Hope Amidst Challenges in Medicine Today - Dr. Ben Frush & Dr. Brewer Eberly

At the 2026 Hippocratic Society Conference, Dr. Ben Frush and Dr. Brewer Eberly discuss how one can hope amidst the pressures and difficulties of the practice of medicine. How can physicians be hopeful in the face of rising distrust in practitioners, bureaucratic pressures, time constraints, and the looming force of artificial intelligence? How can moral friendship sustain us? Drawing from philosophers and artist alike, Frush and Eberly offer a look at what it might mean to practice hope as a clinician.

50 minutes • Published Jul 17, 2026 • Download • Transcript

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Hi and welcome to the Hippocratic Society Podcast. In this series of episodes, we break from our usual content to share presentations from the 2nd Annual Hippocratic Society Conference, during which physicians, trainees and students from across our chapters came together to reflect on what it means to live out the virtue of hope in medicine.

We hope you enjoy so without further ado, I'd like to introduce Dr. Ben Frush and Brewer Eberly.

Brewer Eberly is a third generation family physician in Raleigh, North Carolina and a McDonald Agape fellow at Duke Divinity School.

Brewer's writing and artwork have been widely published across journals in medicine and the humanities.

He's the author of the program the Healer's Vocation, a small group for Christians in healthcare. And Brewer is a physician advisor for the Hippocratic Society.

Ben Frush is a physician trained in internal medicine, pediatrics and hospice and palliative care.

He is currently a Medical Assistant professor in the Department of Medicine at Duke University and a McDonald Agape fellow at Georgetown University's Kennedy Institute of Ethics.

His writing and research centers around medicine, theology and ethics, with a focus on the question of moral formation and medical training.

Ben is an advisor for the Duke Chapter of the Hippocratic Society.

And just for some context, Ben and Brewer have been involved in the Hippocratic Society before the Hippocratic Society was the Hippocratic Society when it was first the Hippocratic Forum. They were the overly harsh editors of the first blog of the Hippocratic Forum before combining with the Society for Just Medicine.

So we are always pleased to have you here and please welcome Bren Fresh and Brewer Eberly.

Thank you everyone. This is,

this is really a delight to be here. I at the sake of sounding cheesy on the offset, I really have already had so many conversations that have filled my soul with hope just in the last few hours.

And I think what makes rooms like this so special is of course what happens in the meals and the margins of the time.

And so we've, we've worked hard to try to honor that and to set up a conversation today that will equip us all to talk at our tables, which I'll speak about more in a moment.

Thank you again, John Michael and Allison, Ben and I were talking yesterday that we're always just in awe of your lecturing clarity and skill and I think we all got to enjoy that again today.

So thank you.

I want to open with a poem.

This is a poem by Seamus Heaney, the Cure at Troy,

from his work on Sophocles,

human Beings suffer,

they torture one another,

they get hurt and get hard.

Can fully right a wrong inflicted and endured.

History says don't hope on this side of the grave. But then once in a lifetime the longed for tidal wave of justice can rise up and hope in history rhyme.

So hope for a great sea change on the far side of revenge.

Believe that the farther shore is reachable from here.

Believe in miracles and cures and healing wells call miracle self healing,

the utter self revealing double take of feeling.

If there's fire on the mountain and lightning and storm and a God speaks from the sky,

that means someone is hearing the outcry and birth cry of new life at its term.

It means once in a lifetime that justice can rise up and hope and history rhyme.

We've been asked to begin a conversation about hope amidst the challenges of medicine today.

And I was reminded of Hannah Arendt's great line that it's a curse to live in interesting times,

which we could perhaps, especially given Alison's wisdom for us, reframe,

as it's a gift to live among arduous circumstances that give us the possibility of magnanimity.

So it can be an interesting time and not necessarily a curse,

a time in which we might be able to imagine what it would look like for hope and history to rhyme when people look back on what's happening in this room 10, 50 years from now.

So our plan for the next 75 minutes is Ben and I are going to speak a little bit about sort of why hope now. Why is hope an interesting thing to think about in the context of our time?

We're then going to move into sort of really two big sections, just reflecting on hopefully amidst the profession and then hope for clinicians and physicians in particular.

And our hope is that that very framing would act as a nice bridge possibility between Dr. Postell's lecture and between the conversation that's about to happen between John and Farr about hope as it plays out at the bedside with patients.

So we see this as a kind of bridging conversation between the two.

We've also structured it such that Ben and I are going to try to not talk a lot. And we've built in lots of time to discuss, discuss at tables.

And so we would encourage y' all to lead into that space to talk together.

