we have lost in knowledge?

Kristin Collier

I think there's so much knowledge to learn in medicine, and it's so glittery and it's so powerful. But I think, you know, we've paid a price for sort of relegating wisdom to the margins.

Kristin Collier

And I think, you know, the problem with relegating wisdom is that we are going to lack the tools necessary to think through big questions in medicine. Not only the ones I think directly related to care, like in the case that John, that you described, of the person in front of us,

Kristin Collier

but to the profession itself, right? I think, you know, of course, I'm on the Hippocratic Society podcast. I think of Hippocrates and I think of his oath, right, where he says, into whatever homes I go,

Kristin Collier

I will enter for the benefit of the sick. It sounds great, but, like, what does the benefit of the sick mean, right? I think that requires wisdom.

Kristin Collier

And then I think, you know, this idea of, you know, for the profession, what. How should we think about emerging technologies and biotechnologies to think properly about the rudder of the ship of medicine?

Kristin Collier

How is medicine to be rightly guided so as to not become corrupt like this requires wisdom.

Kristin Collier

And I think without phronesis, also for our patients and wisdom, I think we risk overmedicalization,

Kristin Collier

over diagnosis, falling into a one size fits all approach,

Kristin Collier

falling into the idea that machines can care for people.

Kristin Collier

And I think also if we neglect wisdom also, I think one of the things that maybe I think is a consequence, I believe we won't be able to heal our own wounds.

Kristin Collier

I think medicine has deep wounds that somewhat ironically, I think science does not have the power to heal. Like science cannot tell us how medicine ought to be. It cannot tell us if medicine is sick or not.

Kristin Collier

You know, science is without wisdom, but the humanities are chock full of wisdom. So I think for medicine to be rightly ordered and our patients rightly cared for, physicians need to cultivate wisdom.

Kristin Collier

And if we don't do that, it's to our peril.

Yeah, I think that that's a beautiful reflection. And the only thing that I would add to that is this idea that you brought up already, Kristin, is that wisdom is very deeply human.

I think that if we were to talk about like the themes that we've talked about before on the Hippocratic Society podcast is like, what does it mean to be deeply human?

And we talk about this idea of relationality and that this dependence on one another as an aspect of being very deeply human.

And wisdom does focus on that because there is an aspect of this relationality that's so important to wisdom, not only in what we've discussed with regards to the value of those who have come before us and valuing their experience, but also this development of a community of physicians, like this community of wisdom that we as a group of physicians or physicians,

all physicians, right. As we reflect together on the questions of why in medicine. And in that way it makes us also reflect or forces us perhaps to reflect on the interdependence on one another, the relationality on one another that's so important to the development of wisdom.

Because in the cultivation of virtue,

an important aspect of virtue, I think is also failure, right? Like that you try to grow in a particular virtue and you fail,

and then you continue to struggle with it and grow in it.

But there's also an aspect of virtue where one grows by the experience of others, right? So, like, I don't need to experience getting addicted to drugs to understand that drugs are not good for Me.

Right. And in the same way, I could learn that through the experience of listening to stories of others,

and therefore develop this sense in which,

through the experiences of others, I can also therefore cultivate and grow in the virtues, too.

Kristin Collier

Beautiful. Thank you.

Thank you, John and Kristin. Those are very beautiful reflections. And it seems that this medical wisdom, phronesis, as you were saying, Kristin, is really core to the practice of medicine. And if we continue without it, it's almost just treating bodies as machines.

We're fixing robots very technically.

And so as you were referencing these wounds that medicine has, Kristin, I wanted to ask, where did something go wrong? Where were these wounds developed? What has medical wisdom's role traditionally been?

And where was that lost in the shuffle in the development of new technologies or healthcare health systems? How do we get to where we are now?

Kristin Collier

Yeah, I don't want to make it sound like I'm romanticizing the past or making it seem like at one point we had this, all this wisdom, and now we've been some corrupt vocation.

Kristin Collier

I don't think it's that at all.

Kristin Collier

Every period history has its sins and its faults and its blind spots. But I do think that,

Kristin Collier

you know, I think one of the ways that I think, you know, I hear. I do. So I practice primary care and see patients over time. And I hear from my patients about their decades of experience within the US Healthcare system.

