Friday, February 4, 2011

Medicine: The Modern Priesthood (2 of 2)

Part 2

Priesthoods have served many various purposes throughout history, and have had many features which I’ve described. But the one that is perhaps most critical and constant is the role of the priest as intercessor for the people. Priests mediate between man and his gods. In ages past, these gods ranged from spirits of the deceased to Greek Pantheon and eventually to a unified God. The priests would be the intercessors, the ones who, through rite and ritual, could make the requests of the people known to the gods.

Doctors serve the very same purpose today. The people now are secular, and the gods whom they worship are material. We no longer fear lightning from Zeus, but we do fear thrombosis from Hypertension. We do not worry about black bile (“Melancholy”), but we do Major Depressive Disorder. Demons torment us no more, but bacteria do. There once were demons which could not be driven out, and now there is MRSA.

We have the role of telling people what the people must do to ward off disease, and if they are afflicted with it, how to cure it. Our role in society is the same. The major difference is efficacy. Shamans indeed mediated, but only recently have we developed the tools to have some assurance that we’re actually helping.
For most societies, intercession was no civil discourse between priest and god; it was a thing of fear and wonder. Throughout the ages, men would bring their firstfruits, the first and best of their harvest or animals and these would be given up to be sacrificed by the priests to the gods. The unblemished, the pure, the best, the strong were given to ward off disaster and to bring blessings.

We are no longer farmers, and we have no lambs to offer, but we also offer our first and our best. These payments are truly firstfruits; for many, healthcare is paid by the employer and the money is never seen by the employee. The major difference is not in currency, but in amount. Under a Theocracy, the Hebrews had to pay a tithe (“a tenth”) to God and this amount then became a benchmark (or goal) for giving in various Christian systems. But what do we hand over to our priests? Of every hundred dollars we earn, sixteen go to the priests (3). And unlike the merciful Bronze Age, we demand more from our poor than we do from our rich; we demand the poor pay twenty of every hundred dollars to appease our gods of disease (4). We make these huge sacrifices for the blessings of health and longevity just as our fathers and our father’s fathers have for generations.

So what shall we do? Should medicine repent of our becoming a Priesthood? No; the people have bestowed on us these holy garments, and we must honor them as best we can. Medicine is set apart (literally, sanctified) from other professions; our order predates the twentieth century. We have become part of a proud tradition, a tradition critical for the flourishing of the soul of humanity. We are not just chemical mechanics, raising blood levels of this, blocking receptors with that. One of our professors recently said, “People don’t come to a place like Stanford to be healed. They come to find out why this is happening to them.” A reason is what people want of us.

 I think the medieval physician Maimonides described our role best:
 In Thine Eternal Providence Thou hast chosen me to watch over the life and health of Thy creatures.(5)
We must remember that ours is a holy calling, one set apart. Let us make ourselves worthy of the honor bestowed on us. Let us humbly and graciously accept the trust our patients give us with their bodies and even their souls. They want us to walk with them, to explain the world to them, to talk with them. They want us to mediate for them. And though our training is mostly in offering dollar sacrifices to MRIs and branded drugs, let us be the sort of priests that aspire to heal both body and soul. Most of all, let us watch over the life and death of our patients.

(4) [Stat on poor paying more]. Baker, Lawrence “Health Policy: Health Reform: Proposals, Policies, and Politics.” Lecture. Monday, 3/2/2009


  1. thanks for your thoughts Dave, I particularly enjoyed the bit about fears changing as well the closing. I keep said "Daily Prayer of a Physician" handy after being handed a copy by a wise patient on my first third year rotation. I think it was actually written by Marcus ben Herz rather than Maimonides (though not surprising that it was attributed to the latter for a long time).

    Hope you are well


  2. That is an awesome prayer! It's so much better than all the other physician oaths!

    Maimonides Prayer (the long one) seems to be actually from Maimonides (at least according to the 1917 "California State Journal of Medicine", see the second reference); the shorter Oath is probably from Herz. I had previously quoted the Herz version; thank you for the correction.

  3. Interesting writing....I would add that Christian doctors should be representatives of Jesus Christ (2 Cor 5:20)and should have more than just physical/chemical answers. CCC offers Health students spiritual preparation in the Health Student Project

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