A woman sits with her head inside a complex scientific aparatus.

Making the Case for History in Medical Education

David S. Jones, MD, PhD will give the annual James H. Cassedy Memorial Lecture on Thursday, September 20, 2018 at 2 P.M. EST at the National Library of Medicine on “Making the Case for History in Medical Education.” Dr. Jones is A. Bernard Ackerman Professor of the Culture of Medicine, Faculty of Arts and Sciences and the Faculty of Medicine, Harvard University.

Circulating Now: Tell us a little about yourself. Where are you from? What do you do? What is your typical workday like?

An informal portrait of David Jones outside.David S. Jones: I am a historian and psychiatrist, though I stopped doing clinical work ten years ago to focus on teaching and research in history of medicine and medical ethics. I currently divide my time between Harvard College and Harvard Medical School, which allows me to teach these topics to a wide range of students: undergraduates, graduate students in History of Science, medical students, and sometimes residents and practicing physicians. As a result of this, I don’t have any typical days. My schedule depends on what I’m teaching, where I’m teaching, and what else is going on at either campus. This certainly keeps things lively.

I was born in Minnesota, but have spent most of my life in the Boston area. I always planned to leave, but my wife and I were out of sync in our training (she went straight through medical school, but I was in the MD-PhD program), so we each had to stay in Boston while the other finished a stage of training, and this happened repeatedly until we got stuck. We were both extremely fortunate to be able to keep finding jobs in Boston—it’s one of the perks of the city’s enormous medical enterprises.

CN: Your upcoming talk—NLM’s annual James Cassedy Memorial Lecture—will be “Making the Case for History in Medical Education.” In 1966, Dr. Cassedy contributed to a conference, Education in the History of Medicine, held at the NLM and sponsored by the Josiah Macy, Jr. Foundation. How has the discussion changed in the last 50 years?

People wearing headphones interact with a kiosk.
Medical Education Jukebox, an instant library for the health team, ca. 1970
NLM #101445856

DJ: Historians of medicine have been working to make the case for history in medical education since the late 18th century. Traditionally history had been the core of medical training: students would study Galen, Hippocrates, and the other classics to learn the practice of medicine. As medical science turned to new sources of authority in the nineteenth century, the history of medicine lost its immediate relevance. Physicians interested in history began looking for other ways to make the case, and the arguments have ranged widely. They have argued that knowledge of history can teach humility, help doctors appreciate the social and economic contexts of their work, or instill professional value. The 1966 conference was one in a long series of efforts to study this problem and improve the status of history at medical school. It came at a crucial time: a series of scandals and dilemmas in the 1960s created a sense of crisis in medical professionalism, one that gave rise to both bioethics and the field of medical humanities. Those two projects (especially ethics) have gained substantial ground in medical curricula since the 1960s, some of it at the expense of history of medicine. Historians now must jostle for position not just with the basic sciences, but with other humanities, arts, and social sciences. As the knowledge base of each continues to grow, the curricula get more and more crowded. And recently medical schools have begun to shorten the pre-clerkship curricula, from the traditional two years now down to 18, 15, or even just 12 months. This has put tremendous pressure on historians and all other medical faculty to make the case for their areas of study.

CN: You find that history is not always prioritized in medical education, how does a familiarity with medical history support health professionals in their work?

DJ: Over the two hundred years that they have been doing it, historians and physicians have pushed many different arguments about the relevance of history. There’s a kernel of truth in all of them. I’m most persuaded by the ones that argue that history is as fundamental to medical knowledge as anatomy, biochemistry, or pathophysiology. Doctors need to understand disease, and there are certain aspects of disease that are best studied through history (e.g., how can you account for the changing burden of disease in societies over time, or for the persistence of health inequalities in populations over decades, even centuries). Doctors need to offer treatments to their patients, and they ought to have sophisticated understanding of the phenomenology of therapeutic efficacy, something that is best learned through history (or anthropology and the other social sciences). Historians need to understand our standards for ethical conduct, and it is even better if they understand why the profession has the standards that it does, and, again, this is best taught through history. I could go on at great length here, but it is better to refer you to an article that colleagues and I published in the Journal of the History of Medicine and Allied Sciences in 2015.

CN: As you developed your case, were you motivated by any particular event or story?