Kristin Collier

And often my patients will say they don't feel like they're seen in the fullness of who they are. They don't feel like they're seen as persons, but they're. They're seen as, you know, sort of,

Kristin Collier

you know, a disease or even sometimes a symptom. Right. Or not even like a full, full person.

Kristin Collier

And I think of Abraham Heschel, right, who said. The Jewish theologian who said that medicine should not be an impractical,

Kristin Collier

impersonal practice on sick bodies,

Kristin Collier

but a personal vocation for ill persons. And this concept of personhood, I think, has been lost because I think we've forgotten the idea of, like, who or what are we treating?

Kristin Collier

Which requires wisdom and engagement with the humanities.

Kristin Collier

As a Christian person,

Kristin Collier

I knew her Christian person. I was baptized in 2016.

Kristin Collier

After my baptism, I came to the realization that the people I'm taking care of are made in God's image.

Kristin Collier

And this sort of imbues a new type of meaning to the work that I do.

Kristin Collier

And I think the idea of person, however you derive meaning in sort of thinking about the meaning of the people you take care of. Person is a metaphysical concept and sort of oddly, the concept of person, I don't think is ever really fully engaged in medical education.

Kristin Collier

And oftentimes you talk to students,

Kristin Collier

they did come into medicine to take care of persons, not diseases, not receptors, not symptoms.

Kristin Collier

So I think when patients don't feel like they've been seen as persons, the medicine, I think, has lost its rudder and lost its way and I think is wounded. I think we also have other wounds.

Kristin Collier

We have, just like the society at large, we have wounds of ableism and racism and ageism within medicine because I think we've lost a view of fundamental human equality because we've lost the idea of the WHO or what are retreating, namely the imago dei.

Kristin Collier

And I think about how we have not taken care of patients in the way they deserve. I think of the U.S. public Health Service at Tuskegee. I think about patients not being listened to.

Kristin Collier

These are deep wounds that medicine has to reckon with. And I'm not sure that we are going to be able to reckon with them deeply in a way that's sustaining without wisdom and asking big questions.

Kristin Collier

Who or what are we treating? What is or who is a person? What are the goals of medicine? I think the wound that could be fatal for us, that we're on the risk of sort of falling into the cliff on is the, you know, the PSM model, the provider of services model.

Kristin Collier

Like, is medicine becoming a profession that just is a dispenser of services, that if it's legal and the patient wants it, that we give it to them? That will literally deprofessionalize and demoralize the profession.

Kristin Collier

So that's a wound that we might not ever to be able to recover out of. But again, it's going to take wisdom to decide, you know, where should we go from here?

Kristin Collier

Like, how much of that should we sort of think about in the purview of what medicine is for versus sort of this way of medicine that Tollefsen and Curlin talk about.

Kristin Collier

So the wounds are many and numerous, but the answers to those big questions are not going to be found in a techno scientific model. It's going to be found through the humanities and philosophy and requires wisdom to answer these questions.

Kristin, just because you mentioned the humanities,

I wanted to see your perspective on this as well, because I'm part of a group where we're reflecting on humanities education and oncology trainees.

And I think that the, you know, obviously there's like a lot of literature out there about how to improve or how to think about humanities education and oncology. Residents. But what I've been seeing in the literature is that there's an absence of the themes we're talking about, which is like the teleology or perhaps the why behind like why is humanities and oncology education important?

And I was wondering if you wanted to talk a little bit about that because of your experiences in the humanities as awakening some of these questions.

Kristin Collier

Yeah,

Kristin Collier

that's a good question.

Kristin Collier

And I do see,

Kristin Collier

I think because a lot of folks realize that medical knowledge is necessary but insufficient for good formation of physicians and good care of patients, that there have been more pathways and tracks within medical education in medical humanities.

Kristin Collier

I think this is a good start.

Kristin Collier

I think there's a couple problems there. I know Jeff Bishop has talked about this. Is there some kind of dose effect that we hope to have with the students? And you just have the right dose of this and you'll be fine.

Kristin Collier

Or thinking about maybe even the view that sometimes because these are pathways that people can elect into that still, like, oh, you know what, this is sort of extracurricular or co curricular and not really core to who doctors are and sort of still outside the real work of medicine,

Kristin Collier

like this is the eye rolling stuff, right? This isn't the hard science.

