Hope in Medicine: William Stigall Abstract Session - Medicine as (Aristotelean) Art
In this abstract session of the Hippocratic Society Conference, Dr. William Stigall, Vice President and Chief Research Officer at Cook Children's Healthcare System, discusses the art of medicine under an Aristotelean framework. He strategically parses out what makes the medical profession distinct in its essence from other professions and types of work.
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Hi, and welcome to the Hippocratic Society Podcast. In this series of episodes, we break
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from our usual content to share presentations from the second annual Hippocratic Society
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Conference, during which physicians, trainees, and students from across our chapters came
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together to reflect on what it means to live out the virtue of hope in medicine. We hope
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you enjoy.
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Next, I'd like to welcome Doctor William Stigall, who's the Vice President and Chief Research Officer at Cook Children's Healthcare System in Texas here.
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he practices as a pediatric intensivist. He's trained in business, medicine and philosophy, currently pursuing a degree in healthcare management at Harvard. Is this still happening, Doctor Stegal? All right. All right. Outside of his work, he enjoys traveling, sailing, and time outdoors with his wife and three sons. welcome, Doctor Stegal.
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This is even more, I I don't think ironic, appropriate, AI-generated Aristotle after our Aristotle talk. Yeah.
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In the September 2015 issue of that venerable journal of social science, Esquire, DePaul University's Boswell Distinguished Professor of Creative Writing, Tom Shiarella, published the findings of a one-man experiment. He entitled the article What Happened When I Dressed Like a Priest? It was subtitled An Investigation in the Power of the Uniform.
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Mr. Shirella conducted a non-randomized but controlled case study by donning the uniforms of a priest, a security guard, and a doctor, and walking about our nation's second city, noting the effect of the uniform on those around him. His data were presented in flowing prose. I was a priest standing at the bar at the Billy Goat Tavern beneath the great concrete decks that brace up downtown Chicago. Strike that. I was not a priest. I shouldn't say that. I was me, me wearing the uniform of a priest.
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It was 10 30 on a Friday morning. The bar was a well-lit temple of Formica. I was visiting my favorite bartender, as is my want when I'm in Chicago. Priest or no, my uniform was an old school liturgical cassock. Twenty buttons, rising to the traditional clerical top, part tunic, part Nehru jacket, with a big open flare at my feet. That thing really kicked up the wind when I walked in the city. The thing really had some sweep.
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He continues. When I walked in, my friend immediately set me up with a no disrespect intended pour of bourbon with a draught beer back. My shoulders were turned to the half-full restaurant. A small circle of recent acquaintances screened me. I'd like to say I was mindful of being the most visible man in the room, me the priest, but who was I kidding? People had been staring at me for twenty-three blocks.
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One hour in the uniform, and I knew this much, on a bright summer's day in a sprawling city, a priest in a cassock is a thing to behold. People draw out their eye contact with a priest. They give nods or bow just a smidge, or they stare, openly, respectfully, distantly.
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When walking in pairs, men wind up their cheeriest selves to burl out suddenly, Good morning, father. I habit, no doubt, learned in high school, revisited gladly. Twenty-three blocks and the world could not take its eyes off me, a priest striding north. And so in a what the hell moment, I lift the glass, I nodded to Jeff the barkeep, and took that long, good swallow. Only as I put the glass back in its ringlet of condensation did I notice a woman who'd maneuvered herself to some pass-through window, and she was filming the whole thing on her phone.
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You're gonna be in the internet before you eat lunch, said the barfly to my left, without looking up, and then adding, Father. I picked up the beer, I took a sip, and I told him, I'm not a priest. He turned, narrowed his eyes, gave me a lazy up down, and said, What's this then? He said. And he meant the frock. It's a uniform, I said, and that was true. That was my plan. Be honest. And that seemed to be enough, because he went back to his box schools. A couple minutes later, he said, One thing's for certain: some priest somewhere is gonna get in trouble for that.
