How Did The Profession of Doctors Emerge?

In 1849, Elizabeth Blackwell became the first woman to be awarded the degree of medical doctor. Two years prior, she had applied to 19 medical schools. At the Geneva Medical College, they did the unconventional. They let the students decide, with the criteria that if even one of them declined, she would not be admitted. They voted unanimously, convinced she would not succeed.

Medical schools used to admit male students. Females were left out. Countless times, in the past, men have underrated the ability of women in spaces where they eventually were disproved. My favourite example is the women of the Six Triple Eight Battalion. Blackwell’s case was no different. She graduated at the top of her class.

Quick dismissal of the unconventional is not new in medicine. And yet, becoming a doctor is unconventional. We assume it’s natural when, in the wild, we don’t see such a cadre.

In the past, humans resorted to options that, in retrospect, seemed strange. And yet, in the history of healthcare, unconventional means have been the steppingstones that led to the changes we continue to see in medicine. It starts with a group which society calls physicians or healers.

Understanding the origins may alter our perspective on the care of patients. It may even inspire clinicians to break away from the sacrosanct norms.

Doctor, the word, has its origin in Latin. Docere means “teach”. A doctor is meant to be a teacher. Nowadays, doctors don’t suffer fools. I have witnessed this in my practice. And the best way to discern where a doctor is a “docere” is when they break down bad news or give a family updates on the care of their loved one.

Richard Feynman once claimed that if you cannot explain it to a 6th grader, you don’t understand it. A doctor is meant to explain to families in a way that makes it easy for them to understand all that the clinical team is doing to support or treat the patient. This is my usual Tuesday, having worked in ICU for over three years now.

The best way to understand a topic is to teach it. Lecture halls are flooded with medical students who don’t have this perspective. Doctors, as Dr. Walong would remind us, were meant to diagnose and treat. Most of the top students who matriculate to become doctors don’t have the patience to teach families. Some don’t even spare time to train their juniors. Those that do are a special breed; they understand the relevance of succession.

Bedside teaching underpins the role of the doctor. See one, do one, teach one. It also means that just as the tool shapes the toolmaker, the patient shapes the doctor. As much as the doctor is supposed to teach, they are students; students who learn from patients and diseases. Patients are selfless teachers, without the doctor’s training. Doctors, should they embrace their teaching roles, learn from every patient. From a professional standpoint, a qualified doctor is first and foremost a teacher.

Teachers held positions of authority in ancient history. But they never used writing as their main medium of instruction. The first teacher was the parent. Oral narration was the natural means of instruction. Stories had lessons children carried into adulthood, which they passed to their offspring. But even parents had those they revered, those they looked up to.

The greatest storytellers were lyrical poets and musicians. Music was the best education. It still is. Children are taught the alphabet in rhyme. We remember the songs into adulthood. It’s hard not to change a song once it’s set. It’s also shared and communally owned. Teaching was and should be a social enterprise.

In contrast, modern academia gets funding from taxpayer money, and the results are published in paywalled peer-reviewed journals. With the advent of text, teaching shifted gears. Teachers no longer use music. And no lecturer in medical school uses music (I’m hoping to change that, as I always try to inject aspects of music in all my classes). Music is dismissed just as it was by the authors of ancient texts.

Imhotep was the Egyptian physician and arguably the father of medicine, contrary to the popular narrative that Hippocrates holds this title. Coincidentally, Imhotep was a revered poet. And he was also a high priest.

In Greece, the Oracle of Delphi, the priestess from the temple of Apollo, made her prophecies and issued her instructions in dactylic hexameter, the poetic structure that was used to establish authenticity and authority. As the Oracle was purported to get instructions straight from the gods, musical or lyrical instructions were taken as the language of the gods. J. Ivy raps:

But I get my hymns from Him. So it’s not me, it’s He that’s lyrical
I’m not a miracle. I’m a Heaven-sent instrument

To my knowledge, no doctor teaches the relevance of music as a topic in schools. And yet, some of the surgeons I know would hardly work without music playing in the background. Dr. Fawzia Butt, the leading maxillofacial surgeon in the country, doubled as my mentor and supervisor. She used to tell me that she could not start her operations without playing house music. I have seen the trend in many operating theatres.

In the ICU, one of the cardiothoracic surgeons likes to perform procedures, such as inserting permanent dialysis catheters, with music playing in the background. I too don’t like to begin a routine procedure I know may take some time without playing music. The effect is not as heavily studied as other interventions in the pharma field.

Music is one unconventional concept that may be quickly dismissed, yet it served as the best means of instruction among an illiterate people. In the same vein, an unconventional decision led to women being admitted into medical school. The practice of variolation marked the beginning of vaccination, after an unconventional idea was tried and eventually tested.

Once texts were used as a symbol of authority, music lost its lustre. Its impact, nevertheless, remains. What’s more, since music was considered to be the language of the gods, musicians doubled as priests, shamans, healers and physicians. Imhotep was the high priest of Egypt. Hippocrates, however, began writing and debunking much of what they thought was superstition. Who wouldn’t think music as therapy was superstition? I’ll address that in a bit.

For now, we need to trace the origins of the modern-day docere. This, you will find, is in music.

We are all here for a reason on a particular path
You don’t need a curriculum to know that you a part of the math

— J. Ivy

From an evolutionary perspective, doctors are unconventional. According to the gene-centered view of evolution, a doctor is an anomaly.

Organisms are meant to support their kin, so their genes could be propagated in subsequent generations. It’s a selfish strategy. Doctors care for everyone. They don’t do genetic relationship tests before attending to the sick. It’s like the lifeguards. They jump to save whoever may be drowning.

This cadre has existed for millennia. We have only recently known about genes. Not all doctors know about genes. Geneticists don’t even know about genes. The more we study them, the more they mystify us. Selfish strategies cannot explain the generational persistence of the health caregiver.

