By Joan Amtoft-Nielsen, MD, PhD, DC

I can remember that even as a small child, I always knew I would be a physician. I can still recall the joy one Christmas, when I received a children’s doctor kit. I always knew that I wanted to fix and help people. This idea was strongly reinforced throughout my many years of studies, where we were taught how to help people; to “fix” them so to speak. However, I gradually realized during my years of practicing medicine that fixing people is not what this profession is all about. The question “How can I help?” has become meaningful in recent years, but perhaps there is a deeper question to consider. Perhaps the question should truly be “How can I serve?”

Serving is different from helping, for helping is based on inequality. It is not a relationship between equals. When we help, we use our own strength to assist those of lesser strength or ability. If we are attentive to what is going on when we are helping, we will find that we generally give help to someone who is not as strong or more in need than we are in the moment. This inequality can be sensed by all involved. When we help, we may inadvertently take away from those we help more than we could ever possibly give to them. We may diminish their self-esteem, their sense of self-worth, their integrity and in fact their very wholeness.

But we do not serve with our strengths, we serve with ourselves. We draw from all our experiences to serve. Our limitations serve, our wounds serve, even our darkness can serve. The wholeness in us serves others and the wholeness in life. The wholeness in you is the same as the wholeness in me. Service is a relationship between equals. Helping incurs debt; when one helps another, there is a sense of being “owed” in some way. Yet serving, as with healing, is mutual. There is no debt; served and server are equal beneficiaries.

When one helps, one derives a feeling of satisfaction. When one serves, one derives a feeling of gratitude. These are clearly different blessings. Serving is also different from fixing. When one fixes another there is a perception of brokenness and a subsequent call to action. When one fixes, there is not the perception of the wholeness of the other, nor the trust in the integrity of the life within that person. When one serves, one trusts that inherent wholeness and responds to and collaborates with it.

When one individual is fixing another, there exists a necessary distance between the fixer and the one being fixed. Fixing is in fact a form of judgment and all judgment creates a distance, a sense of disconnection and an experience of difference. In fixing, there is an inequality of experience and expertise that can create a moral distance. Ironically, we can only serve that to which we are profoundly connected, that which we are willing to touch. This was Mother Teresa’s basic message: “We serve life, not because it is broken, but because it is holy.”

Healthcare in America is currently in a state of crisis. When we exist within these very challenging times, we must find something to sustain us. The pursuit of scientific and empirical truth alone is simply not sufficient to sustain us. In recent years, the practice of medicine has become far too difficult. The levels of stress, depression, cynicism and burn-out are so high that we must find something stronger than our science to hold onto, something more satisfying to nourish us as individuals and as healers.

I suspect that living well in times of crisis will require us to pursue meaning in much the same way that we have pursued knowledge in the past. We therefore must educate our physicians to pursue meaning, in the same way that we now educate them to pursue knowledge.

Patients with devastating illnesses are experts in living in a state of crisis. I have personally had the opportunity to listen to many of them and it has taught me that in times of distress, meaning is of the utmost importance for healing, and ultimately for living one’s life. Meaning does not change life; meaning changes our experience and perception of life—and our work as well. Doing work with a sense of meaning is very often lacking in the medical profession today.

Surviving the current crisis in healthcare may require each physician to re-examine and re-connect with not only what we came to do, but with why we chose to do it. Finding meaning means that we must cultivate a real relationship with our patients. We are closer to the true meaning of our work when we know our patients’ stories as well as we know their diagnoses. We are closer to the true meaning of our vocation when we know our colleagues’ stories and what they have sacrificed to their professions. Stories inspire and touch, they enliven and strengthen. Stories remind us of who we are, and why we continue to do what we do.

The original intention for the medical profession has not changed since the time of Hippocrates. The strategy used to fulfill this intention has changed radically. The original meaning of this profession was service, and science only the tool used to offer the service. All of us, doctor and patient alike, exist in the service of life itself. Service is not a technique or skill, nor is it a relationship between an “expert” and a patient with a problem to be solved. It is a relationship between two whole human beings.

Science may have distracted us; it may even have covered over the meaning of our work. We may have become alienated from the very life we are attempting to serve. Restoring a sense of service to the practice of medicine will require re-thinking the education of medical professionals. It will require a radical re-tooling of medical thought. At present, the predominant emphasis in medicine is on fixing, manipulating, controlling and gaining mastery over health and life. This is not service. We serve life, not because it is broken. We serve life because we possess a deep inner knowing that life is, by its very nature, holy and whole.