Trust & Character

With Dr. Jonathan Imber

Episode Description:

Today, Ben chats with professor of sociology Dr. Jonathan Imber about his book “Trusting Doctors, the Decline of Moral Authority in American Medicine” which examines how American physicians in the early 20th century acquired an unprecedented level of trust that was subsequently lost.  They touch on some of the themes from the book, the importance of reflection and character for medical trainees, and Ben asks Dr. Imber if the medical profession can regain some of the trust it previously held.  Listen to find out where some of that trust remains!

Show Notes:
18:44 – “The Finest Traditions of My Calling: One Physician’s Search for the Renewal of Medicine” by Abraham Nussbaum
18:53 – “What Matters in Medicine: lessons from a life in primary care” And, “A Measure of My Days: the Journal of a Country Doctor,” by David Loxterkamp
19:57 – “Treatment Kind and Fair: Letters to a Young Doctor” by Perri Klass

20:40 – “Taking Care of the Hateful Patient” NEJM article by James Groves

33:10 – “Forgive and Remember: Managing Medical Failure” Charles Bosk

Ben 0:00
Hey y’all welcome back to beyond surviving residency, a podcast dedicated to helping residents like you find more rest, fulfillment and clarity amidst the chaos of residency. I’m your host, Benjamin long. Through this series, I hope to equip you with practical tools to move away from just surviving residency, and toward flourishing despite it. Today, I’m chatting with Dr. Jonathan Imber. He’s the Jean Glassock professor of sociology at Wellesley College. And prior to that was the class of 1949 Professor of ethics, his research is both sociological and historical, addressing the moral and ethical foundations of modern medicine, and the role that religious authority has played in defining the medical vocation. His book “Trusting Doctors, the Decline of Moral Authority in American Medicine” examines how American physicians in the early 20th century acquired an unprecedented level of trust, and then traces the subsequent decline of that trust. It’s fantastic read and my discussion with Dr. Ember today is equally great. We touch on some of the themes from his book, The importance of reflection and character for medical trainees and speculate whether or not the medical profession can regain some of the trust that previously held. And I hope you’ll enjoy this conversation as much as I did. So let’s get started.

All right, I’m here with Dr. Jonathan Imber. Dr. Imber, thank you so much for coming onto the show.

Jonathan 1:45

Thank you for having me.

Ben 1:47

Yeah, absolutely. And I do want to say, I’m really appreciative of your book, “Trusting Doctors”, which I’ve kind of already given a snippet of that to the listeners. But I actually I think I actually found the book just at like a secondhand bookstore, when I was just kind of perusing the medicine section, and immediately gravitated to the, the title and the purpose of it. And it was in my last year of Pediatrics training. And I just remember this feeling of clarity, because I feel like so you know, for medical education right now, we are so disconnected from our history and the context of what’s brought us to where we are in medicine today. And I feel like your book really helped ground me in that history a little bit better. So thank you so much for your time and writing. I really appreciate it.

Jonathan 2:44
I appreciate your comments. I think it’s worth saying that the book was published almost 15 years ago, and I had been working on it probably for 10 years before that.

Ben 2:57

Jonathan 2:58
But what’s important to me is that not only did you find it, but that when you read it, you recognize – and I appreciate this very much – you recognized that even though it’s giving an account of past historical issues in medicine, there’s still something to be said, for trying to bring that understanding in the past, into our present to make sense of what we feel is going on today.

Ben 3:29
Yeah, yeah, absolutely. And, and so if you can give us a little glimpse into how did you become interested in kind of researching and writing on the topic of the book of trusting and doctors and the shift that occurred in American medicine?

