An Open Letter to (Future) Clinician-Historians.

On the relevance of the American Association for the History of Medicine.

Kristen Ann Ehrenberger, MA

University of Illinois at Urbana-Champaign, USA.


The history of medicine has developed from the physician’s pastime to a discipline in its own right.  But that does not mean that clinicians do not still have something to get from—and to give to—the American Association for the History of Medicine.

Keywords: AAHM, history of medicine, physicians, students, clinician-historians


“The AAHM [American Association for the History of Medicine] is a scholarly association dedicated to the study of the history of health, healing and disease.  It is the longest continuously functioning academic society of this kind in North America.  The membership of the Association includes historians, health professionals, librarians, curators and archivists as well as graduate students in history and the health sciences.  Each spring the annual meeting of the AAHM offers a wealth of workshops, seminars, lectures and luncheons and includes over two days of peer-reviewed research and scholarship on the history of healing, health and disease” (1).

In some circles, the history of medicine has a pretty poor reputation.  Historians often assume that the field consists mostly of physicians writing biographies of their mentors, triumphant surveys of scientific advances since ancient times, or else something not terribly interesting or important to “real” historical scholarship about politics, identity, or culture.  For instance, I recently attended an invited talk by a history professor from a prestigious university who is working on the international politics of a global health issue.  He admitted that he had not considered consulting his colleagues in the history of medicine department at his school.  He took their institutional separation to indicate intellectual separation too.

At the same time, many scholars fail to recognize that the work being done around them on bodies, medical and scientific technologies, reproduction, disabilities, lifestyles, and death could be incorporated fruitfully under the rubric of “history of medicine and allied sciences.”

Medical humanities often fare no better among clinicians and scientists.  Just five years ago, when applying to joint MD/PhD programs with the stated intention of pursing a doctorate in history, I was often met with silence, explanations about lack of funds or communication between departments, or in one case, an online application form with a pull-down menu for “PhD discipline” that literally made History not an option.  A number of state medical boards have also adopted the USMLE’s recommendation to exclude students pursuing graduate work in disciplines not covered by Step 1 from any exception to their rule of allowing no more than seven years between Steps 1 and 3 (2,3).  This means that if students take more than two years to research and write their dissertations in history of medicine, medical sociology or anthropology, or medical economics, their licensing choices diminish.

The antipathy goes both ways.  Lay academics in history of medicine sometimes erroneously believe that clinicians make poor historians.  And now that most academic positions in the history of science or medicine are occupied by the “PhDs” who also contribute the bulk of current scholarship, many clinicians who once fostered an interest in the medical history as a hobby no longer feel welcome at the annual meetings of the American Association for the History of Medicine, and their presence on the membership rolls has begun to fade.

So why study the history of medicine at all?

I have aired our dirty laundry in the hopes that it can serve as ballast for the praises I nevertheless want to sing: first, of the continued relevance of organizations such as the American Association for the History of Medicine, and second, of medical history itself.

I opened this opinio with AAHM’s mission statement because—despite the very human tensions and frustrations in the field—I want my fellow (future) clinicians to know that the Association, as an organization, is officially open to anyone with an interest in medical history.  In fact, three of the last four presidents hold both an MD and either an MA or a PhD in history.  On a purely practical level, AAHM’s annual meetings offer Continuing Medical Education credit for either presenting or attending, while the Clinicians’ Breakfast offers a socializing and networking opportunity for MDs and DOs and RNs.  The 2009 meeting will be held April 23-26 in Cleveland, OH, and registration information can be found on AAHM’s homepage (1).  The 2010 meeting will be in Rochester, MN, and the 2011 meeting in Philadelphia, PA.

As Co-Chair of the AAHM Ad Hoc Committee on Student Affairs, I also want to invite you to join both AAHM and our Yahoo! group (4).  Most members of our caucus are PhD students who treat the Association and its annual meetings as places for professionalization, education, and socializing.  A small minority are, like me, in some stage of acquiring both an MD and a graduate degree in a medical humanities field.  Few traditional medical students have joined yet, but they are certainly welcome both on our listserv and at the annual Student Luncheon, held on the Saturday of AAHM’s annual meeting.  All student members enjoy discounted dues as well as home delivery of the Bulletin of the History of Medicine, AAHM’s official organ and a leading journal in the field.

CME credit and a line on your CV are not the only concrete benefits of attending an AAHM meeting (or doing a little reading on your own).  Most clinician-historians, myself included, agree that their medical training gives them a unique perspective on their historical work that is no better or worse than that of their lay colleagues.  Some also believe that their historical awareness makes them better clinicians.  In Clio in the Clinic: History in Medical Practice (5), hematologist and past-AAHM President Jacalyn Duffin and other clinician-historians share stories about how their historical knowledge—or their willingness to look for literature older than 10, maybe 15 years—has actually helped them diagnose or treat a patient.

