Here is an excerpt from Ezra Pound, a 20th century poet.  He wrote a book called the ABC’s of Reading.  To be fair, it is directed more at the reading of poetry than other forms of writing.

The textbook, first published in 1934 by George Roudedge Limited, surpasses the usual dreck on the interview and examination of the patient, in Pound’s insistence on clarity in perception and precision in expression.

Ezra Pound had more to say about the skills necessary for both good poetry and good medical diagnosis, than any living medical theorist knows today.  His work far surpasses the IOM’s writing about “Diagnosis” that was published recently, even though the book is about 80 years old.

Diagnosis in medicine involves being able to hear, really hear, a live human being, and to understand what variances from well existence might show themselves, and how they might be clearly understood and expressed.  I am a very experienced diagnostician – I know.

I have excerpted Pound’s writing about poetry, and I have taken the liberty of pointing out the obvious relations to medicine in red.

We live in an age of science and of abundance. The care and reverence for books as such, proper to an age when no book was duplicated until someone took the pains to copy it out by hand, is obviously no longer suited to ‘the needs of society’, or to the conservation of learning. The weeder is supremely needed if the Garden of the Muses is to persist as a garden.

The proper METHOD for studying poetry and good letters (and medicine) is the method of contemporary biologists, that is careful first-hand examination of the matter (patient), and continual COMPARISON of one ‘slide’ or specimen (or patient) with another.

No man is equipped for modern thinking until he has understood the anecdote of Agassiz and the fish: A post-graduate student equipped with honors and diplomas went to Agassiz to receive the final and finishing touches. The great man offered him a small fish and told him to describe it.

Post-Graduate Student: ‘That’s only a sunfish.’

Agassiz: ‘I know that. Write a description of it.’

After a few minutes the student returned with the description of the Ichthus heliodiplodokus, or whatever term is used to conceal the common sunfish from vulgar knowledge, family of Heliichtherinkus, etc., as found in textbooks of the subject. Agassiz again told the student to describe the fish. The student produced a four-page essay. Agassiz then told him to look at the fish. At the end of three weeks the fish was in an advanced state of decomposition, but the student knew something about it.

By this method modern science has arisen, not on the narrow edge of medieval logic suspended in a vacuum.

‘Science (and scientific medicine) does not consist in inventing a number of more or less abstract entities corresponding to the number of things you wish to find out’, says a French commentator on Einstein. I don’t know whether that clumsy translation of a long French sentence is clear to the general reader.

…In Europe (and America,) if you ask a man to define anything (especially pathophysiology), his definition always moves away from the simple things that he knows perfectly well, it recedes into an unknown region, that is a region of remoter and progressively remoter abstraction. Thus if you ask him what red is, he says it is a ‘color ‘. If you ask him what a color is, he tells you it is a vibration or a refraction of light, or a division of the spectrum. And if you ask him what vibration is, he tells you it is a mode of energy, or something of that sort, until you arrive at a modality of being, or non-being, or at any rate you get in beyond your depth, and beyond his depth.

I mean a medieval theologian took care not to define a dog in terms that would have applied just as well to a dog’s tooth or its hide, or the noise it makes when lapping water; but all your teachers will tell you that science developed more rapidly after Bacon had suggested the direct examination of phenomena, and after Galileo and others had stopped discussing things so much, and had begun really to look at them, and to invent means (like the telescope) of seeing them better.

Even if the general statement of an ignorant man is ‘true’, it leaves his mouth or pen without any great validity. He doesn’t KNOW what he is saying. That is, he doesn’t know it or mean it in anything like the degree that a man of experience would or does.

Thus a very young man can be quite ‘right’ without carrying conviction to an older man who is wrong and who may quite well be wrong and still know a good deal that the younger man doesn’t know.

One of the pleasures of middle age is to find out that one WAS right, and that one was much righter than one knew at say seventeen or twenty-three.

This doesn’t in the least rule out the uses of logic, or of good guesses, or of intuitions and total perceptions, or of ‘seeing how the thing HAD TO BE ‘. It has, however, a good deal to do with the efficiency of verbal manifestation, and with the transmittability of a conviction.

There seems no defense of the true scientific method in medicine today, in the presence of those with sufficiently huge egos.  To be an empirical scientist, one has to tolerate the blows against the Self that may be struck by Reality.  Very few of the leaders in Academic Medicine can risk competing in any game that’s not rigged.

To claim the mantle of “evidence-based” physician nowadays is to believe only that which is published in “reputable” journals, meaning the publications of one’s friends and confirm one’s prejudices, should be reaffirmed in one’s opinions.  Those observations made by lessers, such as Agassiz’s graduate students, may be safely ignored until  the author is legitimate and recognized by the ‘scientific community.’

A great self-assured academic physician-leader can promise the American community that many lesser physicians fail in the delivery of best care.  They need not give evidence – they have taken the mantle of “evidence-based” and need no longer be questioned on the matter.

I fear it is too late to stop the decline; the earth must be turned, and lie fallow for a while.  We are practicing swidden agriculture, letting knowledge die off and lay fallow.