By Russ Gonnering at Brownstone dot org.

When I was a first-year medical student, I happened across The Citadel, a novel published in 1937 by A.J. Cronin, himself a physician. The following is from the review on Amazon:

The Citadel follows the life of Andrew Manson, a young and idealistic Scottish doctor, as he navigates the challenges of practicing medicine across interwar Wales and England. Based on Cronin's own experiences as a physician, The Citadel boldly confronts traditional medical ethics and has been noted as one of the inspirations for the formation of the National Health Service. The Citadel has been adapted into several successful film, radio, and television productions around the world, including the Oscar-nominated 1938 film starring Ralph Donat, Rosalind Russell, Ralph Richardson, and Rex Harrison.

From the Wikipedia entry:

Cronin once stated in an interview, 'I have written in The Citadel all I feel about the medical profession, its injustices, its hide-bound unscientific stubbornness, its humbug …The horrors and inequities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system.'

Reading this novel had a profound impact on me, and that impact has lasted up until today, more than 50 years later.

Medical school always had its own set of peculiar struggles, as does everything. Certainly, Basic Training in the military is an eye-opener. What makes medical school unique is the profound contrast of the reality with the ideal. Like many students, perhaps most, I entered medicine with a deep sense of the magnitude of what I was doing. It had a "spiritual" element, almost as though I was entering a religious order and now would be taking on the mantle of responsibility that was more than just a job. I had read the Oath of Hippocrates and could sense the heavy responsibility that had been felt by the ancients and the duty that this road would take.

It would serve no purpose to recount those years in detail. Suffice it to say that, like those of Andrew Manson, the protagonist in The Citadel, my experiences were intense. They ranged from the utter heights to the deepest depths. The mettle of my character was refined and amalgamated in ways difficult to fully understand, even now. I graduated having many of the same feelings described by Cronin in the interview referenced above. I was conscious of my own mortality. I understood what it was like to make mistakes, but over all of it I had a firm desire to really make a difference in a system that was filled with obstacles.

The worst aspects of medical education have improved significantly since the time I spent there. The 40-bed wards are gone. Attending physicians take a more active role in the care of patients. Medical students and resident physicians no longer spend an exhausting 80 hours or more a week in patient care. There are multiple safety measures in place for patients and those caring for them. Up until Covid, I thought that we had made real progress in things.

But those are the externals. Has the internal moral compass really changed? Yes, it has in many individuals, but what about collectively in our profession? Consider those who told their patients, "I would sooner watch you die than give you hydroxychloroquine." Has their moral compass changed? What about the medical leaders who allowed patients to die without allowing them to try ivermectin, despite the pleas of their family? Did their moral compass change? Or those who treated the unvaccinated as lepers? What about the medical ethicists who advocated denying care to those unvacinated?

How about the late-night comic on this YouTube clip who advocated a similar policy? Or those in the audience of that comic who thought this was outrageously hysterical? True, he was not a healthcare professional, but the problems we see run very deep in our society as evidenced by the audience response.

Now it is known that the premise upon which those people based ...