Abraham Flexnerʼs “Mooted Question” and the Story of Integration

Abstract

Contemporary medicine is characterized by dualities. They include psyche and soma, subject and object, and, most important, science and humanism. The authors, in exploring Flexner's landmark publication, suggest that the history of curricular evolution has been marked by a quest for the integration of two knowledge bases: science and clinical medicine. They describe this goal as a preoccupation of medical educators, arguing that it was triggered, in part, by Flexner's recommendation for a two-phase curriculum. Their claim is illustrated with an analysis of motives for curricular renewal at one medical school and a review of published reports from educational opinion leaders. They discuss Flexner's conception of integration-namely, that unity could be achieved through methodology and, in particular, through inductive reasoning. They situate this perspective in the context of other purported integrative principles such as bioethics, narrative medicine, and the biopsychosocial model. They conclude by recommending an alternative framework for integration. The authors propose that a synthesis of two separate knowledge domains can be achieved through a common purpose and that, in a clinical context, that purpose is the well-being of the patient. Well-being is defined as the patient's ability to pursue achievable goals and purposes. It can be brought about by changing medicine's emphasis from the eradication of disease to the restoration of functions impaired by sickness. This idea is congruent with aspects of Flexner's understanding of medical practice, as shown in his statement that the restoration of normal functioning should be the doctor's "goal in action."