An engraving of a courtyard surrounded by classical buildings.
Harvard Medical School, Engraving by Ernest Roth, ca. 1945
NLM #101394199

DJ: Many different events have contributed to my thinking about this. I have now been involved in two rounds of curriculum reform at Harvard Medical School, which launched a new curriculum in fall 2006, and another one in fall 2015. In each process, the faculty in different disciplines were asked to justify their role in medical education. This created many opportunities to develop, try out, and refine these arguments. In 2013 I hosted a conference of historians who teach at medical schools (in some respects a follow up on the 1966 NLM conference) so that we could all compare strategies, both successful and unsuccessful. While different schools have different needs and opportunities, it was incredibly useful to compare our experiences and work towards a common vision. Harvard Medical School, convinced by our arguments about history, decided to include history (under the umbrella of social medicine) in its required curriculum. As a result, we now get the challenge and opportunity of justifying history’s presence at HMS to a new cohort of students each year. Our students have very high expectations of the faculty and our curriculum, and they are not shy about telling us if they disagree about our approach. So we have had ten years of trial by fire, working to make the case for history both to faculty colleagues and to our students. We certainly haven’t mastered it yet, but we are making progress.

CN: How did you originally become interested in the history of medicine? What inspires you in your work?

A woman sits with her head inside a complex scientific aparatus.
Positron emitter detector used to detect brain tumors at Brookhaven National Laboratory, circa 1961
Courtesy of Brookhaven National Laboratory

DJ: I had studied history of science as an undergraduate, but at the time I was interested in the history of geology and evolutionary biology. After briefly considering a career in geophysics, I opted for medicine. In my first semester in medical school, I took an elective on the history of medicine, to see what it was about. The professor, Robert Martensen, had just been asked to take part in the Advisory Committee on Human Radiation Experiments that President Clinton set up to sift through the 3 million feet of Department of Energy documents that he ordered declassified after a Pulitzer-prize winning exposé about Cold War plutonium injection studies. He hired me as a his research assistant and I loved the material. I decided to extend medical school to include a PhD in the History of Science. My research interests immediately went off in different directions, but I have always managed to find a series of interesting projects to work on. Disease and medicine are both fundamental aspects of the human experience, and I don’t think that physicians, patients, or their families really understand either of them well. I think history can make important contributions to our understanding of these problems and, by doing that, improve our ability to care for each other.

David S. Jones’s presentation is part of our ongoing history of medicine lecture series, which promotes awareness and use of the National Library of Medicine and other historical collections for research, education, and public service in biomedicine, the social sciences, and the humanities. All lectures are live-streamed globally, and subsequently archived, by NIH VideoCasting. Stay informed about the lecture series on Twitter at #NLMHistTalk.

7 comments

  1. About 30 years ago, when I was library director in a 350 bed hospital, a journal cover featured Banting & Best. I happened to ask an intern if he knew who they were–what their claim to fame was. He had no idea, and I was appalled. A teaching moment, indeed.

  2. I would be very curious to hear Dr. Jones’ opinions on the current break from emphasizing, or even acknowledging patient’s fundamental right to informed consent. There seems to be a smug hostility toward patient’s self determination, either creeping or storming into medical practice nowadays, depending on your viewpoint. Have you, Dr. Jones studied this trend, and what are your thoughts?

    1. Informed consent is one of the most interesting areas of medical ethics, not just for patients, doctors, and ethicists, but also for historians. I don’t think anyone doubts patients’ fundamental right to informed consent. Doctors have an obligation to provide whatever information — really whatever education — patients want. While actual practice might stray from this ideal, it is clear what the ideal is. But what should doctors do when patients ask for their opinion about a decision: “doctor, what would you do in my situation?” This is a reasonable, and common, question: doctors have expertise and experiences that patients lack that should let them form a professional judgment. But this creates a bind. If a doctors says “I would do X,” then a patient might feel pressured to choose that option out of fear of disappointing the doctor by rejecting the advice. I have many colleagues who refuse to answer those sorts of questions. They limit their role to providing the information that patients need to make their own informed decisions. Is this fair to patients? I am not sure. Many patients respond by asking again “but doctor, you’re the expert, what should I do?” The right answer here is probably different for different patients.

      1. Thanks for taking the time to respond. I appreciate it. My chief concern is around the issue of mandated vaccines, both for children entering school and for workers whose jobs are on the line unless they submit to a flu vaccine. It seems like no-one is given complete information upon which to base a decision. Here in California the decision has been taken away from parents because with SB277 you no longer have a choice if you want to put your kids in school. Asking questions about vaccines stirs up a hornets nest. You get kicked out of your pediatrician’s office unless you acquiesce. Is that not contrary to the tenet of informed consent?

        1. I cannot help myself; I’d ask if the parents had themselves been vaccinated as children and, secondly, had they ever seen the diseases vaccinations prevented. Born too soon for those vaccinations myself, I not only suffered every one of those childhood diseases, but had several as an adult. Not fun. Hurrah for California.

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