Morality and Medicine: Best-Selling Author David Brooks Explores Character, Culture, and Medical Education

David Brooks
David Brooks (New York Times image)

David Brooks is, by most measures, tremendously successful. He’s written scores of influential columns on politics and culture since joining the New York Times in 2003. He’s published several books, including a Times top seller, The Social Animal. He’s a commentator on PBS NewsHour and a senior fellow at Yale University. He’s also been a senior editor at the Weekly Standard, a contributing editor at Newsweek, and an op-ed editor at the Wall Street Journal.

But a few years ago, Brooks began to wonder if he was truly successful. He certainly had what he calls “resume virtues,” yet he wasn’t so sure about his “moral virtues.” As he admits in The Road to Character, “I wrote [the book], to be honest, to save my own soul.” The lessons he learned about kindness, loyalty, and other noble traits would likely resonate with anyone hoping to lead a meaningful life—and may have particular relevance to those who strive to heal the sick and improve the nation's health.

Brooks will serve as the opening speaker at Learn Serve Lead 2017: The AAMC Annual Meeting on Nov. 4. Below, he shares thoughts on such topics as unconscious bias, the future of health care in this country, and, of course, character.

In The Road to Character, you write about the need to focus on moral characteristics such as courage and honesty. Which traits do you think are most important for physicians to develop?

I have debates over which traits are the most important, but I think, especially for physicians, humility is the most important. And humility is not thinking lowly of yourself, and it’s not even not thinking about yourself. To me, the best definition of humility is the ability to stand outside yourself and see your strengths and weaknesses and operate from an awareness that you may not know what you’re doing. 

To operate on a body or to prescribe any course of medicine requires great confidence. You’re potentially holding a heart in your hand, so I see the need for confidence. The problem is that confidence can so easily slip over into arrogance.

In the book, you reject the notion that the best way to select a vocation is to simply look within. What advice do you have for future doctors as they make pivotal career decisions about a specialty or where to practice?

The novelist Frederick Buechner said vocation is where your deep gladness meets one of the world’s deep needs. So it’s got to be both, something you intrinsically enjoy and that also addresses a problem the world needs solving. 

“I have debates over which traits are the most important, but I think, especially for physicians, humility is the most important.”

I’ve seen friends who, the more they were in medical school, the more they let the daily schedule, the financial rewards, and the status of the specialty influence their decision. In my experience, our desire to lead good lives and to feel like we’re doing something really worthwhile, something meaningful, is more powerful than money, status, or even a daily schedule—and the people who make their decisions based on the latter three are likely to end up less happy than the others.

In The Social Animal, you wrote about the unconscious part of the human brain. Doctors’ unconscious biases—whether based on a patient’s race, gender, or some other trait—can negatively affect care. What can be done to address this problem?

Biases are just built into our culture. Struggling to know what they are and to fight against them is the beginning of empathy. There is a debate about how much you can successfully fight your own unconscious biases. I believe the experience of the world is that you can grow more compassionate. For example, most of us now find torture abhorrent, and people didn’t before. It just takes a conscious effort to know which way you’re going to be led astray by your biases.

You’ve written about the devastating impact of the opioid epidemic. What can the medical profession do to help address it?

I think the profession is wrestling hard with this one, both on the educational level and on the prescription level. [But] whenever you get a social problem of this magnitude there are so many causes behind it that the only thing you can do is throw many different solutions at it and hope you can create some sort of positive feedback loop. [The epidemic] tracks so closely with social isolation, loss of social capital, and hopelessness. What hasn’t happened is a neighborhood-by-neighborhood approach, where you work to rebind communities and give people some sense of purpose.

“In my experience, our desire to lead good lives and to feel like we’re doing something really worthwhile, something meaningful, is more powerful than money, status, or even a daily schedule .”

What do you think our health care system will look like in 5 or 10 years? 

A lot depends on whether the exchanges survive, whether they stabilize, whether they’re inherently unstable, whether the Trump administration does something to make them unstable. I would see two things happening politically. One, I think single payer is becoming a litmus test in Democratic primaries. I also suspect that if the Republican Party survives in anything like its current form—which I’m not sure it will, but if it does—universal coverage will become a litmus test for Republicans. That doesn’t mean they’ll do it with single payer; obviously, they will do it some other way. I think the failure of Trumpcare proves that you can’t take away coverage.

As medical schools and teaching hospitals prepare the next generation of doctors, do you have any thoughts you want to share?

We have a trend in our educational institutions, especially at graduate levels, to turn them into career academies. I think it’s important to return a bit to what they used to be, which is character-forming institutions. To do that you have to see the student in a different way, not just as a brain on a stick that you download information to. 

I think it’s useful to offer [students] alternatives from different philosophies or faith traditions so when they hit a moral dilemma they have ways to think about it, and so they think about their own spiritual growth. Frederick Nietzsche had a saying that he who has a “why” to live for can endure anything. If you have a purpose, then you can handle setbacks, but if you’re not aware of your moral purpose, then the setbacks can really destroy you. We may think of these things as squishy and fluffy, but actually they are the most important.