Thursday, February 3, 2011

Medicine: The Modern Priesthood (1 of 2)

Part 1

At Notre Dame in Paris
We have always known that physicians had a special role in society. For some of us, that may have been one of the things that got us interested in the field. Our profession is unique, but it is unique in a way that sets it apart from all others. There has been another class of people throughout all of history in nearly every society that has been in a similar position: priests.

There are many superficial similarities between the priesthoods of old and our present system of medicine, and then one really special one that I believe has been a central unbroken cord throughout human history.
The first thing to note about priesthoods is that many of them were hereditary. The priesthood would be passed on from generation to generation. Though we don’t like to admit it, medicine is the same way.  In the US, the prevalence of doctors is 2.67 per 1000  (1). If medical students were taken equally from all families, one with any parent with an MD should come around slightly less than every other year (2). Do you know of anyone in your class whose parent was an MD? Statistically, you shouldn’t.

Another thing that priests throughout the ages enjoyed was the respect of the people. Our priesthood is no different. What parent hasn’t coaxed, if ever so gently, entrance into this order? Which of your parents didn’t brag when you got in? But beyond simply proud parents, there is the average Joe on the street. I heard a story of a doctor who shared at a party that he had invested in a particular stock. Someone at the party heard it, sold his stocks, and bought the one the doctor did. Why? Because doctors are smart (a modern translation of ‘blessed’)! We have a world of opportunities before us, far exceeding the scope of our explicit training. How many of us have positions which were utterly closed to us the moment before we got the call from Dr. Garcia?

Society rewards our hard work with one of the highest and most regular incomes available. There are outliers who make more than us, but as a class, even counting our schooling and malpractice insurance, we will do very well for ourselves. Like confessors, people reveal to us their darkest secrets. What other class of people is entrusted with an incredible spectrum of substances so powerful and even lethal that they can prescribe as their opinion dictates? What professional since the Inquisitor could, on the authority of his opinion alone, deem a person a danger to others and have him imprisoned without recourse or appeal (5150)?

And what priesthood is complete without a Rite of Initiation? There must be some way that the uninitiated pass from the laity to the priesthood. Hebrew priests would memorize the entirety of the Torah. We must memorize the entirety of First Aid. Medieval priests would speak in Latin, a language that no one understood, thinking it holier. We speak in a language that our patients don’t understand, thinking it science-ier. “Unfortunately I don’t know what caused your…” becomes “idiopathic” and “I’m terribly sorry, but I screwed up,” is “iatrogenic.” Through the initiation into the old priesthoods, the hierarchy of the institution would be made clear; the initiates would painfully learn that, though they were above the people, they were at the bottom. We have learned and are learning that we are not on top. Though Stanford does not make us wear our shame with inadequate short white coats, pathologists point to invisible findings that are ‘clearly evident’ and attendings use many great and terrible implements of humility (including pimping).

Go to Part 2 --->

(2) The probability of having either parent a doctors is 1-(1-2.67/1000)^2= 5.33 per 1000, or about every 188th person. With class sizes of 86, that’s rarer than 2 full Stanford classes. 


  1. I'm looking forward to the second part. Maybe a priest as mediator element? You've got me on the edge of my seat.

  2. "Seriously, baby, I can prescribe anything I want." - Dr. Nick

  3. Thanks Dr. Nick!

    We actually can. That's the scary thing. In a few short years (3, if everything goes according to plan), I'll be able to "prescribe anything I want"