"To be a humanist doctor is a way of being in society. It is not a circumstantial addition to professional interests. It is a personal and professional option that shows itself in everyday work. It is not something cosmetic with a dash of culture and a whiff of snobbishness. It is a promise between people and a radical way of understanding man and life. In no way should the humanist doctor see this legacy as a kind of imitation jewellery, but as a precious intellectual cargo that should be taken care of and transmitted. To believe in humanity is to believe in a way of life constructed from noble values and with the intention that our lives will leave a positive impression on history.
Gregorio Maranon, considered by many to be the paragon of humanist doctors, reflected frequently on pursuing the humanist ideal as a doctor. I have read and re-read his broad introduction to the topic:
“In intelligent men the tendency is innate, that they live subject to the exercise of a profession, to compensate the monotony of that exercise with public practice or secret cultivation of other activities. We all carry within us a much more complex personality than our official façade indicates. Even in the case where we have found our true vocation, a hidden tendency – and sometimes more than one – pushes us to serve in silence occupations that do not win us bread and to catalogue ourselves in professional patrons. In this way we keep ourselves alive, in the first place, the necessary enthusiasm for diversion in a strict sense, that is, of combating the tedium of routine, official chores, the everyday, deriving part of our attentions to different paths. The profession more sincerely felt and loved, closer to our aptitudes, ends by being automatic, losing us in friction with the atmosphere, becoming an easy mechanism and in the end affected”
In this well known text, Maranon shows how the cultivation of humanities and arts as a diversion or pastime is useful for those who have a demanding profession like that of the doctor. I cannot share the totality of this vision, for it is limited in its objectives and scope. However we have to recognize that it is a position that is widely held among generations of doctors that choose a smattering of Humanism rather than embracing it as a way of life.
Maranon wrote other texts in which he expands on this subject. He realised that this reduced vision does not help to transmit the humanist ideal. He went on to consider Humanism as an attitude to life, that one either has or does not have. He acknowledges that it is difficult to teach and to learn, but we should strive to introduce it into the doctor’s training because of the undoubted benefits for all concerned. He himself overflowed with humanity and had plenty of humanistic training. Unfortunately, his texts have been used by the less well-trained and less intelligent to suggest medical humanities is nothing but a pastime, a respite from the real war.
To focus the debate on whether or not Humanist Based Medicine is a real option for medicine today, I will employ the words of another great Spanish medical Humanist Pedro Lain Entralgo. In 1971 he published an article entitled “Skill and Humanism in the training of modern man”. In the epigraph he asks: “Is Humanism in its death throes?”. Here is his beginning: “What is all this for? So that the doctor can interpret his electrocardiograms better or so that the chemist can more skilfully practise cryoscopy or fractional distillation? So the professional technician can earn more in the practice of his office? Undoubtedly, no… but neither for the simple enlightenment of the university graduate in the lecture halls at which he is present, or the conferences where he speaks. The humanistic training of the technician and the man of science has, in my opinion, a double ‘why?’: in the case of non-creative men of science and technicians, it serves to make them more fully men – so that they will operate on an intellectual and ethical level and not only in a biological operative mode – and apply what they learn to their own science and particular skill; in the case of creative scientists and technicians, in order to discover new horizons and even, on some occasions, new fields of study.”
Our belief is daring at the same time as attractive. We want to manifest a Decalogue, with the intention that it serves as a useful tool for the doctor. It tends towards an ideal, with some of its articles based on the doctrinal body of the Deontological code of Spanish medical ethics, and others on the ideas and values that originally conceived Humanism.
I wrote the first version of this Decalogue in the year 2000 and I published it in the (no longer existent) magazine of art, culture and people ‘Allegro’, which I edited. I have allowed myself the luxury of modifying some points from that first Decalogue, with the intention of improving and updating it."
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