Jonathan 3:47
Well, the short story is, I’ve always been interested in the intersections between religion and various institutions, medicine, law, and the like. And I was reading an article that referred to a commencement address that a minister had given to medical students in the 19th century. And I thought to myself, That’s very interesting, because what I was always trying to do was to make sense of not just what doctors think about what they’re doing, there’s plenty of that written, but what outsiders people not in medicine, thought about what doctors are doing. And this commencement address led me to the National Library of Medicine 30 years ago, and I dug out for them a whole range of commencement addresses and sermons that ministers dominantly Protestant ministers had delivered to medical students at different points. In the second half, particularly in the second half of the 19 century, and what struck me at the time, was that, even though we would probably say, there was a lot of rhetorical flourish in what these ministers were saying to doctors, they were actually making sense of how doctors should think about themselves as much as how doctors did think about themselves. And so I wrote the book, first with these addresses in mind, then I realized, well there other religious traditions in America, even in the 19th century, besides Protestant ones, and I wrote a chapter on the Catholic thought on medical practice. And here the difference to me really stood out that Catholic casuisistical/casuistry approaches to thinking about medical matters. “What do we do in this situation?” “How do we make sense of our decision making process?’ and the like, was very different than the, what the Protestant ministers were saying to the doctors who were saying, in effect, “You have to be upstanding in your character. You have to engage in a way that elicits trust on the part of patients.” It’s not that the Catholic doctors didn’t agree with that sentiment as well. But there was very different kinds of sense that the Protestant ministers had about what it meant to be an upstanding, Christian doctor. And don’t forget that in the second half of the 19th century, the demographic sociological fact was that the vast majority of doctors were white male Protestants.

Ben 6:58
Yeah, and I think it’s so critical to talking about this rise in the trust in medicine, as you so aptly put in your book. And I think one thing I know I didn’t really think about a lot was the fact that the time before that there is a period of, or there’s always been some amount of distrust in medicine, as far as one just kind of what medicine was able to offer for so long to people. Can you go into that at all a little bit as far as kind of what preceded this rise and trust in American medicine?

Jonathan 7:42
Well, I think that the, again, the short answer to that is that, by the end of the 19th century, doctors are actually able to do a number of things, like recognize diseases, treat diseases. And that’s success had a great deal to do. In a kind of parallel set of developments in the history of medicine, it had a lot to do with establishing trust. But there’s a kind of irony or if not, that a paradox that’s built into the actual scientific, medical, scientific improvement of medical treatments. Because throughout the 20th century, it raised the sense that doctors knew how to do things. And when they didn’t, when that didn’t work, it created a certain degree of uncertainty on the part of patients who were not any less grateful for being healed. But who had much higher expectations, because by the time we get to the second half of the 20th century, you see how consequential specialization that really began in the 1960s had on patient trust in doctors. And you know that 1960 was the last year that the American Medical Association gave them an award called GP of the year general practitioner of the year. And it’s then in that period, that there’s a whole re orientation about these kinds of expectations about not just who to trust, but who could be relied on as a specialist to provide the kind of treatment that would result in a successful outcome. And I think that what parallel that, to me, what was interesting was that doctors were being characterized in a much more instrumental way to achieve the ends that Madison had always sought. And you find then in the 60s, that a variety of movements, social movements, we call them in sociology did developed a kind of distrust of the medical establishment not so much individual doctors that would come a little later and a dramatic rise in malpractice suits. But all of those developments created an opportunity for a whole new movement of reflection on what doctors were doing that came to be called, as we all know, bioethics. And I’ve written about bioethics, really, as an outsider, I have not considered myself a bio ethicist in any particular way. But I have been interested in the way that bioethics became a kind of informal appointed voice for how medicine should understand itself and how it should proceed. And I think I said in the book that if you are looking for the way in which that kind of movement, the bioethics movement developed, you had doctors who were getting degrees in philosophy, were going to law school, there are all kinds of representatives like that today. And medicine itself became a way of insisting on a public reflection on almost everything doctors did. So historically, outsiders didn’t really develop an intense scrutiny of the internal workings of medicine. On the contrary, the trust was so profound, I think, up until the middle of the 20th century, that doctors were able to form their associations and their approaches, based on what they thought was the best way to go. And then the second half of the 20th century becomes our time, really, which is that there are a lot of competing voices outside medicine, that want to help the profession determine how it should be best organized. And I have more to say about that. That’s not particularly in the book at this point. Because I do think that you can’t say that the way that the medical system in this country is organized, that it hasn’t had a really profound effect on the morale of doctors in training, I understand that. And I think that it needs to be depicted more as a way to help doctors who are in training, come to terms with the fact that there’s some things they can do things about, and there’s some things that they can’t, and the pressures that exist on the outside, economically, structurally, are there. And so what we would I do as a teacher of undergraduate women, is to encourage them to think about how they can best manage and cope with exigencies that are greater than their power to do anything immediately about.