We're hoping for a few moments of sort of call out,

which again, I'll offer some additional framing around,

in which after you talk, we might invite some comments.

But then at the end, we've also left a good amount, about 15 minutes at least for us to talk together as a room.

So we really see this as a laying down seed for hopefully a fruitful conversation again in the meals and the margins of this conference.

So I'll say a little bit about why hope now?

I heard Makoto Fujimura,

famous artist, say a few weeks ago that we live in a time of foolish hope concocted by false prophets of hope.

That was a very interesting line coming from an artist.

We live in a time of false hopes in which it might be difficult to argue that we have at any given moment, an accurate assessment of what's going on.

One way to think about this is that there seems to be a tension between a moment in the profession of medicine marked by a kind of resignation or despair in the future.

And you can anchor that simply in the emergence of AI and the kind of coming AI revolution,

a sort of sense of despair about what AI might bring.

The kind of ongoing talk that the healthcare system is so broke, is broken beyond repair, right? It's a hopeless system.

What would it look like to change it?

The kind of ascendancy of the provider of services model that Farr and Chris Tollefsen and others have critiqued, in which clinicians have been sort of contorted into merely providers of goods and services within this large industrial healthcare machine,

in which it can feel very much like being a cog in a machine simply by being a doctor.

And then on the other hand, you could also say that there's an almost overwrought hope in the future of medicine. And again, AI is an interesting example where on the one hand it can be a doom and gloom conversation, or it can be AI is this godlike thing that might save and solve all of our problems,

including in healthcare, perhaps an overwrought hope in healthcare reform,

whether that's universal healthcare reform models, or even sort of the rebellious nature of the direct primary care movement, which I hail from and I'm happy to talk about at other times.

This is what I hear in that Seamus Heaney poem, which is why I wanted to open with it, because Haney, who many in this room will recognize was a gastroenterologist himself,

is hoping for a great sea change on the far side of revenge.

And a lot of the hopes that are, as I hear them as a clinician and as I think of my patients, a lot of the hopes that are touted in our time strike me as rather vengeful.

They're against the system,

they're angry. They're motivated very much by anger, and not motivated necessarily by love and by the sort of first move that the clinician makes by reaching out towards the suffering person in front of them.

And so I believe in that farther shore which is reachable from here. I believe in miracles and cures and healing wells, and those are the things that are only ever known and discovered in the care of a suffering person.

So we're interested in exploring that perhaps gentler but no less miraculous healing wells open to us, of which I think this very society represents struggling for a time in which jump and hope in history rhyme.

Just want to open by saying thank you to everybody who helped make this conference possible, especially Michael and all of his efforts.

It's remarkable to see everybody here when we're talking about hope. I like to think about it as Brewer and I were there when HippSoc was just a glint and John Rhee in Farr Curlin's eyes four or five years ago.

And to see it come to fruition now is really a wonderful thing.

As Brewer said, we're going to try to situate our discussion here, which is going to be more of a conversation and an opportunity for engagement with you all between Allison's philosophical psychological exploration of hope and John and Farr's discussion of hope at the bedside and what will follow us and I the main thing I want to say at the outset is just welcome,

especially to you all, if this is your first time at a HippSoc gathering or your first experience around this group of people.

Brewer and I are clinicians at heart. We're not philosophers, we're not theologians. We love the intellectual life and doing this work.

And we also recognize that sometimes we can err on the side of getting too caught up in ideas and theory.

And so our our goal with this talk and engagement with you will also think very intentionally about what hope looks like on the ground for purposes of the the practice writ large and for clinicians like us,

provide some further soil, maybe to kind of shape the conversations that follow. Today, I wanted to just very briefly give some additional texture to a sort of theory of hope that comes from the world of the arts.

I grew up training in art before choosing medicine, so it's sorry, it's hard for me not to let this bleed in a little bit. This is allegorical figures of love, hope and beauty, struggling with the figure of time.

I love this in part because I love the philosophy of beauty and how beauty shapes our imaginations and moral lives. And this is a pretty aggressive image of beauty taking time by the hair and about to, you know, slap time in the face and be like, wake up.

But how interesting to have hope, beauty and love struggling together with the time,

the time that's in front of us.

So just very quickly,

a few things that, again, I hope run sort of in parallel to Allison's talk.

The forward looking nature of hope. It's amazing how many personifications of hope either have hope blindfolded, as we saw in one of the images you used,

or hope staring off into some unseen horizon,

hearkening back to what Dr. Chisholm showed us last night in the Visual Thinking Strategies exercise,

but also hope as entailing some sort of understanding of an anchor,

a still point, a launch pad from which one acts. So many personifications of hope also have hope standing next to an anchor or a plumb line.

