Hildegard of Bingen, a Saint of the Catholic Church, was born in 11th century Germany. I know about her because I am listening to an audiobook called Great Men and Women in the History of Medicine by David Angus and Benjamin Soames. It's a Junior Classics meant to read with your kids but I find it really fun to listen to and don't care that I am a full grown adult with three degrees reading a kid's history book.
Hildegard is slotted between Galen and Ibn Sina in the history of doctors. Also, she is the only woman discussed in the book, which should really be called "Great Men and Hildegard in the History of Medicine." At least she made it in, right?
As a young child, Hildegard was sent to live with an early version of a nun in the Catholic Church who taught her reading and music . Hildegard became a popular musician and later became a self-taught doctor using the writings of Aristotle, Hippocrates and Galen to inform her practice, which was a merging of the spiritual and the corporeal. She is in fact credited with the idea that a doctor could heal the body and a priest could heal the soul, thereby soothing some of the rifts between the Church and an emerging rationalist model of medical science.
Early on, Hildegard thought of writing her own book. She formed a convent - what sounds like the first - and provided most of what we now call obstetrical services to the women in the community. She insisted on cleanliness and no one seems to have any clear idea where she came up with this but she is the first one to describe it as important in the provision of medical care.
Despite advancing obstetrics, and medicine writ large, she didn't feel like she could write her own book on the subjects. She wrote that she lacked the confidence to commit her practices to history. It wasn't until the Pope himself instructed her to write medical, spiritual and philosophical books that she did so.
Of course a woman with the intellectual bona fides of Aristotle, Hippocrates and William Harvey was the only women in her cohort, and the only one we know exercised humility in her practice. The only male in the club to have demonstrated this same self-awareness was Arab powerhouse Ibn Sina who famously published his failed experiments and wrong-headed ideas alongside his major wins. He published over 350 texts and articles on all sorts of subjects during his lifetime.
Thank goodness Hippocrates was confident! He put medical knowledge down on record so that humans could push it along for another 2000 years, sometimes totally ruining it in the dark ages when jaundice was treated by tying a dead bat to one's arm, but that's beside the point.
I don't know if Hippocrates knew he would end up being wrong about nearly everything in medicine, but he wrote it all down anyway and worked his butt off in service of patients. If Hildegard hadn't been told to write, it could have taken hundreds of years for someone to write something down that made some medical sense about how babies get born without killing their mothers. Her lack of confidence did not serve her people. Perversely, this lack of confidence is also connected to her well-established intellectual humility, which is a really important part of being a doctor now and 1000 years ago. She was modest about what she knew and this served her practice well.
So where is the right place for our confidence and our self-skepticism to cross? How do all doctors bring themselves to that space?
On my first day of medical school, the Dean addressed all 203 of us by calling us "the cream of the cream of the cream of the crop." Of over 4000 applicants, we were the lucky minority to gain a seat in a strong class of future doctors.
It was so irresponsible to tell us how good we were. I have always been critical of this approach to instilling worth into medical students. What we really need to be valued for is our vulnerability, our willingness to be wrong and our resilience in coming back to the table to learn some more the next day. We were a group of people used to being right and, in this way, we were like most doctors. When you're used to being right, you don't find yourself with the opportunity to be wrong - and to develop self-awareness as a result - very often. And I think this is a problem because it limits intellectual humility.
Medicine suffers from the egocentric bias in the same way that other really technical fields do: our consumers don't have perfect information so we are relied on as truth-tellers and knowers-of-special-things.
Medical training constantly demands that we perform for our preceptors, obfuscate our weaknesses and look really smart. When we're good, our egos hear it. When we're bad, we try to hide until we can go home and study enough to get back in the good books. Vulnerability is bad, power is good.
And I get why that's important. On Friday, one of my patients was moving quite quickly towards a grim outcome and I needed to act confidently and swiftly in the right direction. The circumstances were a little strange, and I knew there were things I didn't understand, but I couldn't afford analysis paralysis because the situation was volatile. My ego allowed me to overcome doubt and to act. I could tell the nurses what to do because my vulnerabilities were balanced by some useful ego.
I am sure you can see how ego alone - if unchecked by intellectual modesty - could have taken this patient right down the tubes. When the ego prevents us from asking for help, taking an extra minute to clarify the situation and ask good questions or admitting that we don't know what's happening, we are victims of bias and the gloat of own previous successes.
I would argue that what I do in medicine today is all borrowed miracles from the founders and visionaries, from Aristotle to Osler. They figured it out and I apply their principles to each case. I am not inventing cures for things but I am doing the heavy lifting of making sure people access these advances. In this way, I object to the use of the word 'miracles' to articulate what we do, but Peter - a mentor and colleague - has been doing country medicine without back up for four decades so he gets to call his work miraculous.
Every inner dialogue I have around the next right choice in the care for my patients will summon the tentative self-awareness of Hildegard of Bingen and the unfathomable certainty towards action of the world's first surgeon, Andalusian physician Al-Zahrawi. To all my creamy counterparts edging into solo practice, I wish you good luck.