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The experiment then continues, and Mr. Shirella dressed as a security guard. He then collected his data, he turned it into the final phase of his experiment. He donned the garb of our professional circle by dressing as a doctor. As a good investigator, Mr. Shirella didn't just start immediately with experimentation. He did his pre-study studying. His pre-study activity was an observational study. He observed you. More specifically, people dressed like many of you, but only in Chicago.
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He said, I sat in a hospital beforehand and I watched the foot traffic of doctors, students, and staff. They moved with chronic urgency, and they unfailingly stared into their phones and tablets distractedly, or they carried clipboards or stopped to flip pages rapidly. They seemed to spend significant time looking to the guts of a problem, blocking out the world around them, a perceptible purpose and direction to every step. Slow or fast, they seem to be moving from one situation to another by social contract. I started with that, walking north.
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But I walked fast and I stopped only to look into my phone or flip pages on my clipboard. I looked up the street anxiously. I pictured the destination dimly to the north and manufactured a problem that demanded I get there now. I wanted people to think, this guy doesn't even have time to hail a cab. Somebody needs him. He's got to be a doctor.
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And you know, the world gives way, he continues. The girl gives way. Please, people step aside. Cabbies wave you through intersections. Before long, I started to really sweat. So I ducked into a restaurant to pick up a little AC action. And almost as soon as I was inside, the urgency subsided. This will not stand. So as the hostess approached, I held up my finger. Hold on one second, I said. And then I stared into my phone. Perhaps that's some test result that had just come in. I decided just to stare, to see how long it could last.
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Minutes passed. Eventually I pretended to be scrolling down using two fingers rather than the one on the touch screen. I thought that was a nice touch, riff with versal initude. When the hostess approached again, I interrupted her and I took a shallow half step back. I said, just one sec. I said without looking up, knowing full well that I now risked being the rude doctor. But she said, Of course, of course. We wanted you just to know, do do you need a glass of water? She didn't even consider me a customer anymore. I was a doctor who needed a place to work.
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I went to the block, stepping into a sporting goods store, and I did it again. I asked for forbearance and a little space. I looked into a problem, and then a bank and a waxing salon, a shoe warehouse, a veterinary clinic. People made room, room for responsibility, a little space to help. They offered me a seat. When people asked me where I was headed, I just hooked a thumb over my shoulder and I said to the north. This was true. And I looked back into my phone. So Mr. Ushuriella thinks: clothes make the man. The subtitle, remember,
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Is an investigation in the power of the uniform. But I think he actually mistakes the effect for the cause. Uniforms are signs, they're effects. They signify something about the person wearing them. Uniforms profess. They profess that the person wearing them is the kind of person who does the sorts of things uniforms, that is cassocks and gowns, lab coats, profess they do. So what do a doctor, a lawyer, and a priest have in common? Besides being
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The beginning of over half the world's jokes. Well, each has a uniform, and each has an investiture ceremony where novices are granted their signifying uniform, and each is a profession. Collectively, these three, along with their instruction, are the entire set of what historically was known as the noble professions: medicine, law, theology, and teaching.
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So calling these occupations professions isn't just the aesthetically pleasing use of synonyms. What I hope to show you today is that calling medicine a profession means that medicine is the sort of activity that will make you a better person if you do it well. But just as importantly, as a profession, it's the kind of activity that done poorly makes you a worse person.
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Now these claims are probably a bit startling. They were to me when I first encountered them, and they still are in some ways. The claim is that as a profession, medicine isn't just a way of putting money into our pockets. Medicine is much more than a job.
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The claim is that our professional work actually has bearing on our moral quality as people. And to be clear, we're not talking about illegal activity or willful misconduct, the abuse of power. Though these would all make a bad medical professional doing these bad things, a bad person. The claim I'm making is even deeper than that. A professional who breaks no law, who makes no intentional misstep, doesn't use power abusively, still has not met the standard that a professional must meet to be good at medicine.