Kristin Collier

I also worry sometimes because these are deep questions of metaphysical goods and existential concerns that we are talking about today of like who or what is a human being, you know,

Kristin Collier

what is the telos of medicine?

Kristin Collier

These questions invoke spicy buckets, right? Like morality,

Kristin Collier

ethics,

Kristin Collier

sometimes theology.

Kristin Collier

And you know, medicine doesn't have really, I think sometimes the best literacy about how to navigate those positions well. And so we sometimes thin out these concepts until there's a line by RJ Snell, who's a philosopher at Princeton, you probably know him.

Kristin Collier

And he has this.

Kristin Collier

I'm going to get the quote a little bit wrong, but he says something like we thin out these concepts until they are unable to bear the weight of actual living.

Kristin Collier

So Warren Kinghorn wrote a piece a few years ago about the Emperor has no clothes in medical education. He talks about, we have co opted virtues within medical education and words, right, that are awesome.

Kristin Collier

Words like wisdom, words like compassion, words like love.

Kristin Collier

But those words have historically meant something. And they're anchored oftentimes into deeply rooted sort of traditions, oftentimes faith traditions or theological traditions.

Kristin Collier

But because we don't feel like those places have any space in the academy, we unroot them from these traditions and then expect to sort of use them, but they become so thinned out that they become actually useless.

Kristin Collier

So I think for medical humanities to actually have thick teeth and to mean something,

Kristin Collier

they need to be thick. Like, they need to lean in as a substance, or they're not gonna be of any use, and they sort of get thinned out so that they're almost like cellophane.

Kristin Collier

So I think, you know, the conversation about how to best do this, again, requires wisdom and prudence and all of that. But I do think we need to have sort of a reckoning with the idea of, like,

Kristin Collier

are we gonna have the maturity to lean in, to think deeply about some of these concepts with maybe people we disagree, and people lean into the thickness of who they are.

Kristin Collier

Not to say that we teach people what to think, but thinking about how to think sometimes happens best within thick conversations of different views of the good as we think about our path forward.

Yeah, I love that reflection, especially because we've been having these virtue sessions for the basis of. Or these dinner discussions as the basis for what we do in the Hippocratic Society.

So we meet at an attending's home over dinner and talk about a clinical case and talk about the virtue that's perhaps missing or should be cultivated in that particular case.

And the one that we're talking about this month is compassion, because you just mentioned a particular word and how compassion comes from the root of suffering with.

And even the word patient comes from the word passion in the Latin root as the one who suffers.

But it's interesting how that word also has been, in a certain sense, had a huge evolution where initially it came from this root of suffering and therefore had a very strong relationship to the suffering from a Christian sense.

Right. So we know Mel Gibson's famous the Passion of Christ as a movie because it is about the suffering of Christ.

And then, of course, the word kind of evolved to actually meaning something negative, like negative strong emotions like hatred or anger,

and then evolved also to kind of having like, a sexual kind of connotation.

And then now has evolved even further, though, that those kind of connotations are still used to something that one really derives deep pleasure or deep meaning from something that somebody is passionate from.

But we've lost the initial actually etymology of where the word passion or compassion comes from. And therefore,

without that type of understanding of that,

we may then have a false understanding of what compassion means and perhaps even fall into the risk of thinking about compassion as even ending somebody's suffering by killing them. And I think that that's like an interesting kind of thing to reflect on because of the history also of how the Hemlock Society has now become compassionate choices has used this word compassion,

as a way of talking about the ending of suffering through the perhaps ending of the person. Right.

And so just like, how the origins also of these words that we've used without a real tradition of understanding that word and therefore,

perhaps can also result in an incorrect understanding of like, what it means to suffer with the patient and our tolerance for suffering, perhaps to suffer with the patient.

Because it also then draws on deeper themes of like, what is the meaning of suffering? Or what does it mean to suffer with the patient?

And therefore,

again, kind of more metaphysical questions that are involved with.

With the care of the patient. Because ultimately the privilege we have in medicine is this care of the person in front of us, which at its core is a moral practice, therefore, because we're caring for another human being.

Kristin Collier

Now, that's exactly as you were talking about compassion. I actually had the group compassion and choices in my mind, actually, because I just debated someone from Compassion and Choices in a debate for the Michigan State Medical Society on physician assisted suicide.