One way to explain how this group could have emerged and persisted is the authority that is given to these professions. Long ago, the healers could double as musicians. Remember, they were touted to be in communion with the gods. As for those who didn’t, they had a good understanding of medicinal herbs and portions. Reverence for the healer stretched across all class stratifications.

Respect was always sought. In the animal kingdom, it comes through the pecking order. In eusocial groups, the leader, usually the queen, used pheromones to bend the colonies to her will. This authority came with perks. Food. Mating options. And yes, respect.

It made sense that those inducted into these professions would undergo special training or rituals. It had to be kept secret to have the kind of reverence it is known for. Today, doctors spend countless years in training. Before they are awarded the title, they have to make an oath, a practice consistent with private sects and cults.

The oldest known texts on medicine date to the evolution of medicine and surgery. Texts were used as objects of reference for training, as was the oath established by Hippocrates. Doctors were to observe the highest goals attainable in preserving life. Do No Harm. Over the years, this has been modified. Texts tend to have this malleability.

As with text, so it is with the title of physician. It began to be separated from ideas of superstition, music, communion with the gods, and more logic, empirical factors started to gain precedence. The theory of humours was one of the products of this type of thinking, further propounded by Galen, hundreds of years after Hippocrates. Today, we know the theory to be false.

Through documentation, texts began to cement the authority of doctors. The word “author” gains its roots from the word authority. As it was in the past, authority came with its perks. Food. Mating options. And yes, respect.

Doctors were no longer regarded as teachers. They were the new versions of healers. From the gene-centered view, they moved from one oddity to another. Educational institutions now treat teachers differently from doctors.

Strangely, the highest form of education regards individuals as doctors. The title of PhD holds its origins in teaching. Nevertheless, preserving these origins does not erase the fact that teachers also teach those who are not their kin.

The underlying feature in all these perspectives is that healthcare has been unconventional from the get-go. And medical guidelines are just that — lines that guide. Courts need to have this in mind, because a doctor, a person who has had sufficient training, may decide to go against the guideline if they can logically justify their actions.

Evolution, also, makes leaps, genetically or otherwise, to establish the arrival of the fittest. Medical professions use guides, borrowing the authority of survival of the fittest. New ideas and interventions are examples of the arrival of the fittest. Medicine would hardly make progress without these perks.

To this point, a doctor is an unconventional teacher who diagnoses and treats without prejudice. Tongue in cheek, you could say doctors are naughty by nature.

In the same spirit, I would wish to take us back to a time when we used unconventional means to treat patients. The similarities. But first, we need to define music.

First, I had they ear. Now, I have they heart

— JAŸ-Z

Music is the art of using an instrument to generate ordered sounds with purpose. Birds have syrinxes. Humans have larynxes. The club-winged manakin has solid ulnar bones.

Ultrasound is a detection tool. Unknown to most doctors, we have been using musical instruments for decades. The idea of using ultrasound began in World War 1, a time when human lives were being lost and found, the typical story in any hospital. Today, this tool is being put to use in a myriad of ways.

In children, transcranial ultrasound is used to observe cerebral blood flow and strokes. In adults with abdominal bleeding, FAST scans are used to detect fluid in critical body spaces. Fibrosis scans can establish the degree of fibrotic changes in the liver. Dopplers can find thrombi in vessels. Phacoemulsification is a treatment option for cataracts. Histotripsy is a means of treating cancer. Lithotripsy breaks down urethral stones using sonic waves.

These are all medical strategies that use an instrument to generate ordered sounds with a purpose. They are musical in spirit, origin and structure.

I have already mentioned how doctors can use music when performing procedures and operations. I am guilty in this regard. Stranger still, music is used to induce various trance-like states. A shaman would prepare a potion and use musical instruments and songs to conduct a visitor into an altered mind state. Today, doctors have dropped music and now use anaesthetic medication to change the mind state of patients, usually before operations.

Ketamine is one of these medications. It’s known for its dissociative effects. Patients in recovery after a dosage of ketamine usually experience hallucinations. This is hardly any different from what the shamans and healers used to do. What distinguishes the two is the use of music. This effect is seen in large EDM concerts, where attendees take various substances, and the music converts the crowd into various trance-like states.

In Foundation, the series, the Mule uses a musician to control large crowds. The gifted music conductor used music to control mind states. It’s harnessed in hospitals, although limited to interventions such as ultrasound. The practice has been disassociated with medical potions, what we call sedatives. Anaesthesiologists cannot take a patient under using music, but they will be in operation theatres where the surgeon plays music before and after a patient has been infused with anaesthesia. The practice of shamans continues in hospitals. As JAŸ-Z raps:

I seen them put it together, watched them take it apart

Perhaps the reason music can hardly be prescribed is that it cannot be manufactured like pharmaceutical drugs. It cannot be prescribed in regular doses. Big Pharma cannot make money off it. We have therefore not taken it seriously as we may, like all the unconventional options that have been tapped to improve health care.

Maybe we should. After all, the origin and persistence of doctors has been unconventional from the start.

Cats think I’m delirious, but I’m so damn serious.

The first docere began with selfish ambitions turned generous. The actions are unconventional. The modern world has most practitioners weary of litigation when the unconventional is at the heart of the practice.

I’m particularly interested in music, which creates outcomes that don’t have the fine lines of medication. But if we’re to observe keenly, drugs have desired, side, and adverse effects. Music does too. The origins of the doctor too had their desired, side, and adverse effects.

We have answered the question that formed the topic of this article. It’s unconventional. As for the subtitle, that too has been answered: the doctor emerged for unconventional reasons.

This song inspired some of the lines used in this article. Source — YouTube