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So to prove the claim that medicine as a noble profession, affects one's person, we need to define a few terms. We'll need to define what's meant by profession and what prefacing it with noble does. But before this, we need to understand what kind of activity the noble profession of medicine is and what part of us directs and governs its activity.
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This will be done by examining what exactly was meant when medicine was first referred to as an art. We moderns think the phrase the art of medicine implies some sort of inexactitude to medicine that's found in the the the aesthetic arts, maybe not in the sciences. And that's true, but it's incomplete.
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So Aristotle is the most thorough excavator of what the ancients meant by saying medicine was an art. For Aristotle, medicine isn't really an art because it has parts that are hard to pin down in the scientific formula, nor is medicine an art because our emotions are involved in the work. So Aristotle tells us medicine is an art because art is one of the three broad categories of human activities. There are three kinds of things humans do, in particular, that makes us distinctive among all other things.
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Aristotle defines man as the rational animal. We're an animal just like any other beast is. We live, we metabolize, we propagate, we die, just like any other animal does. But what sets us apart from all other animals, our specifying difference, the difference that makes us a special species of an animal is that we are rational. We think. We're the animal that reasons. Well, note, I did not say that we were reasonable animals.
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One need only look at the unreasonableness of our society, our tastes, our conventions, the last 30 years of our politics to know that we're not always good reasoners. A purely reasonable society of beasts would have no place for deep-fried butter. For Avatar to be the highest-grossing film ever made, ever, or any need to keep up with the Kardashians at all, and much less for 20 years. So we don't think well all the time, but we are the only animal that does think.
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So Aristotle told us that there are three different modes of thinking, three different activities of thought. We can think in the abstract, we can think to do something, or we can think to make something. So we think speculatively, practically, or productively. That is, we think as knower, as doer, or as maker. There are no other activities of humans in as much as we are rational animals. We do, we know, we make.
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So when we think as knowers, we seek to know the truth. And when we think as doers, we seek to do the good. And when we think as makers, we seek to make the beautiful. So the difference between speculative and the other two forms of thinking is pretty clear. This is the difference between theoretical physics and engineering.
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Theoretical thinking seeks to know the beginnings, the ends, the middles of the various sciences. And this is knowing for knowing's sake. Practical and productive thinking aren't for their own sake, they're for something else. Speculative thought is an end in itself. Practical and productive thought are means to some other end. So then to distinguish then practical thinking of doing from the productive thinking of making, we have to look at those ends. That is, where do the activities of practical and productive thinking terminate?
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So when an agent makes something, the operation passes from agent to object. So a carpenter imposes the form of the cabinet in his mind onto the wood. He thereby transforms the wood. The purpose of the act, the good of making, lies in the external object.
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One looks at the object to say whether the act of making was a good act or not. A good cabinet is one that most excellently conforms to the idea of the cabinet in the carpenter's mind that's been transformed into that wood. A good cabinet can be made by a bad man. A good cabinet cannot be made by a bad carpenter. A good carpenter just is someone who makes good cabinets. Carpentry is productive kinds of things.
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When an agent does something, though, the operation stays within the agent. A man acts bravely by being brave. The operation of the act, the good of the doing, remains in the agent. One must look at the agent to determine if the act is a good one. So a good doing cannot be done by a bad agent. That's because practical activity is itself how agents are made good or bad. Bravery is a practical kind of activity. A brave man is made brave by doing brave things. Cowards are cowardly by doing cowardly things.
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Sure, a brave man in general can do a cowardly act, but in that act he's not brave. He's a generally brave man behaving cowardly. But at some point, if a generally brave man continues to act cowardly, he becomes generally what he is in those individual acts. He becomes a coward. And that's an important point. We are both what we do and what we have done. And what we do is at least partially determined by what we have done. We are continually making ourselves in the kinds of persons we choose to be. And our current choices are at the time.
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same time influenced by our past choices. The person who chooses to get out of bed every morning without using the snooze alarm becomes the kind of person who gets out of bed without snoozing.
