The oldest specialised profession in the world is…, no, not that one, it’s the medicine man, witchcraft woman, shaman and holistic healer (which probably predates the other one by millennia). While our forager ancestors had little specialisation - even hunting and gathering is often done by both sexes - the holistic healer with both knowledge in herbal remedies and spiritual well-being sticks out in many forager societies as a specialisation, which otherwise only came much later after the agricultural revolution.
Like many other institutions, the medical profession has taken a dive in general trust during the COVID pandemic, even though it has been historically one of the most honourable and prestigious ones. Ever since Hippocrates doctors have sworn an oath that commits them to the highest ethical standards. What’s more, for a large part of history doctors were the embodiment of the polymath. Apart from being a physician, Galen was a surgeon, philosopher and psychologist. Ibn Sina (Avicenna) was an astronomer, philosopher, and psychologist apart from being a physician.
Doctors today are still often seen as heroes, like the Médecins Sans Frontières or Doctors Without Borders, an international humanitarian medical non-governmental organisation. However, as often our faith in our healthcare system is waning rather than waxing. When a dentist extracts a tooth, I often feel he wants to extract a monthly salary rather than being concerned about my health.
Joking aside, let’s try to learn something about humankind from doctors. I recently read a German book about highly sensitive people, that claimed that most doctors used to be highly sensitive people (HSPs), who are extremely good at perceiving stimuli and patterns other people miss, but that our modern high-stress environment (long shifts, huge hospitals, etc.) has led to non-HSPs taking over the medical profession as HSPs are disadvantaged (to compete) in such environments. Now, this may sound somewhat esoteric, but makes a lot of sense. We can assume that Hippocrates and Ibn Sina were all HSPs and often would be outcompeted by non-HSPs if they wanted to go into the medical profession nowadays, and not only because these two were introverts who easily feel overwhelmed and not feel at ease in a modern extroverted work environment.
At college, I had to take some anatomy and physiology classes for linguistics (phonetics), which I really enjoyed, but at the same time, I was relieved that I didn’t study medicine, which would have taken me many more years to complete and much more stuff to learn by heart. We HSPs tend to be intuitive big picture thinkers and we hate memorising stuff. For professional programmers, a distinction was made between mappers (pattern-recognizers) and packers (memorising in packages). It should be clear that most pioneers in medicine were mostly mappers, whereas most people who go through years of medical training are more likely packers. Another similar distinction would be the Big 5 traits of “openness to new ideas'' (O) and consciousness (including industriousness). These two traits correlate highly with liberalism and (social) conservatism.
Let’s see if there is anything meaningful about doctors we can find out in this regard. I found the following two statistics very interesting:
As you can see, there is a solid correlation between high-paying jobs and medical professions dominated by conservative Republicans. Now I am going to make some horribly gross generalisations to make the patterns clearer and divide doctors into two distinct categories:
I have argued that these tendencies come from our evolutionary history, in particular our modes of subsistence in foraging vs farming. If we substitute group A and B with foragers and farmers respectively, we get matching patterns.
Now, let’s imagine, for simplicity’s sake that people were “un-mixed”, that the world consisted only of forager and farmer types. Two socioeconomic classes would quickly emerge if everyone had the same occupation. In a farmer society, foragers would be highly disadvantaged and would, therefore, be hard-pressed to diversify. Say, becoming a doctor would be a viable alternative. Doctors soon would have higher prestige and income than farmers, which would motivate farmer types to move into medical professions. They can only do so insofar as the required skills can be acquired by packing, i.e. with more formal schooling and less intuition. Psychiatry remains highly intuitive to this day and is, therefore, a poor field for famer types as ready-made and tried and true techniques are often not very useful. Once sequential learning opens up paths into the new profession, farmer types can follow provided these occupations bring status and wealth. In a transitional phase where most people are “doctors” there is relatively high socioeconomic equality. Once the high-income occupations are filled with farmer types, socioeconomic classes start to form again and forager types have to pioneer new areas that require a lot of mapping rather than packing, say programming computers. The skills become more formalised again and farmers can start to move in again.
WEIRD as this sounds, this in a nutshell has been the driving force in economic development since agriculture. Each industrial revolution was basically a move away from physical work to more cerebral work.
Foragers are highly unwilling to take up farming, they find it too troublesome. You can call them work-shy or lazy if you will. Put a forager into a competitive and stressful area and they will naturally try to increase efficiency and reduce the routine workload.
This is a very abstract model and doesn’t tell you not to have faith in conservative/farmer physicians. In fact, the physician my wife trusts most highly is a highly conservative one who - to our horror - expressed his support and admiration for Putin (before the war in Ukraine). Even if this is totally against our liberal conviction, it doesn’t make him worse at his job. In fact, each type may have very different strengths, like farmer types being able to cope with higher work-loads. Moreover, forager types like me often are absent-minded or suffer from ADHD. I can picture myself totally as the surgeon who left the scalpel inside the patient.
No, it’s not about individual people, but where we are headed to as a society. The trend is that medicine is more and more about making money and it’s here where it is starting to become unethical. It’s not accidental that almost 70% of surgeons are conservative. I have nothing against surgeons, but there is a danger it becomes unethical, especially in plastic surgery. Plastic surgery does not help an individual’s health in any way, on the contrary, it has considerable health risks. I guess Hippocrates would say that every plastic surgeon should really try to dissuade his patients from having plastic surgery. What’s more, this whole plastic surgery has led to a superficial beauty craze that is bad for society on a large scale.
And it’s not only plastic surgery. Prescription drugs are one of the biggest industries and doctors are often bribed by the big pharma companies. As a patient, I have come to trust doctors who are reluctant to prescribe drugs more than those who are quick to describe them. Last, but not least, the health of a country’s healthcare system may in itself be a good indicator of how healthy its political-beautrocratic system is.
For more information check out my book Foragers, Farmers and Pastoralists : How three tribes have been shaping civilization since the Neolithic
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