By Aaron Kheriaty at Brownstone dot org.
Physician Ronald Dworkin, a very fine writer, has published at Civitas a review of Making the Cut that is a terrific essay in its own right on the subject of doctoring. I am republishing it here with permission.
While pondering their early years in medicine, some doctors, reading Dr. Aaron Kheriaty's thoughtful and entertaining memoir of being a physician, Making the Cut, will probably think meanly of themselves. I did. Right from the start, while still a student, Dr. Kheriaty demonstrated the proper disposition for a physician. He loved medicine; he was awed by its significance; he was humble; he liked talking with patients; he had a natural bedside manner.
In my case, it's not that I had poor bedside manner so much as I had no bedside manner. I didn't do bedside manner. Nor, as a young anesthesiologist in training, did I expect to. Once, during my residency, a middle-aged patient informed me of my deficit. I snapped back, "You shouldn't expect good bedside manner from your anesthesiologist. Just be grateful that you woke up." To paraphrase Willy Loman, I was not liked, let alone well-liked, by patients.
I changed over the years, but Dr. Kheriaty wisely explains how medicine can accommodate all sorts of odd personalities; even if I had not changed, I would have found my place. Not surprisingly, given his strengths, he pursued a career in psychiatry, where his career flourished at a California university until the pandemic, when he challenged the university's vaccine mandate policy in federal court and was subsequently fired. Government efforts to censor the medical field through social media control led him to become a plaintiff in the Missouri vs. Biden case, in which the judge decided that the Biden administration had, in fact, violated physicians' First Amendment rights. Besides having a good bedside manner, Dr. Kheriaty has courage and backbone.
His book opens with the enthusiasm of a young person learning how to practice medicine - enthusiasm gradually tempered by reality. The hours in medicine are long. The smells are bad - he opens the first chapter with a story of having to manually disimpact a morbidly obese patient suffering from constipation. The hierarchy among physicians, stretching from the lowest medical student to the highest attending physician, can sometimes border on the ridiculous.
In nineteenth-century Russia, the status of the serf was such that a noble could beat him without suffering legal consequences. Dr. Kheriaty describes a similar experience during his early years in a teaching hospital, where medical students, already emasculated by the shortness of their white coats, can be berated, ordered about, and humiliated by attending physicians, with no right to defend themselves.
Dr. Kheriaty is at his most interesting when he uses those everyday training experiences as a springboard to wax philosophical. In one example, he humorously describes how doctors approach the sensitive subject of sex by engaging in what he calls "the sterilization of the erotic." By making sex seem no different from bowel habits or joint mobility, doctors try to put patients at ease so they will be more likely to discuss their concerns.
Yet the language doctors use to talk about sex also risks changing the way they think about sex. Phrases such as "safe sex" or "sex life" make sex seem like any other physiological process. Gone is the sense of awe and mystery. At the same time, Dr. Kheriaty admits, medicine's efforts to erect a completely sterile field around sex are useless. "Love and sex remain forever beyond our impoverished clinical words," he writes.
This last point resonated with me. While a medical student, I learned how to perform a pelvic exam on a live model provided by the medical school. Along with several other male medical students, I waited anxiously outside the building for my turn. I felt like a sailor on shore leave in a foreign port. When my turn came, the naked wo...