Allison, you had said that hope being caused by love.

And it. It strikes me how many images of hope actually have hope as a literally breastfeeding love, so. So providing nourishment to love.

So how interesting that love causes hope and then hope doubles back and nourishes love in return.

Hope is something that can be wise or foolish. I think of the drawings of Francisco Goya and how on the one hand, he can portray a physician with such tenderness,

and on the other hand, he can portray a physician as foolish.

And so again, hope can be something wise or can be something foolish, depending upon circumstance.

And the last thing I'll say is hope as a sort of leader of practical wisdom. So several images, and not including here, just because we're not going to survey all of it.

But hope literally taking the place of a horse drawing the chariot of practical wisdom forward.

And then hope as in a kind of constant struggle with time.

Both.

Both what Father Time represents, with his great scythe coming to mow down all things that will decay and die.

So hope, hope being. And I kind of struggle with that.

So to get more concrete, though, I think these artists are just reflecting on how important it is to think about what we experience in medicine. The challenges that always feel like struggles with the time available to us, with the circumstances of the time,

in the way that Hannah Arendt means by the curse of living in interesting times, whether that's AI or healthcare reform,

the challenge in medicine to continue to care with love,

and then the ongoing challenge of foundations and first principles represented by hope's entanglement, or not entanglement, but hope always having an anchor by her side as it is.

All right, so now we're going to kind of turn to hope in a little bit more concrete context.

Ben's going to speak about hope for the profession and then we'll provide some time to talk at our tables.

Before Ben does that, I do want to point to this image we've chosen as background.

This is José Pérez's the Bureaucrats of Medicine.

José Pérez is a whimsical artist. You can find his whole series on the nih. He holds back on no profession.

All right, so the first part of our exploration of hope that I'll discuss here is hope for the profession of medicine writ large.

I'll start with a quote that's probably familiar to many of you all by the late moral philosopher Alasdair McIntyre. McIntyre says,

I can only answer the question what am I to do? If I first can answer the question of what story or stories do I find myself apart?

And I think to make sense of the moment we're in, in 2026 in medicine, which,

and I use this word very cautiously cause it's, it's overused, I think is unprecedented,

we have to have some sense of the story that we inhabit and the set of circumstances that led to where we are today with what Brewer mentioned,

bureaucratized, corporatized view of the practice,

the looming threat or opportunity of artificial intelligence. And so I'm going to take just a couple of minutes to try to tell that story very succinctly because I think it will give us the sound apprehension, the intellectual foundation like Allison was mentioning, to get a firm prudential sense of what,

where we are and how we got here and how we can move forward, which, which hope relies on.

So Western medicine, and probably many of you know this if, if you're a member of the Hippocratic Society, but you know, is a tradition to millennia in the making which historically has subscribed to a very firm sense of caring for the ill and infirm.

It's a robust practice again in the terms MacIntyre would use as sort of a socially coordinated activity working towards the good in the case of medicine, of health,

requiring virtues among practitioners to do that practice well.

But for the last probably 50 to 60 years. And if you want a good summary of this story, Farr, in Chris Tollefsen's book, the Way of Medicine, I think is a great place to start.

There have been these forces at play, that which Brewer mentioned that in important ways I think have corrupted this vision of the moral work of medicine and that end of health that we're working towards.

So namely forces impinging on medicine that prioritize goods like efficiency and throughput profit and a sense that as physicians, oftentimes we feel beholden to working towards preference fulfillment rather than what.

What is a good and right healing action for a particular patient.

And over the course of that last half century or so, there's also been a concomitant self protective impulse by the profession,

where medicine as an institution has been very careful to kind of mark out and protect its jurisdiction of the practice and protecting physicians from vying professionals who would seek to tap into the market of healthcare and shoring up protection against litigiousness and the prospect of medical malpractice.

And I think what's happened over the course of that time is physicians have been engaged in work that has historically been very meaningful.

But to invoke a biological metaphor, I think we have largely atrophied in our ability to live out or articulate what the suppositions of our practice is.

And this hasn't really been.

This is something I'm proposing. It's something we're kind of working on together.

I think these are the conditions which have allowed the last couple of years, with the infringement of artificial intelligence to feel so threatening.

We inhabit a practice which is incredibly morally robust, which allows for us to be hopeful about the good we're working towards and caring for sick people to, to grow and flourish in our course of the work.

But through those forces,

I think we've set ourselves up to be threatened or called to give an account in a way that is unprecedented by the prospect of artificial intelligence technology specifically. And there was a article in New York Times a few months ago,

the title of which I think is telling and would have been considered absurd even five or ten years ago. And it title was AI is making physicians ask the question what are they really good for?