Ben 13:07
Yeah, I would love for you maybe to go into some of those things that you’ve suggested.

Jonathan 13:13
Well, the first thing I would say is that by associating yourself with others who have similar kinds of concerns, because, you know, the medical profession is a big tent. And there are a lot of people who choose to go into it with different motives and the like. But people who have similar motives, might be able to find a kind of respite in what I have been engaging in for the past decade or more. One is called the conference on medicine and religion, which started in Chicago, and is a kind of gathering of people who really do think that there’s are important connections between their religious traditions that they come from, and the practice of medicine. And I don’t mean that they come to say that my religion says, we have to do it this way. And your says that it’s really about getting people together, just to talk about the ways in which a basic condition of human existence that arises when we’re confronted with such serious questions about death, and illness and suffering, and the things that doctors obviously see a great deal more of, than the rest of us mortals. And that conference, I think, has two purposes. It’s one to get people thinking about those things, but getting them together, to commune to be in each other’s presence to assure the people there that they’re not alone. And that’s just once a year so it’s not a huge Each byte of time commitment. The other one that I’ve also been attending, which is much less known, because it comes out of particularly a Catholic tradition, called Communion and Liberation, whose founder was an Milan Italian physician, rather, minster priest named Luigi Giussani. And that’s called the “American Association of Medicine and the Person,” which is a kind of gathering of like minded, committed Catholics in this case, but not just them. They bring in people from many different backgrounds and traditions to do in effect what the conference on medicine religion does, which is to provide people with an opportunity to reflect, I would call it in a broader tradition, that they present kinds of retreats that help people think about the role that religion and in particular spirituality. You know, there’s, there’s a lot of talk about what the differences are, may be between religion and spirituality. And spirituality has the beneficial sense of it, that you can find spirituality in every religious tradition, or at least most of them. And that inspires people to come together to say, “Well, from my tradition, I look at dignity or I look at suffering, or I look at any number of issues that doctors face, routinely, from my tradition,” and you can learn something by listening. You don’t have to end up believing that’s not the point. The point is that you’re in an environment that these reflections can can take place. The only other thing is, you may have noticed, I’m an inveterate reader, weekly of the Journal of the American Medical Association and the New England Journal of Medicine in particular. And when I’m pointed to other, more specialized journals, I’m always looking as for instance, in JAMA, there’s a section called humanities and with, with some very interesting kinds of articles, music and the Hippocratic oath and the like, and the New England Journal of Medicine, there’s a section at the beginning of each issue called perspective. And there have been some powerful voices, all of them come from people inside medicine, so that there’s even a kind of communion there are people who are writing both. I think I kind of call it a kind of therapeutic effort to try to describe their feelings for what they’re encountering, and that the encounter of a doctor and a patient is something worth reflecting on. It’s not as my students understand, by the time we’re done with the course. It’s not just a job. It is a job, but it’s not just a job. Yeah. So I think that there are also some recent books that have been written by doctors that acknowledged the fact that it’s important for doctors to talk among themselves about these things. And the one I would most recently recommend published a couple of years ago by a psychiatrist named Abraham Nussbaum, N-U-S-S-B-A-U-M, out in Colorado, called “The Finest Traditions of My Calling: One Physician’s Search for the Renewal of Medicine.”

Ben 18:51

Jonathan 18:53
And another may be less known as by a country doctor up in Maine named David Loxtercamp who wrote a book called “What Matters in Medicine: lessons from a life in primary care.” And another one, “A Measure of My Days: the Journal of a Country Doctor,” the these you know, the physician writer, has been with us for quite a while. It goes all the way back to Oliver Wendell Holmes, the senior not the justice, but his father, who, who taught here in Boston, pathology in fact, and who wrote consistently about issues in medicine, both novelistically, and met and in a more medical frame of mind that has been routinely copied by many physician writers, the one who I assigned to my class early on is Perri Klass, K-L-A-S-S, who wrote a wonderful book about letters to her son, who who’s gone into medicine, he’s, I think he’s a psychiatrist. She’s a pediatrician. She has a wonderful fluid prose that enables students to immediately enter into the world that she wants them to understand and reflect on. One of the things that I have been interested in for a very long time is based on a classic article, I don’t know if you’re familiar with a cold, the hateful patient.