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The more often she makes this choice, the more the choice becomes habituated, the more habituated the choice is, the easier the choice is to make. A non-snoozer can definitely take a day off and sleep in and still be a non-snoozer. And she can probably even take a couple of days off from getting up on time. What if she took four days off? Four days in a row, this non-snoozer snoozed. Well, probably she's still a non-snoozer. What about 14 days? What about 40 days?
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If you think you're still a non-snoozer after six weeks of snoozing, you're not only a snoozer, but a dreamer. There are only 40 days in Lent for a reason. 40 days make choices habits. Habits are curious things. They're not choices, they're not actions. Habits are dispositions.
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They're tilting towards a kind of choice. So snoozers have habituated the act of hitting the snooze alarm. They're disposed to sleeping in. Non-snoozers have habituated the act of rising with the alarm. They're disposed to rising. So one becomes a snoozer by snoozing, one becomes a non-snoozer by rising. So habits aren't just curious things, they're very important things. They actually make us the kinds of people we are. In fact, studies have shown that up to 40% of all the decisions we make in a day are actually habitual.
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And when we're stressed, we actually rely on habits even more. Thinking and choosing are hard and energy depleting. Habits make choosing easier, for good or ill. The reason why most of us eat poorly during times of stress isn't because stress makes us eat poorly, it's because we have not developed the habit of eating well strongly enough.
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If you're a health food nut and you've habituated yourself to recoil at the smell of McDonald's's fatty goodness, you're going to eat less McDonald's during times of stress, not more. This has been shown to be true of habits of what we eat, how we study, whether we watch the news. The stronger the habit, the more likely we are to engage in it when we're depleted. The weaker the habit, the less likely. In fact, this has been shown to be the case in infants as young as 15 months of age. Stressed infants exhibit more habituated behavior than non-stressed ones. Non-stressed infants exhibit more exploratory and novel behaviors.
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So we are free to choose, but we are not free from the habituation of those choices. If we choose well, we habituate the good choice and we develop a good habit. And that's the definition of virtue. A virtue is a good habit. But if we choose poorly, we habituate that poor choice and we develop a bad habit. And that's the definition of vice. A vice is a bad habit.
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If we choose well, our future choices are more likely to also be chosen well. But if we choose poorly, our future choices are more likely to also be chosen poorly. So keep with me. What does this have to do with knowing and doing and making? Or what does any of this have to do with medicine as an art? Well, that's because art is the good habit of making. Art is a virtue of making. Artists are those who have habituated making well. Art is the virtue of production.
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This is the kind of art that the ancients meant when they said medicine is an art. So, what virtue governs doing? Well, prudence. Prudence is the virtue of practical activity. Prudent people are those who have habituated doing well. So the word prudence comes from the Latin prudentia, which is a contraction of the words providence. Providence is where words like providence and providential and provisional come from. It means foresight, the ability to look ahead and choose correctly.
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So, prudence is the application of right reason to action, and art is the application of right reason to making. But we shouldn't think that doing and making are wholly separable activities. There's a lot of doing in any making. A carpenter has to think about the form of the object he wants to make, he has to choose to acquire the skills that allow him to make that object. And then he has to foresee problems that come up along the way in the making of that object. Those are all doings.
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And they happen in the application of any art. And for this reason, prudence not only governs doing, prudence actually governs all action, including that of artisans in at least two ways. So, first, artisans as persons need the general prudence that governs all activity. General prudence determines where, when, how, what extent a person will engage in any action. General prudence is the prudence Aristotle termed a moral virtue, a habit by which one is moral or not.
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I habit by which one is virtuous or not. That's general prudence. Through general prudence, prudence, a person is a good person. That doesn't mean you're necessarily a good artisan.
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Just because you are prudent in general does not mean that you will be good at an art. To be good at an art, artisans must have the special prudence of their art. An artisan must know how to practically be able to bring bring about their art work, and that takes the use of practical reason, prudence, to do so skillfully. But this sort of special prudence isn't a moral virtue, though. A good carpenter isn't necessarily a good person. A bad carpenter may in fact be a good person. And a good carpenter is just anyone who makes good cabinets.
