JUST ONE QUESTION

Learning the history of medicine can point the way to a better future.

BY SARAH SPIVACK LAROSA

Even if the letters “PhD” or “MD” follow your name, your training in science or medicine may not be complete. Not only is the history of medicine fascinating in its own right, but it also can uproot assumptions, disrupt bias and point the way to a better future, says medical historian Gideon Manning, PhD, director of the History of Medicine Program in the Department of Biomedical Sciences. ¶ Cedars-Sinai houses the only substantive history of medicine program embedded within an independent academic medical center. The research group has become a scholarly destination welcoming speakers and researchers from around the world. ¶ Here, Dr. Manning makes a strong case for casting your gaze back to earlier days of science and medicine.

How can clinicians and investigators benefit from understanding the history of medicine?

Dr. Gideon Manning: We take many things for granted today concerning the organization of medical knowledge, the benefits of technology, who should be a physician and even who qualifies as being ill. These and similar assumptions inform the practice of medicine and biomedical research, as well as patient experiences, and each of these assumptions has a history. When you look carefully at the emergence of a scientific medical culture, you see that it is a human creation that took shape over a long period of time.

Let me give you an analogy. Medicine is like a building that has taken generations to complete, like one of Europe’s Gothic cathedrals. If you have the right training and look carefully at such a building, you will find evidence of the builders’ hesitation or incompetence, and you’ll notice some of the parts don’t quite fit together because there were different builders over time with different priorities and interests who even used different building techniques.

All to say, studying the history of the building can help us understand and explain why the building looks as it does and why the floors sometimes creak and the ceiling occasionally leaks. In medicine, history can illumi - nate why some things don’t work so well today and what might be changed in the future because it needn’t be the way it is.

Take the case of sickle cell anemia: We effectively knew all the genetic information we needed to know about the disease even before the Human Genome Project was complete. But research into the condition wasn’t actively pursued because it predominantly affects people of recent African descent, and they haven’t had a sizable access to clinical trials. We need more diversity and inclusion in medical research to fix the problem.

There are also long-standing disparities in heart health between men and women, an issue that CedarsSinai has been working hard to correct. Information about whose voice matters, who gets sick with what disease, or simply who becomes a scientist or a physician are at the root of many such disparities.

The history of medicine is, in part, about bringing attention to the contexts in which these assumptions have taken hold, and, in so doing, directing us to those places where the floors creak and the roof leaks in modern medicine. Historians of medicine, like the rest of us, are out to fix these disparities. We just carry slightly different tools in our toolbox when compared to clinicians and other investigators.

Reclaiming the Joy of Medicine: Finding Purpose, Fulfillment and Happiness in Today’s Medical Industry

By Alen Voskanian, MD, MBA, Medical Director, Cedars-Sinai Medical Group

New Degree Press, 2022

190 pages

How to Stamp Out Burnout

BY LISA FIELDS

Physician burnout is at an all-time high because of widespread fatigue and work-related distress caused by the COVID-19 pandemic.

As many physicians nationwide are questioning their longterm commitment to medicine, Alen Voskanian, MD, MBA, shares a hopeful perspective, explaining how he found purpose and meaning as a physician after experiencing work-related burnout 20 years ago.

After Dr. Voskanian chose to leave a grueling position that required him to see patients every 10 minutes and handle an avalanche of bureaucratic tasks, his passion for medicine reignited. Now at Cedars-Sinai, he’s taken on an administrative role to help other physicians rediscover their love of medicine, hoping to change policies that “conflict with some of the core principles of being a physician—namely the autonomy and flexibility to choose the best care for our patients.”

Dr. Alen Voskanian experienced physician burnout 20 years ago. In his new book, he explores reasons for burnout and suggests ways to conquer the problem.

Dr. Voskanian shares his personal journey, plus stories from other physicians who have overcome burnout. Instead of suggesting that his colleagues strive to become more resilient, he advocates for widespread change from healthcare organizations, which should “focus on removing the unnecessary tasks that lead to death by 1,000 paper cuts.”

He suggests that physicians may benefit from remembering why they entered their field, choosing positions that align with their values and “realizing what is and what is not in our control— and not worrying about the latter.” It may not be the first time doctors have heard such advice, but it’s well worth reiterating, whatever field you’re in.