Ben 20:39
No, I’m not.

Jonathan 20:41
It’s kind of a classic statement, “How do doctors deal with people that they have a reaction to?” That you and I and other people would probably say, “that’s not right, you shouldn’t feel that way about that patient!” But in fact, you do. And how to think about that, and how to manage it from a humanistic perspective, is acknowledging that the way that we understand others, and the way that we understand ourselves is not only complex, but it has a fragility to it it, it has a dimension of uncertainty.

Ben 21:25
Yeah, yeah, absolutely. Wow. Thank you for those suggestions, and is of resources. And yeah, I think what you were saying that really resonated with me on part of the importance of not only the humanities, but also bringing our full selves to medicine, and how that is unique for people who have a commitment to a religious identity. You know, I’m curious, from your perspective, how that has shifted in American medicine, like you kind of said earlier how, for a large part of American history, physicians, were more of a homogenous population being white, male, typically Protestant population. And then most people would agree, it’s great that we have increasing diversity and perspectives. And but I, from my perspective, it seems like with that, it also kind of mirrors what’s happened at the culture enlarge, as far as our ability to trust a basis of moral knowledge and what we can say and agree upon. That is good, bad, right? Wrong, appropriate and inappropriate. And so it seems that if you have more of a homogenous population initially, that there’s a lot of friction there, because most likely, people are going to have similar beliefs and viewpoints. But then as that diversity increases, then you’re getting all these other perspectives on that. Yeah, maybe just for my diatribe,

Jonathan 23:14
I, I tell you where my own reflection on these kinds of matters, you know, historically, I mean, in the last 50 years, had gone under the rubric of bioethics and medical ethics. I wrote my first book on doctors decisions about whether or not to perform abortions and how far in pregnancy and like, but what I’ve been more recently interested in is the whole idea that has emerged around medical aid and dying or physician assisted suicide, but it was always called even 10 or 15 years ago, euthanasia. Now, there are a whole range of distinctions, even in that terminology, whether the doctor is participating directly, or is just prescribing so you can get into all of that. But what I’m interested in is how does something like conscientious objection to participating in what otherwise may be defined as legal and therefore can be adopted as professional? How does something like that make for tension in both the instruction in medicine and also for the decisions that doctors make about what kind of medicine they’re going to practice? And those are matters that are coming to a head, aren’t they, both at the beginning of life and at the end? And it doesn’t surprise me that that’s what’s happened because there is a great cultural chasm that has emerged around the convictions that defend or oppose, in this case, something like medical assistance in dying. I think that one way that a resident physician can make sense of these kinds of things, is simply by observing how their peers and their teachers reflect on these matters. The way that I come at it as a teacher, is that I always asked students who are going to apply to medical school to know something about these issues, not to have to have an opinion about what they would do or not do. But to understand that there are opinions that there really are conflicting points of view. And that’s part of the world that they will be engaged in more so in some fields, obviously, than others. I guess the religious foundations are themselves at some level, also confusing. I might even say in some religious traditions confused, but, you know, then I’m getting into my own personal convictions. And that’s valuable, if someone asked me and wants to know what I believe in those matters. But I’m also a sociologist, and one of the commitments that I have is helping students understand better what the conflicts are about. And I think that historically, in that the religious traditions served a valuable function in that regard, you can’t read, you can’t read the Tanach or the New Testament without recognizing that the world has always been in a great struggle for people to make sense of what their obligations and duties are. Just getting students to think about things in that way, is perhaps more of a challenge, because we don’t have a foundational consensus on a lot of matters, which is to me illustrated by conflicts that have emerged, both at the beginning of life and at the end of life. And doctors are implicated, obviously, in those matters, if they choose to be around patient populations that either end, I don’t know if you recall, Ezekial Emmanuals, Atlantic piece some years ago, on that he didn’t want to live past 75. It was, it was a famous article. Now he is past 75. And I think he’s changed his mind.