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So the moral virtue of general prudence governs a carpenter as a person, but not his carpentry. The non-moral virtue of special prudence governs his carpentry, but not the carpenter as person. So general prudence then governs the application of his art to this time, this place, this person, or that, for these reasons or those. The special prudence of the art, though, governs the art itself.
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So a farmer is a prudent farmer in as much as he rightly reasons in regards to farming. And an architect is a prudent architect in as much as he rightly reasons in regards to his designing and instructing buildings. A medical professional, a doctor, is a prudent doctor in as much as he rightly reasons in regards to the practice of medicine.
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But medicine differs from farming and architecture and most other arts in that the object of the art of medicine is the body of another person. And because of this, other virtues must be brought to bear because action that affects other persons is a different kind of action than that which affects objects. So justice is the virtue that governs action regarding other persons. Justice is another moral virtue.
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There are some actions appropriate to do to an object that it would be unjust, immoral to do to another person. And there are some actions that are only appropriate to do another person and immoral to do to an object. One uses a saw on a tree in a different kind of action than one does on a person. One should respect persons in different kinds of ways than one does trees.
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It is this necessary role of justice in medicine that makes medicine a moral practice, because it is the making and doings that affect other beings directly and essentially. And because justice involves action, it too is governed by general prudence. But now we've introduced general prudence into the art of medicine. All arts are governed by the non-moral special prudence of the art, as is medicine, and all artisans are governed by the moral virtue of generous prudence, inasmuch as they are persons, as are medical professionals.
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But now we see that artisans who practice the art of medicine, us, that we are governed in our actions as professionals by general prudence as well. So being a bad carpenter means that one lacks the art of carpentry.
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Which is governed by the special non-moral prudence of carpentry. But being a bad doctor means one lacks the art of medicine, which includes both the special non-moral prudence of medicine and the general moral prudence involved in acts of justice, whereby we are morally obliged to treat others rightly. So a bad carpenter treats wood badly, a bad doctor treats people badly.
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A bad carpenter is someone who shouldn't be paid. A bad doctor is someone who shouldn't be allowed to work with the sick or the vulnerable.
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Bad doctors can be bad for multiple reasons. That is, a bad doctor could be bad because they last tech techniques of they lack the techniques of medicine. They don't know how to use the ventilator or how to treat shock or with antibiotics. They could lack in the practical decision of medicine. They could lack in the special prudence of medicine. And that's how doctors and carpenters are alike. They both have these special knowledges that they need to apply. But a bad doctor can also be bad by lacking general practical reasoning of doctoring, the moral expertise where we treat our patients with respect and kindness.
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And concern because they are sick and vulnerable and in our care. So to be a good doctor then, we have to have both the special technical expertise and moral expertise, because our art makes its production in the bodies of other people. So medicine isn't the only art that actually requires moral as well as technical expertise. Other arts also aim at other persons rather than products for other persons.
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Law aims at others' relationships with society, excuse me, society and state. Theology aims at others' relationships with God and cosmos. Teaching aims at others' minds. And that's why these are the four noble professions.
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We we moderns have difficulty distinguishing professions and other occupations, though, because we have a hard time saying why being a doctor is different than being a small business owner. We like the framework to say how a professional differs from a trade. That's largely because we voc we focus primarily on both being ways of making money. But if we want to know how professions and trades differ, we need to dispense with their similarities and focus on their differences. Effectively, and I'm going to go more quickly here.
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Professions are characteristically different than trades in that we have to publicly pronounce them. All the professions tell you that they're a you're a doctor, you're a lawyer, a priest. This is one of the reasons you wear their uniforms.
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Professions are persistent. You're always a doctor, even when you're not on call. They're noble, the goods they serve is honorable. They're arduous, they're very hard, these goals to pursue. They self-regulate. Professions all police themselves. So even before you had the Texas State Medical Licensures, you had guilds that would police ourselves. Why is that? Why is it that doctors have to police themselves?