And that's where I take to be. What I take to be the place that we're in is, I think we in some sense gotten fat and happy and lost the ability to give an account, a professional account of what it is we do and why we matter, but more importantly,

why medicine matters and what it's for.

And the last couple years we're facing sort of a jurisdictional challenge which we never could have imagined.

So that's the moment that we're in and why, I think so much of this talk of hope or hopelessness feels especially pronounced at our cultural moment.

So given that sense of disillusionment, confusion,

the philosopher Jonathan Lear used the term moral vertigo to try to gain our bearings of what it is and what we do,

I think there are two ideas and thinkers that it's worth engaging for purposes of what a hopeful way forward for medicine as a profession looks like. Now,

the first is a guy named Jesus. You might have heard him.

I know, I know HippSoc is not a. Is not a religious institution. I do think whether one is a Christian or not,

there's a turn of phrase Jesus uses in one of the gospels that I find really intriguing for what it means to be a physician today at this cultural moment, facing the challenges of hope in our profession, both for our own prospects as physicians, but maybe even for what it means to be a human and to care well for sick humans.

So I don't remember which gospel this is from, but Jesus is near the end of his ministry, is anointed with a very expensive oil perfume.

And one of his disciples rebukes the person who anointed Jesus and said,

why did you.

Why did you waste that? This could have been sold to the poor. This, this, this perfume or oil could have been sold for a fortune and distributed to the poor.

And Jesus looks at his disciple and says something to the effect of this person did what is right. I am only here for a time, and the poor you will always have among you.

And that second line has really been on my heart for the last couple of years as we've thought about what physicians do and the promise, Inspector, of things like artificial intelligence.

In a strange way,

it seems to me that hope is bound up both in a vision of the good and the possible and a sound apprehension of the obstacles to that good and a commitment to work towards work towards it.

But in a strange way, I think hope is reliant on a certain chastened humility which acknowledges the limits of what we can and what we are called to do.

I think hope requires a gap, a difference between the way things are and the way they ought to be,

and a firm commitment to try to narrow that gap.

And yet,

you know, one of the greatest moral, moral teachers, and depending on what you believe,

maybe God himself said, the poor you will always have among you, right?

And so I think to hope well and to think well as clinicians amidst what Brewer said is potentially the false hope or false promises of overcoming the human condition,

a certain form of restraint and humility about what it means to engage in the practice of medicine,

to commit towards trying to restore the health of sick patients while avoiding the allure of saying, as the theologian Stanley Hauerwas puts it, that we can get out of life alive.

I think those limits necessarily discipline and constrain what we do as physicians and give us,

again, sort of an intellectually reasonable goal of what we can accomplish on behalf of our patients.

And that form of. That virtue of humility is cultivated by way of prudence and practical reasoning and communal wisdom in the types of parallel institutions that the Hippocratic Society represents today.

So I think humility is the first point, and the second is related to that. And I just mentioned community.

So Jonathan Lear is. The late Jonathan Lear is a philosopher who is an incredible thinker and has written a few really powerful books, one of which is entitled Radical Hope.

And it's an existential examination of the idea and virtue of hope,

and you should read it. So I won't recapitulate the whole thing here, but basically it tells the story of the Crow Nation, which is a Native American tribe in the Western United states in the 19th century, as they were being incorporated into the United States by the.

By the military. And,

you know, Lear, through telling the story, asked the question,

what does it mean to hope when the conditions for what we thought life consisted of are completely upended?

And he gives the example of a Crow warrior, before this incorporation of the United States,

could go and engage in battle and come back and plant his spear on a stolen horse from the people they ward with.

And he was met with esteem and honor,

and he was flourishing KWA Crow warrior.

And then in this very vivid scene, after Crow Nation is appropriated by the United States,

a young Crow warrior does that a few years later, steals a horse, comes back and plants a spear,

and he's viewed as a criminal and put in jail. And his own people don't understand the moral coherence of that action.

It's a really intriguing book because it asked the question, you know, at a moment of incredible uncertainty. And Lear defines hope as courage in the face of uncertainty.

What can we hold onto and commit ourselves to,

to hope in the face of a world we can't anticipate or imagine,

when the conditions for what we took to be meaningful have been upended?

I don't think this is a perfect metaphor for where we find ourselves in the world or in medicine. I think what the coronation went through was much more acutely drastic and transitional.

Nevertheless,

one of the enduring messages from this book and that I think about today, is the role of a moral community to continually continuously debate within itself and in some ways reaffirm and reify what what the goal of that community or the practice it engages in is.