I think I think the point of the article originally was to say, what kinds of resources should we be putting in to an increasingly larger number of older people. And it doesn’t surprise me again, that he would be able to articulate the special kind of anxiety that exists across generations about who is responsible for whom. But here again, to me, the issue is not to say fundamentally, what the answer to that question is, the issue is raising the question at all and reflecting on it, that’s what you would hope there would be time to do. Let me put it another way. residency, which I have now some personal experience with residency is the moment in time where many residents will say they feel it’s an exploitative period in medical training. And there is no doubt about that. What there is doubt about is, I think, what else can be learned in a high pressured environment that enables people to function in it nonetheless. And that’s why I say, even going to one of these kinds of conferences, and I’m sure that there are other ways in which people can gather together just to be able to say to each other these kinds of things have happened. And it was a difficult moment. And I didn’t know best what to do. And my attending didn’t seem very generous in their response and those kinds of things that can get people at least, as I say, reflecting, thinking about it, not necessarily to be in a position to fundamentally change things. Although that can happen to I was, to me one of the most dramatic cases of looking at residents. In a in a context of being overworked was the Libby Zion case in New York. If people who are listening to this do have the chance to read Abraham Nussbaum’s book, The finest traditions is my calling. He has a wonderful several pages of reflection on that case. And it’s nice to for me, when I’m teaching, to kind of say, you know, there’s this newspaper report, there’s this kind of CNN world out there. You can’t deny it, it exists. You don’t have to pay all that much attention to it. But it’s good to know, you know, what’s being said in that domain, but not spend those as bring it back down to thinking about what are the implications of things going wrong? How do we really come to think about that in a way that emphasizes that our vocation is to be committed to trying to understand that, not just treat people?

Ben 30:51
Absolutely. I agree, I think just the nature of residency and how there’s so the number one complaint I get from residents all the time, is that they just don’t have enough time to even think or reflect on the complexities of their patients, let alone to kind of step back and say, what is the bigger picture of what’s going on here? How can I respond to that? And that internal struggle that I had in residency, I think, is what fueled this podcast and trying to have some of these conversations of what does it mean to be a good physician? And an idea of who are we becoming as we are going through this kind of socialization process in our residency? And your comment on not necessarily having to have a, I guess, quote, unquote, right answer for that. But our ability to ask that question, and to be able to have the tools to think about it, and to discuss it and to meet with other people who have those same concerns and motivations is so beneficial.

Jonathan 32:06
I agree. And, you know, I think that one of the things that is worth considering in that regard, is, by the time you’ve reached residency, you have either reflected on some of the things we’ve been talking about, or you haven’t. And so I tried to catch them at an undergraduate level, precisely to make it clear about what they are getting into. And I consider it a success. When a student who’s taken that course, decides, now I understand it better, and I want to do it. But I also think consider it a success. When a student says, you know, I didn’t really know what I was getting into. And I don’t want to do that. Both possibilities are something that is going to be harder to do once you’re in residency. In fact, one other book I would suggest is by the late Charles Bosk, who wrote a classic work called “Forgive and Remember,” he was a sociologist, “Forgive and Remember: Managing Medical Failure.” And he recognized that surgeons can make mistakes. He called them technical mistakes. The attendings can make mistakes, judgemental kinds of mistakes, who we did the wrong thing. But those can be forgiven, because they become as we as those of us who knows something about medicine. Now, there are always those kinds of mistakes, they’re inevitable, and you learn from them. But if you don’t follow the expectations of an attending, or if you’re critical in a way, that would be embarrassing to recount to nurses and to others, those boss called Moral errors, and or normative errors is a term he used. But it meant something to him, that the notion of character in medicine still matters. And that learning to be a doctor and practicing medicine requires what I believe is a certain humility about what your relationships, both to patients and to colleagues are about. Sometimes, I think we tend to forget that people come into their work settings with more than just their educated abilities to do what they need to do. But there could be trouble at home, there could be concerns about loved ones, all these kinds of things don’t get reflected on enough and the ways to do it may not be the most effective ways so far. But I do think that the more we’re able to raise these questions in context that don’t put Keep on the spot. That’s not really what I’m trying to achieve even in my own teaching, but to kind of get students to recognize that what we’re talking about are activities that require a kind of commitment that is both technical, judgemental, normative. And that brings a clear sense to us about what we need to do on a daily basis. Absolutely don’t complain too much, but don’t feel the necessity of denying the feelings that may come out as complaints at different times.

