By Jonah P. Zuflacht
On a sun-soaked spring afternoon this past May, a group of medical students gathered for rounds. As is customary, we arranged ourselves in a semicircular distribution around the patient. Yet this was no surgical amphitheater but rather the (far less sterile) courtyard of the new American Wing at the Metropolitan Museum of Art. Our patient: Daniel Chester French’s monumental marble sculpture The Angel of Death and the Sculptor.
This was our last session of narrative medicine – a course designed to provide medical students with the ability to “recognize, absorb, interpret, and honor the stories of illness.” For our final assignment, we were asked to choose an artwork that you associate with a patient encounter.
French’s piece, a relief sculpture depicting the winged angel of death, intercepting a young sculptor’s hand, was the choice of a colleague. According to his interpretation, the work symbolized the sacred duty of physicians to “help the patient live as long as possible.”
His commentary prompted a powerful retort. Is this truly the role of the physician? Fending off the inevitable? Do we measure success by increased quantity, or preserved quality, of life?
Such questions are emblematic of a pervasive problem facing modern medicine – an expectation that the profession possess the capacity to cure and the facility to fix. As Marvasti and Stafford note in a perspective published in the New England Journal of Medicine, “Societal expectations of a ‘magic bullet’ and a focus on symptom relief…reflect and reinforce the reductionist approach. These scientific and societal values emphasize discovering a ‘cure’ for the major causes of death.”
For more than a century, medicine has embraced this misguided sense of omnipotence. “This strategy made sense 100 years ago, given the prominence of acute infectious diseases in a young population;” Marvasti and Stafford write, “it makes little sense now.”
Lown Institute, where I have interned this summer, is beginning to steer the conversation in the right direction, by drawing attention to the harmful byproducts of this “curing” philosophy, such as the overuse of medical services. A growing network of like-minded individuals – the RightCare Alliance – is sponsored by the Institute and provides a unique opportunity for sharing success stories and inspiring collaboration. RightCare Rounds, for example, engages enthusiastic, creative clinicians committed to changing the status quo. Meeting in Grand Rounds fashion, they discuss sensible approaches to delivering the appropriate care for patients.
As Dr. Bernard Lown himself proclaimed, doctors “are experienced in observing the process of dying, and indeed, they frequently shape the traverse of the final denouement, either as chief perpetrators of a technologic obscenity or as orchestrators of a serene passage.”
In today’s healthcare environment, backward financial incentives tend to reward the perpetrators. Medicine’s cultural aversion to ambiguity, meanwhile, disparages the orchestrators that remain. As we shape the next traverse, for both our patients and our healthcare system, it would benefit doctors, and doctors-to-be (like me), to recall French’s wish “…to protest gainst the usual representation of Death as the horrible gruesome presence…”
Jonah is proud to continue his family’s medical tradition as a third-generation physician, committed to restoring humanism to medicine. His other interests include healthcare quality improvement and innovative care-delivery models.