For medicine, that's historically been the pursuit of health. I think we're in a moment where we are tempted, as though those in the practice of medicine both to believe we can expand like laterally and do more than work towards health for patients, but also beyond health and even work for things like immortality.

And the wisdom of a shared community, again, helps chasten those,

I think,

audacious and inappropriate hopes and encourages us not to look forward, but also to look back, to remind us where we came from and the wisdom that we draw on to,

to know that things will be okay because they have been okay.

And I'll just close with this and we'll give you all some time to discuss.

I can't help,

forgive me if that was a little bit nebulous and not as practical as I had intended, but a very practical note to end on.

I mentioned this before, but HippSoc, the genesis of HippSoc,

began essentially right, when Covid did maybe a couple years before. But Covid was my second year of residency and I was engaged in talks with John and preliminary talks with Farr and others about what this might look like.

Right. And that was a moment where we couldn't imagine what life would look like in 2026. Right.

And life has changed in some unimaginable ways.

And yet here we are. We've convened over a hundred people, young people,

not all of us young, some young people,

to collectively ask the question, what is medicine and what is it for status post this one sort of incredible transformational moment and potentially facing another one.

And so in order to hope, well, I think we have to look to what's already been done.

And the fact that we're here even asking this question today,

when I think so many in the profession are viewing it as either not worth the time or impossible to answer,

is a living testament to the wisdom of a community and embodied wisdom and practice, and a commitment to care for the ill and the goodness of mutual encouragement and edification towards that end.

So with that,

we want to be intentional about making this an interactive session.

So we're going to take about 10

minutes, maybe a little less. Okay. Yeah. Seven, eight.

Yeah, seven. Seven and a half minutes.

Perfect.

Do you have the questions there?

Yeah, yeah, we.

So the invitation here is just to discuss at your tables what's coming to mind and heart for you as you think about hope in the profession and perhaps share a story where you've witnessed hope practiced or exemplified despite that challenge.

This is gonna necessarily dovetail into the next part of the conversation about hope among physicians and clinicians, because it's hard to understand the profession apart from physicians it's hard to understand physicians apart from the profession turning now a little bit more,

I guess, invitation to get even more particular in the kind of daily workings and practices of medicine. This is a painting that came to mind thinking about this.

Peter Hurd's The Dry River Artist from New Mexico.

And again, I was delighted to see how it resonates, hopefully with Dr. Chisolm's painting again that she showed last night.

This idea of a coming storm and is it coming or is it leaving?

You know, is.

Is this gonna. Is this gonna flood the valley or is it going to restore life to this dry riverbed?

What does it feel like to be a lone clinician trying to make sense of,

again, this sort of darkening horizon and how dangerous it is to conceive of ourselves as lone physicians rather than people bound up in moral communities that are forming and shaping us.

So just leaving that there as a kind of backdrop.

I'll be brief here.

I do want to kind of double click on something.

Actually, I don't want to say double click. See, so I'm being captured.

Want to shine light on a quote from Jonathan Lear's Radical Hope.

Maybe again as a place to think about a conversation together.

This is from Radical Hope. The social group may endure and one may be able to identify with being a member of that group,

but the possibility of constituting oneself as a certain sort of subject suddenly becomes problematic.

And the idea there being that this introduces a kind of irony which has been said, is characterized by the question, among the warriors, is there a warrior?

And then, as Socrates has said, as far and others have written about, among all doctors, is there a doctor?

So what comes to mind, has come to mind for us as we talked about this are kind of four things I want to offer for our conversation together, which is experiences of wise and false hope.

What it means to risk imaginative new practices, which is what Lear means by Radical Hope.

It's risking creative new possibilities,

leaning into the challenge of the time rather than sort of retreating from the challenge of the time.

So engaging challenges without resentment or complaint.

And then how moral friendship makes it possible for us to fare forward as clinicians in the midst of these challenges.

So to the first,

just thinking about wise and false experiences of hope. During training, I had a co resident who every time something got really, really

hard

and difficult,

he would just kind of start nodding and say, it's. It's all good, man.

It's all going to be okay. It's all good.

And, you know, it's like the more that he said it was all good. It was like, it is clearly not good. And the more,

the more you're nodding, like, the more anxious, you know, it was amazing. It was like, really was like as. As things got harder, the nodding is all good, you know.

And I remember just finding that experience as well meaning and earnest, I think, as this person was. It's like, that's clearly not hope.

And then in another sense, experiencing the kind of curmudgeonly austere attending who you would never describe as like a cheerful optimist who nevertheless, by their very actions and presence and fortitude with patients,

displayed a kind of hope that was like, utterly infectious.