Ben 35:37
Right. Yeah. And I think our ability to talk about that kind of normative or moral, I guess, aspect is so challenging in the learning environment, because I think one with how ethics is typically taught, it’s usually from this perspective of one, let me teach you kind of typical questions or cases or things like that. So that way, you can pass your board exam, but then the focus on principle based ethics, and I don’t really know how necessarily to say it succinctly, but that there’s no right answer. And because we say that there’s no right answer, then it feels like sometimes those discussions are futile from the outset that you can kind of say, whatever. And as long as you can make a justification for your argument, then that’s the right thing. And I just don’t, I always felt discouraged coming from some of those conversations, because it seems like there is a way to be a good physician. And on this podcast a lot I talk about that we have to discuss who we are as persons as an essential component to being a good physician, because we can’t separate that from the task of medicine. And exactly what you said, there is a certain character that comes with this territory, the easiest way to talk about it is having a an essential range of virtues that you are practicing and living out in your daily life, that a certain appropriate self-effacement or humility is essential. And I think in most environments, I think there are pockets, certainly here and there. But in most places, we don’t have a great way to instruct and direct on that aspect of becoming a physician, if that makes sense.

Jonathan 37:48
I think that is an accurate depiction of the the geography of all this that can be said. And what you’re putting into perspective is the idea that many people will think of ethical matters as a kind of a boxed lunch occasion, you know, you spend an hour and a half on and then go back to work. You know, I think that historically, the people who chose to go into medicine had to fulfill as they still do certain academic requirements, pre med courses and the like. And for many, that was more than enough to have to do to have them locked on top of it. Questions about professional obligation and uncertainty in medical treatment, and a whole range of things that don’t have much more than a kind of tentative aspect to them that things could change, suddenly, in one kind of encounter or another. That’s why I mentioned earlier, the hateful patient, that was just an illustration of the fact that you can’t predict on a daily basis, what you may have to confront. And so what we’ve meant, I think, historically, again, by character is not irrelevant. You use the word virtue, there aren’t really tests for that in an academic sense. They’re only they’re only tests for it in the context of a person’s participation in a work setting over time. And that means that the people who are given the responsibility to make decisions about people coming up the ranks, need to have probably even more of a sense of what counts is virtuous behavior. What counts is a person of what we described as good character. They’re always you know, the history of medicine is not just the history of its positive scientific development, there will always be charlatans. They’ll always be fakers. This is not just an aspect of human nature. It’s an aspect of social life. In general, it’s you don’t find this kind of problem just in medicine. But those are issues like there’s a growing population of impaired physicians, because of the kinds of drugs that are available. I mean, the wonderful physician writer Abraham for Gacy, who wrote one of the first books on HIV, he understood the fragility of his colleagues, he wrote a book about one of them who became fatally addicted to medicine, medicines. And this is another aspect that shouldn’t be shied away from. It should be it doesn’t have to be confronted, every day and all the time. But we have to be able to recognize that what comes with virtue is you hope, a strength of character to be able to weather some of the storms, personal and otherwise, that one is going to encounter. I am in a rank apologist for medicine. I’m not a doctor, I’ve been writing about doctors in a way that would in the history of theology, I think, would have been called an apologia the idea that there’s something there, no matter how much it’s changed, no matter what knowledge has been improved upon, we still call them doctors. And there’s something, at least in my mind, that is encapsulated in that term doctor, that will always ask those who’ve crossed that line where they become responsible for other people’s lives. Not all of us do. I mean, I’m a teacher of undergraduates, but I’m not really responsible for their lives, not like a doctor.

Ben 41:47
And I am curious, before we close out here, really appreciate this conversation and your perspective. And so at a time, when it seems like our trust in institutions, and systems continues to go down, do you think it is possible for the medical profession to regain some of the trust that it kind of previously had?

