The old humanities and the new science at 100: Osler’s enduring message
MEDICINE: AN ART BASED ON SCIENCE
Yet this effort may amount to a rearguard action that arrives too late and provides too little. The humanities should probably be taught before medical school.29 After all, if it’s possible to make a scientist out of a humanist (Osler was living proof), the experience of the past decades seems to suggest that it’s considerably harder to make a humanist out of a scientist—hence the need to revisit undergraduate curricula and admission criteria to medical school, so that students can receive an adequate foundation in both arenas. Ironically, students express positive attitudes toward a liberal education and think it would actually help them as physicians.30 Yet they also understand that the selection process remains tilted towards the sciences.30–32
For Osler, scientific evidence was important but not a substitute for a humanistic approach. As he reminded students, “The practice of medicine is an art based on science,”33 whose main goals are to prevent disease, relieve suffering, and heal the sick. To do so, one ought to care more “for the individual patient than for the special features of the disease.”34 But he warned them, “It is much harder to acquire the art than the science.”35 In fact, “The practice of medicine is a calling in which your heart will be exercised equally with your head.”33 Hence the need to “cultivate equally well hearts and heads.”34 Almost foreseeing our infatuation with guidelines, he also warned against turning medicine into assembly-line work. There are “two great types of practitioners—the routinist and the rationalist,” he said in 1900, and “into the clutches of the demon routine the majority of us ultimately come.”36
Like most great people, Osler was a man of lights, shadows, and contradictions, probably not quite the saint we wish to believe. Yet he provides insights that are as valid today as they were for his own times, and possibly even more so. His 1919 speech is a paean to the humanities, but also a potential eulogy. As a Victorian physician, Osler was a blend of the new science and the old humanities. He knew that “the old art cannot possibly be replaced by, but must be absorbed in, the new science.”35 Yet he could also see the upcoming split between the two cultures, and he tried to warn us. He could in fact foresee the end of an entire way of life. As he said in his address, “there must be a very different civilization or there will be no civilization at all.”1
The crisis we face in medicine today may indeed be a symptom of a much larger cultural shift. As Osler himself put it, “The philosophies of one age have become the absurdities of the next, and the foolishness of yesterday has become the wisdom of tomorrow.”33 Like Osler, we live in times of transition that require us to act. If in 1910 Flexner gave us science,37 Osler in 1919 reminded us that medicine also needs the humanities. We ought to heed his message and reconcile the two fields. The alternative is a future full of tricorders and burned-out technicians, but sorely lacking in healers.