And it wasn't this kind of like forced earnestness in the room. It was a kind of hope made known by the practical actions that this clinician had taken on behalf of a suffering person.

So that's one just seed to plant, as you've experienced clinicians around you who've been what Miroslav Volf, theologian, in conversation with the poet Christian Wiman, recently described as the carriers of hope for which we have a responsibility to identify and in some sense apprentice ourselves to.

The second thing is what might it look like for clinicians to risk imaginative new practices? I can't possibly field and have. No,

I'll just speak from my own experience of trying to do this within the direct primary care world.

This would be a longer conversation, but just the idea of a family doctor, of trying to do something risky and new that restores the possibility of accompaniment and solidarity and radical presence and a ministry of presence to our time with patients.

And it might look like building something new that is not actually a universal solution to all of medicine's problems,

but is a form of subsidiarity that makes possible new love in our local places.

I could say more about that, but I sense it would probably eat up time unfairly, but just that direct primary care I really do see as a form of hope, at least for the world of primary care that I hail from.

In family medicine,

the third thing is engaging.

We'll take the AI example, because I think it seems to be on the tip of everyone's tongue and it's kind of just in the background ether.

Is this a storm that's going to flood the valley? Is this a storm that's going to, in some sense, bring some helpful water back to this dry riverbed?

What does it mean to engage the challenge of artificial intelligence without resentment or complaint is a question I found myself asking a lot. And I'm like the first person to do the kind of doom and gloom.

This is like going to be really, really bad.

And I've been convicted recently that, well, okay, what does radical hope actually look like? Thinking about AI in mind.

For example, this is recently a conversation I heard with David Brooks that one example of I think that's genuinely fearful is the way that AI deskills physicians.

And yet if you have the capacity to approach the tool, having already brought to it all that, all the reasoning that you can say you, you, you could do,

and then approaching it like one would approach a room full of advisors to comment on ways you could grow your medicine, well, then that's been shown actually to increase motivation and increase commitment.

So. So again, I sort of. I remember hearing that and I was like, oh, darn, it's not purely evil.

There's possibility of good. You know, like, I almost wanted it to be a straw man situation.

So I guess just wanting to invite that in the room of what does it mean to lean into the challenge without resentment?

And then the final thing I'll say is just the power of moral friendship to maintain hope. As clinicians. I just read Cicero's on Friendship. I want to read this quote because

I think it's beautiful.

Moreover,

while friendship comprises the greatest number and variety of beneficent offices,

it certainly has this special prerogative that it lights up a good hope for the time to come and thus preserves the minds that it sustains.

It's lovely. It lights up a good hope for the time to come.

And I've experienced that in my own life. Being friends with Ben, being friends with many people in this room.

That hope, it seems to me, is very difficult to do alone,

sort of almost inevitably it seems to necessitate friendship.

And I think that's apparent in this room.

Last thing I'll say that I hadn't thought about until hearing the last comment was my colleague, one of my partners, Zane Lipinski, who I think is as gifted a shepherd and physician as one can be in this world and largely lives a hidden life.

And those things probably, you know, these things tend to go hand in hand.

The virtuous people are often hidden.

Um,

he asks all of his patients, what do you hope for?

And just what that simple question has, has drum up in the room and his experience of caring for people, I, I think itself is a form of radical courage.

Um, what do you hope for?

All right, it's 11:38. What we wanted to do just for these last really 20 minutes or so. There's, there's a few things we want to offer at the very, very end.

So maybe around 11,

you know, close to noon. But we just want to invite a conversation with the room.

So what. What has come to mind for everyone?

What are things we can explore together with hope amidst the challenges of medicine today, with the profession and the life of clinicians in mind,

what's coming to mind for you as we are bridging the, the theoretical foundations that Allison offered to us as we prepare to hear Farr and John talk about how this plays out even more tangibly at the bedside for the medical trainees in the room, what has it been like to think about medicine with AI swirling around everything?

For clinicians in the room who've had more experience than Ben and I,

what have we left unnamed that deserves to be named in this space?

I'm Ana. I just finished my first year of med school.

There's been a lot of talk about hope as courage in the face of challenge and how challenges can be good.

But something I've been thinking about for a while that I wanted to share was the idea that there's kind of two different ways of dealing with challenges.

We can either do our best in the face of the circumstances that we have,

or we can attempt to face the challenge more head on and say, actually, this is not acceptable.

Um, and I don't want to create a false dichotomy between these two things. I think we can do both at the same time. But we all have limited,

you know, limited time, energy and resources. So to some extent we have to choose where to put our focus.