But practical application to my future medical practice was not the primary reason I began studying medical history.  I study history for its problem-solving methods.  When I am curious about why things are the way they are, or if a conflict arises in the world around me, my first instinct is to ask, how did things use to be, and how did they get to the way they are today?  This retrospective curiosity meets my fascination with all things related to health and to bodies in both my medical and my medical-historical training.  When wearing my medical student hat, I take a patient’s history of past and present illnesses; when wearing my historian’s hat, I take a society’s history of its events, practices, and beliefs.  This is the contribution to clinical practice Duffin refers to as “thinking.”

Two other intangible benefits of a background in medical history are “travel” and “timelessness.”  The ability to imagine oneself in another time, place, or culture is far more essential to doing history than the ability to memorize names and dates, and it is not merely an academic exercise.  Can you imagine yourself as the Hmong parent of an epileptic girl you believe has been blessed with “the spirit [that] catches you and you fall down” (6)?  Now can you imagine yourself among the well-meaning American physicians who want to place the girl in foster care so she will be given her anti-epileptic medication?  This is “traveling” with medical history.

As for timelessness, as long as disease and death have been part of the human condition—which is to say, always—medicine has been too.  Some clinician-historians take pride in how much knowledge and technologies have advanced.  Personally, I prefer a fairly relative view of medical systems past: for instance, although we (post)moderns have more or less replaced humoral theories of health and sickness with genetic and molecular ones, there must be very good reasons why some version of the quartet of red blood, white phlegm, yellow bile, and black bile dominated Western medical theory for two and a half millennia (and continue to do so in some Eastern medical theories).  It worked (or works)—for them.  I try to understand why on their own terms.  Moreover, who knows what changes will come in the next two and a half millennia?  In other words, I am forced to accept a measure of humility from my study of medical history.

The fact that you are reading this opinio may mean that I am already preaching to the converted.  If so, I hope you will formalize your interest in medical humanities by joining AAHM, the History of Science Society (HSS), the Society for the History of Technology (SHOT), the Society for Medical Anthropology (SMA), or a similar organization.  Conferences serve as excellent opportunities to network, socialize with like-minded individuals, learn something new, and/or push yourself by presenting a paper or poster.

In addition to AAHM’s annual spring meeting, I also recommend the Joint Atlantic Seminar for the History of Medicine, an independent, student-run conference on whose steering committee I sit.  Although JASHM caters primarily to students on the East Coast of the United States, we usually have a national or even international slate of presenters.  The next JASHM will take place October 9-10, 2009, at the University of Pennsylvania, and more information can be found on their website (7).

In conclusion, I hope you will embrace the role of “clinician-historian.”  Formal historical training and a degree are a boon but by no means required.  The practice of medicine is, after all, a life-long educational journey, and medical humanities is nothing but the current name for the “art of medicine.”  In medical schools these educational goals are often labeled “culturally-related health behaviors” or “racial/ethnic demographics of illness” (8).  Outside medical schools, the American Association for the History of Medicine is available to you as a resource and as an opportunity.  There is much you could get from—and give to—us there.


Kristen Ann Ehrenberger is an M1 student and PhD (History) Candidate at the University of Illinois at Urbana-Champaign.  Her dissertation is currently entitled “Consuming Health Knowledge: Nutrition and Hygiene in Saxon Germany, 1900-1933.”  Kristen is Co-Chair of the Student Section of the AAHM (2006-2009) and sits on the steering committee of the Joint Atlantic Seminar for the History of Medicine.   She thanks her Co-Chair, Niki Nibbe, and an anonymous reviewer for helpful remarks on this essay.  Kristen can be reached at kehren2@illinois.edu.


References.

1. American Association for the History of Medicine [online]. 2008 [cited 2009 Jan 6].  Available from: www.histmed.org. AAHM was founded in 1925.

2. Federation of State Medical Boards.  State-specific Requirements for Initial Medical Licensure [online document]. [Updated May 2008; cited 2009 Jan 6]. Available from: http://www.fsmb.org/usmle_eliinitial.html.

3.  United States Medical Licensing Examination. 2008 USMLE Bulletin—Eligibility [online document]. Available from: http://www.usmle.org/General_Information/bulletin/2008/eligibility.html#tl.

4. AAHM Student Section [online]. 2007 [cited 2009 Jan 6]. Available from: http://groups.yahoo.com/group/AAHM-student-section/.

5. Duffin J, editor. Clio in the Clinic: History in Medical Practice. New York: Oxford University Press; 2005.

6. Fadiman A. The spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures.  Farrar, Straus and Giroux: New York; 1997.

7. Joint Atlantic Seminar for the History of Medicine [online]. 2003 [cited 2009 Jan 6].  Available from: www.jointatlantic.org/.

8.  American Association of Medical Colleges.  U.S. Medical Schools Teaching Selected Topics: 2008 LCME Part II Annual Medical School Questionnaire [online document]. 2008 [cited 2009 Jan 6]. Available from: http://services.aamc.org/currdir/section2/04_05hottopics.pdf.

 



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