O world of spring and autumn, birth and dying!
The endless cycle of idea and action,
Endless invention, endless experiment,
Brings knowledge of motion, but not of stillness;
Knowledge of speech, but not of silence;
In this excerpt from Choruses from the Rock, poet T.S. Eliot starts by comparing the perpetual cycles of the seasons and the life-cycles which continue throughout history, with the endless march of scientific and technological progress.
In our lifetime, the advances in pharmacology and surgical procedures have been astounding. The emergence of new therapies seems to be not only endless, but exponential in growth. I recall when Cimetidine arrived as the first of the H2-antagonists, followed about ten years later by Omeprazole as the first of the proton pump inhibitors. What huge advances these have been on the antacids and bismuth preparations we had to manage dyspepsia and peptic ulcers with previously.
Percutaneous coronary interventions, cochlea implants, laser retinal surgery – yes, these are the days of miracles and wonders, as poet/song-writer Paul Simon expressed it.
Yet we doctors still struggle on a daily basis with patients with medically unexplained symptoms, which often leave us feeling impotent to assist in spite of our incredibly smart arsenal of interventions.
As T.S. Eliot reminds us, we find we have knowledge of motion, but not of stillness, knowledge of speech but not of silence. All the clever toys and tricks at our disposal do not equip us to be still, to have the ability to sit quietly with our patients. To create or allow the space into which the patient may feel they trust us enough to spill some clues as to the true nature of their distress.
To sit still and to listen actively, is an ancient art which has not been replaced by new technologies. In fact, our heads bursting with information often get in the way of effective compassionate medical practice.
T.S. Eliot went on in that same poem to ask,
Where is the Life we have lost in living?
Where is the wisdom we have lost in knowledge?
Where is the knowledge we have lost in information?
Powerful information technology can help us organise data into knowledge, but what about the link from knowledge to wisdom? We can supplement the information we gather from a detailed history with another layer of information obtained from labs and imaging, but how much does that help us to understand the patient’s experience of illness. How much does the information we gather help us to decide whether we ought to proceed with an intervention, just because we can?
Eliot’s poem, although written in 1934, suggests that we might be smarter with more inventions to use compared with previous generations, but we may have lost some wisdom in the quest for more knowledge and information.
This essay was originally published in NZ Doctor, 2022.