And I'll use the example,

I think it's relevant for AI, But I'll use a different example that's been on my mind a lot recently, which is appointment times.

And it seems like, so, you know, especially in primary care,

we have these potentially like 15 minute appointment times that doesn't seem to be possible a lot of times to do good medicine in that amount of time.

And I think there's some people who have the approach,

okay, this is, this is the time that we've been allotted.

I'm going to be a good physician in this amount of time. And that would be one approach where we just,

or we do what we can with what we have.

And then there's a second approach which is,

why are we rolling over?

Why are we just accepting something that seems to stand in the way of doing our work well? And like, why don't we come together and resist that? So more of like a revolutionary approach.

Again, I don't think these are necessarily Mutually exclusive. But I'm curious,

when we say facing challenges, what exactly do we mean?

Are we trying to hope despite of a challenge, or are we attempting to face it head on? And when do we switch over into saying actually this is unacceptable and we should not just take it and roll over, but actually do something about it?

It's just something I've been thinking about.

No, thank you so much. There's so many people online that I, I'm gonna, I'm speak for just two sentences. I, I mean the direct primary care model is a tangible example, I think, of what you're talking about because in some sense it literally did grow out of clinicians saying there's a moral limit in time that cannot be changed.

It, it's like saying I'm gonna listen to my favorite song by listening to it at two and a half times speed.

Like that's an objective.

Cannot be. It doesn't, it's meaningless to say I listened to my favorite song faster.

And so there's. I think you can actually make similar claims about the care for suffering people that while it's, while it's certainly there can be a necessary good to live into what's possible to do in the 15 minute slot you're given.

It may also be a hopeful and faithful disruptive response to say, I'm going to reverse engineer care for the suffering people around what the time it actually

takes and the very brief response. And thank you for that question.

It seems to me that virtues like hope or courage are always embodied and instantiated in particular times and places and people.

And so much of the challenge that we encounter in thinking about courage or hope is when our work is bound up with institutions and we have to make a prudential decision.

Do I do the best that I can within the structure of this institution?

Um, or is it time to think about a separate institution or para, para institution. So that's how I would think about that, broadly construed.

Yeah. Thank you, thank you for this and, and thank you for the,

the, the quote from Matthew because I, I think it does relate to what was just asked, this idea that attending to the person in front of you,

in this case it was Jesus, but also knowing that there are going to be poor. Poor. They're poor everywhere. They're suffering for, for all, all, all future time.

And as a physician, how do you,

how do you care for the person in front of you knowing that you've got a full, er. Full of folks, or knowing that you've got a full day's worth of folks left.

And I guess the question would be,

I can't remember if it was Mary or her sister, but she pours out the whole bottle, she anoints him with the entire bottle. So she's got nothing left.

I guess she gets. How does she get the energy to care for the next person? And so as a physician,

do you get energy from the pouring or, or how do you get energy for the next person and the next one and the next one after that?

Sorry to hog. This is a great question. I'm going to try to restrain myself. I'm going to have temperance in answering this because I could talk about it for so long.

The thing I love about that passage in the gospel is it is a thoroughly anti utilitarian view of the way that we're called to care.

Jesus rejects altogether the notion. Right.

And it seems to me that that's a. That is a virtue. That's a prudential judgment of how to accord my time that oftentimes takes into account intangible, seemingly nonsensical variables and dictates that I accord my time justly.

Which is something I think good physicians do and I don't think can be done by AI because it's,

it's an implicit judgment.

To your second question,

there's a term in the literature that I really like.

It arose in describing the work of Paul Farmer, who's a famous kind of missions public health person. But the notion of kenotic flourishing. So kenosis is outpouring,

right? Which normally we think of as detracting from ourselves. But it's the idea that actually similar to the approaching hard things, we become more of ourselves by giving. Well,

that doesn't mean we get run over and commit ourselves to the wrong things. Those can be thoroughly draining.

But the goodness of, to a limit of pouring out like allows us to become more of who we were created to be.

And again, that flies very much in the face of this sort of utilitarian cost benefit analysis.

But it's just an embodied reality of being a physician. I mean, my heart, my best days have invariably been my hardest days.

Not when I'm jostling with insurance companies or telling somebody why they, you know, shouldn't get Ozempic. But like when somebody is sick and crashing in the ICU and you stay there three hours after your shift,

you're built up in the pouring out.

So yeah,

yeah, I would just second, I. It's very hard to answer apart from how I understand the paradoxical formula. Those who lose their life will find it and so.

Right. Hi,

my name is Maria. I just, I'm finishing up my first year at Hopkins in medical school and I just wanted to share a story that we had a project essentially that was put on us like on a week that was very, very, very stressful.