Kristin Collier

And again, oftentimes, like, they'll frame, you know, physician assisted suicide or euthanasia's death with dignity and such. Right? These words that are co opted.

Kristin Collier

And again, if we had more of a robust understanding of what these words actually meant, then I think there'd be more hands raised or eyebrows raised. It's like, hey, wait a minute,

Kristin Collier

how does this make sense? Right?

Kristin Collier

So no, I do think if, again, coming back to the Hippocratic oath, you know, thinking about it, will enter the homes for the benefit of the sick and thinking like, what does the benefit of a sick mean?

Kristin Collier

There are many multiple ideas of what that means right now.

Kristin Collier

And I think this idea of, you know, especially for those of us that have maybe deeply rooted commitments to nonviolence in medicine, if we are not clear what these terms mean.

Kristin Collier

Right. Dignity.

Kristin Collier

Right. Compassion, and let others define them for us, I do fear that we can lose the integrity of the profession, which is at its core human to human endeavor that's rooted in trying to heal and not to kill.

Yeah, thank you, Christian and John And I really loved that dive into compassion as an example of exactly what Kristin was talking about. Exactly these questions that we have to face at medicine that require something larger than medicine, that require the humanities to really understand what is compassion and how do we practice that.

And so as we shift into a sense of how do we live practical or how do we live medical wisdom in our practice,

I'd like to start more at a high level of what is the place of medical wisdom and the humanities in today's medical education,

specifically in this pluralist society,

how do we foster these conversations with all these different viewpoints and still come to some sort of sense of teaching people how to think?

Kristin Collier

Yeah, I recently gave a grand round at a hospital in Detroit.

Kristin Collier

They asked me to speak about physician conscience, which I,

Kristin Collier

you know, I know things about, but I've never really talked about it as its own topic. And so in preparation for that, I read Xavier Symons book about conscience in healthcare.

Kristin Collier

And he talked about, you know, this, this cultivation of wisdom that has to happen for physicians to be properly virtued. And he talked about this concept I'd never heard about before.

Kristin Collier

But I think actually I'm, you know, so interested in it. And I think it's actually probably the one way, I mean, there are many ways, but maybe one way that has been very compelling about maybe how to grow in medical wisdom and thinking about how to do this well within medical education.

Kristin Collier

So he calls it. He calls it, I know he didn't invent the term, but many scholars have talked about it. But this idea of the physician discretionary space.

Kristin Collier

So this is where physicians have, you know, time and space to come to their an understanding of morality and sort of align themselves with the moral structure of reality, hopefully in a process through experience,

Kristin Collier

but then as John rightly pointed out, but also in dialogue with one's peers and in this process of moral reflection where you have the space to sort of acquire the character and virtue that are required to,

Kristin Collier

you know, realize the goods internal to the medical profession. And as John said, medical acts,

Kristin Collier

you know, as professional acts, are always both technical and moral.

Kristin Collier

And I think when we think about medical wisdom,

Kristin Collier

this intersects with physician conscience because you can't cultivate your conscience, which of course is part of wisdom, without the space to do so and without sort of this, this sort of, I think, professional sort of freedom to be able to exercise your conscience.

Kristin Collier

And so when I think of how conscience intersects with this topic, you know, there have been calls in medical education and healthcare to restrict physicians conscience rights.

Kristin Collier

And you know, Xavier talks about how doing so would, would paradoxically actually stunt the entire profession's acquisition of wisdom because it would sort of like limit your ability to think through what needs to be done because it's not like, you know, wisdom just is required or your conscience is just activated in some fringe cases,

Kristin Collier

like we bring these things to bear actually in every single patient encounter that we have.

Kristin Collier

And if we externalize ethics by not allowing physicians to exercise moral judgment and sort of Only tell them what to do based on some kind of rules that are external to them.

Kristin Collier

Then we're not going to have any time or space for physicians to internally cultivate their phronesis that they need to apply in every situation that they're in.

Kristin Collier

So I love this idea of this physician discretionary space and how this intersects with protection of physician conscience. So I think that's one way to do it. I think oftentimes when I've talked with, with students about sort of, you know, virtue ethics and wisdom and some of these things,

Kristin Collier

you know, it has to be the right, the right space. So I love, for example, John, you talked about it sounds like the model at your place is that people get out of the sterile environment of the school, go to someone's home, right?