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Well, it's because there are obligations required of physicians even when they are not on call. You are always a doctor. There's a couple of states actually that make it illegal for doctors to pass by a scene of an accident without rendering aid. If you're in Louisiana, Minnesota, or Vermont, it is a criminal offense for you as a physician to knowingly walk away from a scene at which an individual requires emergency treatment. In contrast to this,
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Think about all the times that people never intervene in in in cases of crime. This is the most famous case, the Kitagini Besi case. It sort of opened up this field of psychology.
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Kitty was a young nurse and she was raped and murdered in Queens, New York. And it found in the subsequent investigation that twelve, perhaps many as thirty-eight people witnessed portions of the attack, and that lasted approximately 30 minutes. No one called for help. No one physically intervened. So psychologists were disturbed by this. They studied the phenomenon.
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And what they ended up finding was that there's a diffusion of responsibility in a crowd. So the more you have people around you, the less that you are taking on that obligation. It was a very disturbing study. Now imagine I told you that those 38 people that witnessed it were doctors.
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It would be scandalous to think that there were doctors who didn't intervene. And so the dichotomy there tells you that there's something else going on by you professing to be a doctor, you're not changing your relationship with everyone around you. So then why is medicine a profession? Well, medicine's a profession because health is a honorable goal, but it's precarious.
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It's also a profession because the goal that we're seeking is as much a medical metaphysical problem as it is a physical problem. That when someone comes to you sick, they're actually come to you as dying. They're coming to you with an existential crisis. And when you are sick, you are no more reminded than anything else, except for dying, that you are not in control.
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And so this is not just a technical problem to solve, it's an existential problem to solve because none of us want to die. The doctor doesn't want to die, the patient doesn't want to die, and that's actually what's going on in that encounter. Whether or not the patient and the physician are actually aware of it or not. But in that relationship, when the sick are coming to me for help, this is a very imbalanced posture.
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That that although I am the kind of thing that could be sick, I'm not sick now. You are. You are in a very different posture than I am. You are coming to me for help. And I am dispensing help. But what also makes medicine a profession is that I know that I'm one of you. And that's what makes this an equal relationship. This very unequal relationship becomes equal. So
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What I'd like to end with is that I think what Professor Shriella found when he was traipsing about Chicago dresses one of us wasn't that this uniform meant something. It was that people made way for him because they knew that he was set apart. That the uniform itself wasn't setting us apart, it was signifying that that person wearing that uniform was set apart. And that's that's a great and terrible responsibility for being set apart.
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Medicine's greatness lies in our ability to help and heal in ways no one else can, with these techniques that no one else has. But its terribleness lies then in what this portends about our own personhood.
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We must be technically good and morally good at what we do in other ways that other occupations do not require. So if you were the kind of doctor who did not understand what was happening in this relationship, that this sick person was actually coming to you with an existential crisis, you're not a good doctor. And if you're not a good doctor, you are being unjust to people around you who have opened themselves to be in your care.
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We have to be technically good and we have to be morally good in ways that other occupations do not. And if we are, we are so much the better for it. But if we are not, we are so much the worse. I am thankful to be surrounded by such good professionals as I am here. I can tell that Hippocratic society is up to good things. I am thankful that you are such good people. Thank you.
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Yeah, th so this is why we invented baseball. So baseball is the only game that has errors. And baseball is the only game that that that calls someone a bad player, right? and and errors in baseball are are very subjective, but they're objective too. You know the shortstop should have caught that ball, right? What's interesting about baseball is if the shortstop is so out of position that he can't get the ball, then it's not an error.
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but why was he out of that far a position in the first place, right? and so we in the game we we we we decide that there's limits to what you can call an error, right? And so I I I think it's it's similar to that. It's it's it's Dr. Weiss's uncertainty that there is a common practice. That's why community is super important. Like what is the common practice of physicians in your community and are you meeting muster?