We had like three exams or something that week.

And we were given the option of either using AI for the project or not. And it wouldn't necessarily like change your grade or anything like that. And I just wanted to share that 50% of us, despite the fact that it was such a stressful time, chose not to use AI to write like an entire project,

an essay. And then we essentially had like a panel where there were people that were like, brought, and it was a policy public health course. And we were asked questions about like, that project that we wrote.

And it was essentially very evident to know who did and who didn't use AI,

just based on, like, how well you could answer the questions. So I just want to say that I think that there is like, along this topic of like, hope and specifically, like, when it comes to things like AI, there is a growing recognition even among, like, trainees that despite the fact that there's so much on us,

there's.

There is something to be said about like doing that work,

even though it can be like, burdensome. So I just wanted to say that because to me, it's a story of hope.

So, yeah, I just wanted to share.

Thank you.

And with one fell swoop, she says more about hope than we could ever hope to in an hour and a half.

So.

Exactly. That's right.

Hey, everyone.

My name is Noor, one of fourth year med students at ut. Tyler.

I've just been thinking about the parameters of this conversation.

Where has medicine gone? Where did we go and how did we get here? Do we rest on our laurels?

This is all I've ever known.

Like, I've studied the background, the structure. I have an mph.

But for me, when I went through med school, where I am right now, I'm trained to do a five minute history, see my patient and turn it around.

So when we're talking about hope,

every victory for me is the extra minute or two I get to sit with that patient.

A victory for me is when I actually get to sit, ask them about their family, talk to them more about what's going on, ask them how they are feeling in that moment.

So I just really wanted to reframe the conversation because when I look at that picture up there,

you know,

the dry river, is it coming or is it Going from my perspective, it's only up from here.

We have the opportunity to really make a difference in the ways in which we view medicine and the way in which we connect with patients,

because that's what it is at the end of the day, right?

Like the Ministry of Presence.

And I think there's a lot of opportunity to think and reframe because I remember thinking about hope in terms of reframing from our first presentation.

So I think there's a lot to think about, where we go from here. And so hopefully that was hopeful.

The. The Anglo Saxon word for hope, hopa, means the upward going slope of a mountain.

So.

Thank you.

We have time. Brew, or do you guys need to.

I think we.

Yeah, we're good.

Okay. Well, I'm Brian, also from Duke, and I represent the people older than Ben and Brewer.

So I have a thought that I. A source of hope I found. I read a book by a philosopher named Alex Broadbent called The Philosophy of Medicine, and he starts off by asking the question.

For more than 2,000 years,

people have been practicing medicine.

And until the last,

call it whatever you want, 100, 200 years,

they have not been able to do much of anything good for the health of their patients.

But yet, during that entire time, the profession was revered, it was sought after. There are court physicians,

there are famous physicians, people write books, and it's a respected and beloved and desired profession.

And yet,

in the last 50, 75 to 100 years, as we've gotten better and better and better at actually achieving health outcomes,

the satisfaction with what physicians are doing for people is getting less,

the trust in physicians is less.

And the philosopher, you know,

recommends that this is likely due to decreased time with people, more of a attitude of a technician than a carer.

And I think that AI in the coming years may represent a sort of a cleansing fire that we need. Right? Because it will soon be evident that no one in this room can outthink an AI in terms of forming a differential diagnosis or understanding medication interactions or knowing the protocols.

In my field,

an AI can trace a flowchart better than I can to come to the right procedure for this particular patient.

And it'll force us to return to the humanistic and caring aspects of medicine.

And there may be, as sometimes happens with cleansing fires, a weeding out.

Right.

For people who are not interested in that, it may be less appropriate career choice. But I think that it might be.

This might be the onset of a new era in which we're forced to go back to the roots of what we do.

Yes.

That's great.

We wanted to close just with a poem.

I'm going to read it twice.

Well, I won't offer any context. I'm just going to read it and then I'll read it again.

This is Jane Hirshfield's poem, Hope and Love.

All winter the blue heron slept among the horses.

I do not know the custom of herons do not know if the solitary habit is their way or if he listened for some missing one,

not knowing even that was what he did.

And the blowing sounds in the dark.

I know that hope is the hardest love we carry.

He slept with his long neck folded like a letter put away.

I'm going to read it one more time.

All winter the blue heron slept among the horses.

I do not know the custom of herons do not know if the solitary habit is their way or if he listened for some missing one,

not knowing even that was what he did.

And the blowing sounds in the dark.

I know that hope is the hardest love we carry.

He slept with his long neck folded like a letter put away.

Thank you all.

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

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