Kristin Collier

Break bread together.

Kristin Collier

Seems like it's a space where people feel like there's a sense of trust where they can talk.

Kristin Collier

Because there is, I think oftentimes a benefit to doing this communally, but also sometimes in a smaller space, maybe one on one.

Kristin Collier

So, you know, thinking about cultivating time for physician discretionary space, protecting physician conscience and thinking about getting out of the silo of biomedicine.

Kristin Collier

If we're going to do this. Well, like, let's check our hubris that like we have like the answers of how to do this. Like, I realized about maybe, I don't know, six years ago that as someone who had been trained in the hard sciences forever and ever that I had,

Kristin Collier

I basically had, didn't have an education and I had, I'm still going back to filling in massive holes.

Kristin Collier

And I didn't do that with my biochemistry colleagues. I love my biochemistry colleagues. And I wasn't like, I can just do this by myself, right? I was like, you know what?

Kristin Collier

There are people out there that know philosophy. There are people out there that know these things. And I started going to conferences that like engage with these topics and making friends in the departments of philosophy at other schools and theology.

Kristin Collier

So can we think about incorporating our colleagues in theology and philosophy and you know, religion and sociology from these other departments who can help us with medical education, not think just because we're doctors, we're also all these things to all people.

Kristin Collier

So I think it has to be interdisciplinary also.

Thank you very much for that answer. I really loved the reflection on the physician discretionary space, especially as you were talking about not having the space and some of the pushes to limit physician conscience.

I could just imagine any sort of decision that requires wisdom just be bear down to basically a protocol yeah. And I could. Yeah. Just see the immense consequences of that.

And also I love that reflection on incorporating other colleagues into these sort of, sorts of questions. Because at the Hippocratic Society in the undergraduate level, our curriculum is very much philosophically based,

literature, narrative,

basically completely humanities based and dealing with these questions.

And at the different institutions we're at,

we do incorporate people who have backgrounds in philosophy, but also are medically based.

So I love that reflection about incorporating those two aspects together and so moving from the high level down to a lower level of the day to day individuals.

How do we grow in medical wisdom?

From the medical trainee, the first year med student, all the way up to the physician who's seasoned and has tons and tons of clinical experience.

How do we grow in this actual, this medical wisdom that will allow us to flourish in medicine?

Yeah.

Kristin Collier

I mean, so there could be the question of like,

Kristin Collier

how do you grow in this? Is this something that is incorporated into the day to day of medical education or is this something that you're doing on your own? I do think it should be something that's incorporated into the bread and butter of medical education.

Kristin Collier

And that's a really complicated topic because as you know, these things oftentimes will not be done unless there's a change in the way that even the accreditation standards from the LCME and all these other governing bodies changes because oftentimes that's.

Kristin Collier

Those standards are what determine what is in the curriculum, what's tested on what's on step one. It's not in those things. And so like, what's not on step one, like this is sort of extra work.

Kristin Collier

I'm so busy. Right. So this is gonna, this is really, to do this well, it's gonna require an overhaul of what medical education is,

Kristin Collier

which is like almost overwhelming to think about. So before we do that, like ways to grow in medical wisdom.

Kristin Collier

Yes,

Kristin Collier

I do think it. I want to check, you know, be really aware of how oftentimes, you know, the networks that are required to grow in this and to have a mentor.

Kristin Collier

Right. To be at a place like, you know, like, I think of Columbia's medical school and I think of Lydia Dugdale and like Ashley Moyse there, who is a philosopher and the ability to sort of hang out with them.

Kristin Collier

It's obviously there's immense privilege to be able to have access to people like, like Ashley and Lydia and John, for example, the folks on this call. And I know not every student has that, so I just want to, you know, sort of highlight that.

Kristin Collier

I do think that through networking with for highly motivated students who are like, I do need to grow in medical wisdom. You know, sometimes it does require us thinking outside of our own institution, which is actually what I had to do.

Kristin Collier

Like, we don't have actually a theology department at the University of Michigan, and I wanted to sort of interact with some philosophers and start to talk with them on my own that people that weren't with me.

Kristin Collier

So, for example, how I did it, as someone who had no philosophical training, no humanities background, nothing was. I started attending the de Nicola Center for Ethics and Culture conference at Notre Dame.