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So I think that's that's one form of failure that if you are habitually failing to meet muster, which then is why it has to be self-regulating, because only physicians can really know what physicians know and do. So that's why it's always been self-regulating. So you so one form of that is you're excommunicated from the guild, right? Another form of failure then would be that not habitually, but there are some sacrosanct things you do not do. That there's there's a black and white.
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and so thou shalt not kill, right? this is why the Hippocratics are super you know sensitive to these issues. they're sort of putting a a place in the ground. This is how you know what we are, we are not going to kill, and we're not going to treat you if we don't think we can help you. so I I do think there is a so when I say Aristotle, what I really mean is Aquinas. So certainly an Aquinas, he has the ability to understand for the most part.
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Right. So for the most part, a good doctor does things that good doctors do, and for the most part, they do not do things that bad doctors do. And they never go outside the bounds of these sacrosanct black and whites. But then all of a sudden you are smuggling in an entire different set of principles. This is not autonomy, it's not
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individualism at all. how do you know you're a good doctor? Well you ask other good doctors. And that's this circular reasoning that's found within Aristotle and Aquinas that's kinda maddening sometimes, but I think it's it's it's the case that the virtuous city is going to be the best place to know that a virtuous person is an inhabitant that city.
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No, no, it so there there is a real tension there. so in the Hippocratic Oath, one of the reasons why we don't take it anymore is that it forswears surgery. and so I will I will not cut on someone even with stone. Even if you have a you know a a renal calculus, the the doctors will not cut on you. Even today in in England, surgeons are called mister and not doctor. so there is this
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this this tension, I think, between surgery and medicine. and and it's kind of embarrassing for the Abragratico, so that's one of the reasons why don't say it. but it's a tension, but it also is resolved. So for sure, the technical capacities of a surgeon operating on you in a procedure that requires technique, right? that is going to be a higher bar than the technical abilities of a
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Of a physician who's not doing procedures, not doing technical things. That said, there are techniques to psychiatry, right? There are techniques to the interpersonal relationships. There are better and worse ways of doing these things, right? So on one end of the spectrum, I think, surgery, and on the other end, you know, pediatrics. You can imagine someone saying, I'm gonna go see Dr. So-and-so. You know, he's a jerk, but he's a great surgeon, right?
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I'm gonna go see Dr. And so-and-so. He's a jerk, but he's a great pediatrician. Said by nobody, right? But what if you said, you know, he's a great surgeon and last night cheated on his wife, got in a drunken drunken fight, got his DWI, right? You're like, there's something, there's something amiss there. There's something disordered about that. And that's why the Texas State Medic Medical Board is not the only one in the country that does this. It publishes every month the sins of its members.
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Every month the the Texas State Board of Medical Examiners sends out an email to all licensed physicians in Texas and tells you who is getting CME attached to them for filing late bills, or who's getting their license revoked because they slept with a patient. I mean, so can you you could not imagine that happening to accountants, right? Architecture digest doesn't have that list. so I so I do think there is a spectrum, but at the same time, when that surgeon
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Is interacting with the patient, if he does not recognize that there's more to going on there than the technical problem that the that the patient's having, because that technical problem is never a technical problem for the patient. It's a an existential problem. And so the if a surgeon does not understand that the body is way more than just a machine, he's actually a bad doctor. And that I think I there's no data on this, but I'm I'm pretty sure the Dr. So-and-so is an incredible surgeon and a jerk. That that
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Slice is way smaller than Dr. So-and-so is an incredible surgeon and such a good man. Like that's a much better, bigger slice, I think. so I do think there's attention, but I think in general it still works itself out this way. And it's gonna be more obvious in certain professions like these relational professions like psychiatry, like pediatrics.
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Well and I think that's you know, I think this is also one of the problems. This is this is me poking on the the bigger sessions was if you go into surgery thinking you're a technician, you're going to be miserable. Because it's it's too hard to be a fine technician and not a good person. and and and if if if you go into medicine for the prestige or the honor without the sacrifice of doing all you can for your patients who come to you because they're having existential crises, then you're gonna be miserable.
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