Jonathan 42:18
I, I think that the balance between what a physician in training has to know and what is possible to know is a gap that has only widened over time. And for that reason, they’re going to be not just virtuous doctors, but they’re going to be those kinds of practitioners who stand out, both in terms of their knowledge, and its application and their character. And we ought not to ignore the fact that most of us, who are teachers who are doctors, who are lawyers, do our jobs well, but that we acknowledge, we have something to learn from those who have succeeded in even greater ways than we have. And I’m certain that because there will always be sickness, there will always be death, at least as far as we can tell, for the foreseeable future, that there will always be a need for the kind of practitioner who brings to their vocation a sense that a patient feels they can trust them. That’s why I focus so much on trust, because the authority that a doctor has over a patient is not just asymmetrical on the basis of knowledge, which it certainly is, but it’s also on the basis of sometimes a doctor’s best guess. And I think I was saying very early on that one of the critical aspects of the rise in malpractice wasn’t the more doctors were making mistakes, they were always making mistakes, but that there was a much higher expectation among patients, that they should never be subject to a mistake. And helping people understand that if a doctor is able to convey that they’re, they’re paying attention, that they’re doing the darndest that they can do that that’s worth our trust. And that is the nature of their authority. If there’s no trust, there’s no authority.

Ben 44:24
Thank you for that. All right, well, we are over time. So to be respectful of your time. I would like to quickly kind of close how I close every interview with a couple of questions. So the first thing is what’s one thing you’re doing to move toward flourishing instead of just surviving right now?

Jonathan 44:43
I flourish by being able still to sit down most days and write and think and teach. I’m coming toward the end of my career at this point, and recognize that keeping up with things that are going on in the world Is it gets it may get a little harder each year. But it’s something that keeps me in tact. I think the other thing is enjoying the blessings of family, I had both my children nearby. And I get a lot of satisfaction. There’s a Yiddish term novice, I get a lot of knockers from just knowing what they’re up to being able to listen to their concerns and being asked for advice. There’s nothing more flourishing than people still feeling that they may have something to learn from you.

Ben 45:33
Thank you for that. And then one aim of this podcast is to explore what it means to be a good physician. So can you tell me about a good physician you personally know in medicine?

Jonathan 45:44
The person that has been very influential in my life for almost the last decade, if not a little more, is a anesthesiologist at Massachusetts General Hospital, who works in respiratory Respiratory Care. Lorenzo Berra, like Yogi Berra, B-E-R-R-A, he’s part of that association, American Association of Medicine and the Person, the communion and liberation movement. Although we come from very different religious traditions, we traveled to Milan five or six years ago and lectured Humanitas medical school right outside Milan, he’s been very supportive of the kinds of things that I’m writing about, as I said, I’ve been very interested of late and conscientious objection. But it’s the fact that he knows that these kinds of issues are an invaluable resource for getting the people he trains and even a larger audience, getting them to think about these things. So yes, that’s that’s one in particular, I’ve been very lucky and blessed to be able to get to know a variety of physicians over the years, which has kept me interested in what they do.

Ben 47:03
Yeah, wow. Well, thank you so much for your work, this book and your time to come on the podcast. I’ve just been really blessed by this conversation. So thank you so much.

Jonathan 47:17
And I’m very grateful to you, because anyone that could pick out my book 15 years later and ask the kinds of questions that you’ve asked gives me continuing hope that things might not get better in all respects. But as long as there are people like you engaged in this, there’ll be a lot to others to benefit from. So thank you for asking me to talk a little bit about this. I hope it wasn’t too convoluted.

Ben 47:43
No, not at all. I enjoyed it.

Jonathan 47:46
Take care.

Ben 47:58
All right. That was a great conversation, man, that quote there, “and there will always be sickness, there will always be death. So there will always be persons with skill and virtue that inspire trust to respond to that suffering.” I mean, if that doesn’t give you hope to keep going, I don’t know what will. But anyways, I hope you found this conversation inspiring. And if you enjoyed today’s episode, then please please share it with someone you know, post on social media, just tell them about it in the text, whatever. I’m truly grateful for every person who’s listening to this podcast and following me on this journey. I am grateful for your support and glad we’re doing this together. So that’s it for this week. See y’all next time. Bye, everybody.


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