Kristin Collier

I've only. Only ever gone to, like, hard science conferences. And I went. When I went there, I, like, almost passed out. I was like, what. What is this? Like, what is this conference?

Kristin Collier

Like, people are just up there reading, like,

Kristin Collier

papers with, like, words on them about. And talking about, like,

Kristin Collier

ideas. You know, I was, like, in shock for, like, the first couple years. I went. And then I started really, like, being like, okay, like, this language, newly. This is a new language.

Kristin Collier

I don't know who these people are that they're talking about, but I want to know. I want to talk like this. I want to understand, like, what these ideas are, right?

Kristin Collier

So then I, like, went up to, like. I'm just going to use a specific example, and up to Bo Banner, who's a philosopher at Mercy Health Sciences in Iowa. And I'm like, hey, you seem like a real philosopher.

Kristin Collier

And I want to, like, understand, like, what you do and how your mind works. Can I, like, start meeting regularly with you? And so we set up regular zoom calls and phone calls.

Kristin Collier

And he, like, like, took me through some of the basics, right? And then I'm like, what should I be reading? Right? And he pointed me towards Macintyre. And we started studying John St.

Kristin Collier

John Henry Newman together.

Kristin Collier

And then that cultivated in us. Beau and I wrote a piece for Church Life Journal, actually about Medical Education and St John Henry Newman for Church Life Journal a couple years ago.

Kristin Collier

But that's what it looked like for me, right? I took a lot of initiative getting out of the, you know, silo of biomedical education and then asking other people, like, who should I be talking to?

Kristin Collier

What should I be reading right now? Like, what other conferences should I go to? So it's. It's possible. And I do feel like hopefully I've grown in medical wisdom since that time, but it can take a lot of initiative to do so.

Kristin Collier

But for this to get rid of the disparities where, like, oh, it's only certain privileged people who can do it, or People with networks who can do it. I do believe that thinking about maybe,

Kristin Collier

you know, for those in charge of these things, thinking about how medical education could really incorporate this, not as an extracurricular thing, as a co curricular thing, but thinking about building this in from the ground up from medical education.

Kristin Collier

And then one last caveat on that is I do also believe that. But it would be great, right. Thinking about, can we start asking these questions, like Michael earlier,

Kristin Collier

can we start to think about these questions being cultivated in undergraduate work or in our high schools,

Kristin Collier

in the homes of families even, because these are whether someone does medicine or not. These are fundamentally human questions. And so even thinking about be great even before people come to us in medical education if these somehow are cultivated at the undergraduate level and before.

Yeah, I love everything you're saying, Kristin, because that's like music to my ears in terms of. That's what we're trying to do at the Hippocratic Society,

create these discretionary spaces, as you mentioned, to reflect together and therefore create communities at places where there might not be like a Lydia, but there might be still very reflective people and bring them together to discuss these things.

And then also the undergrad curriculum being a way in which we're trying to help people reflect on really deeply, more deeply why they want to go into medicine in the first place because of these larger questions that they would be addressing as a clinician.

Right.

I think one additional thing that I've just been reflecting a lot on is in addition to the space, one also needs time and for virtue cultivation,

or even just some of the virtues that we've actually talked about, like compassion,

kindness actually requires you to slow down and take extra time with the patient. And then it's such a strapped for time,

culture and environment.

I think that it's oftentimes hard then to reflect on these things because we are not either given time or perhaps I should even say, like, making time,

because of course, we could always make time when things are priorities.

But, yeah, having that both space and time to reflect on these things together,

that's.

Kristin Collier

I mean, yeah, that's huge. I mean, I think I've. I've thought a lot about time and medicine, and I always joke there's like all these signs up all over the place at our, at our institution, like, you know, apply for this, you know,

Kristin Collier

this amazing grant to, like, transform medicine and think about this and that. I'm like, the biggest innovation and transformation that we need in medicine is time. Like, you know, we just need more time.

Kristin Collier

You know, we just need More time. And I think about just the tyranny of time in medical education and that the, especially in academic medicine, this, this pressure, right, to always be producing.

Kristin Collier

Where's your academic product? What, what are you working on next? And I just at some point, you know,

Kristin Collier

want to have like a big gap on my CV with no academic products there and someone looking at it and they're like, what happened? What were you doing between. Right.

Kristin Collier

Like 2025 in 2027. I just want to be like,

Kristin Collier

sister, I was just cultivating wisdom,

Kristin Collier

you know, and like, just like at the mic drop, you know, that's what I was doing. Right.

Kristin Collier

It's important. But like, you feel like I can't take the time to do that because I have all these other things to do, which of course have to be done.

Kristin Collier

I don't want to like, diminish the, like, need to like close my charts and like do my fire extinguisher modules and such. But I also feel like we, if we're going to say that we value something in medicine, like we have to have time for it.

Kristin Collier

Right? And we have to actually, like, someone has to show that they value that in a way that sometimes looks very different than the academic products that we are sort of oftentimes asked to show and show and do.

Kristin Collier

Right?

Yeah. It's this theme of time. I've been thinking about it more as well in the context of now that I'm learning about billing and RVUs for patients and how everything is measured in time and so how a patient of mine who's coming to Clinic gets a 30 minute follow up,

no matter if I'm planning on talking about like a very, very challenging goals of care discussion versus I'm saying, hey, great, this scan has been stable.

Tell me a little bit about your family and having a discussion like that and how time has become the outcome variable. And I think it also affects us in just because of that,

how we even think about or live our lives. Because then we think about everything on this horizontal plane of what have I done and what will I do?

And always this anxiety towards whether I have time for the things that I have to do.

Always living in either the past or the future and not living in this kind of infinite moment of the vertical line of the present.

And I think that also affects how we just like are living our lives in this way in which we find that kind of infinite present moment of each particular moment.

And I think that that kind of centering is also necessary for the cultivation of interior,

just silence, life, et Cetera.

Kristin Collier

That's beautiful. Yeah. If you ever. I mean, thinking about time. And this is. I'm going against my own recommendation recommending, like, another academic product, but Abraham Heschel's the Sabbath, the book the Sabbath is, like, beautiful.

Kristin Collier

Right. And he talks about this idea, obviously, of time and thinking. He has this beautiful comparison at the beginning about sort of thinking about Christianity and Judaism. And he talks about Christianity, obviously, there's like this holiness in these spaces.

Kristin Collier

And he talks about the cathedrals and the churches and. And then he talks about Judaism, about holiness in sort of time and how these, like, sort of different sort of markers of the calendar and sort of this pausing in the Sabbath and the Shabbat.

Kristin Collier

It's a beautiful reflection just on time in particular.

Kristin Collier

They saw a lot of parallels with that we could apply to medicine. But, yeah, no, I think time is needed. It's probably the most valuable sort of currency that we have in medicine to be able to cultivate wisdom, to have our patients seen as persons in the fullness of who they are and to reflect and sort of.

Kristin Collier

Of sometimes do this work of the mind that we need to be able to do these other things.

Well,

thank you both very much. That was extremely beautiful. And speaking of time, I think we're probably just about out of time,

but I really hope this podcast has helped anyone who's listening to it find that initiative and that motivation that you were talking about, Kristin, to get out and try to find who in their network can help them grow in medical wisdom and.

And even starting these larger discussions about medical education as a whole.

And so, once again, thank you so much both for that beautiful, beautiful discussion. I know I benefited tremendously from it. I hope our listeners did the same.

Kristin Collier

Thank you, Michael. Thank you, John.

And Dr. Collier, is there any exciting projects or papers coming up that you'd like to share with us?

Kristin Collier

So I have a manuscript pending at a journal thinking around about sort of the.

Kristin Collier

The religiosity and spirituality of us internists. So I'm an internist and I'm interested in sort of. We were interested in sort of looking at us internists and thinking about how the religiosity and spirituality, sort of how they self report and how that maybe impacts their burnout and thinking about meaning of medicine.

Kristin Collier

So that hopefully is coming out this year and then also just have some upcoming talks. I was talking with John. I'll be down at the University of Dallas in G.

Kristin Collier

Southwestern in a few weeks.

Kristin Collier

I'll also be out in Wisconsin talking to some folks there. Some travel around talking to students, hopefully doing some more writing. But yeah, hopefully 2025. Also, I also take some time to continue to cultivate medical wisdom.

Great. That sounds wonderful and we'll definitely look out for those. Well, once again, thank you and we will see you all next time on the Hippocratic Society Podcast.

Thank you very much for joining and reflecting with us today.

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