Because We Care: A Philosophical Investigation into the Spirit of Medical Education

Issue: Although in health care education we encounter the word care at every turn, the concept is hardly ever defined or subjected to scrutiny. Care is a foundational concept of health care education, and if we do not take control of our basic concepts, their meaning can be subject to other influences. We take a philosophical approach to care and ask what care is, to connect different conceptions of care in health care education to their common root. We do this by first examining how the concept is used in health care education, how it features in Martin Heidegger’s Being and Time, and finally, how these philosophical implications may be applied to medical education. Evidence: The use of care in medical education suggests that it is foundational to understanding health care education. However, presently the concept is ambiguous and risks being a ‘container concept’ that becomes meaningless because it is used generally. In publications that feature the concept, it is usually in service of another aspect that is under investigation, and not care itself. For instance, publications on teaching patient-centred care focus on the meaning of ‘patient-centeredness’ rather than care. In ‘health care’, there are debates about what ‘health’ means, but not care. The concept is also used in different and sometimes contradictory meanings: care as the organizational structure of health care that safeguards (health care system), care as empathy or careful attention of medical trainees for patients (caring about one’s patients, treating them carefully), and, finally, care as motivation and focus toward a goal (caring about graduating, making a contribution). We turn to the philosophy of Heidegger to integrate these different appearances of care into a unified structure. Heidegger’s Being and Time describes care as the basic ontological structure of human existence. This turns out to be a structure of time: in the familiar structure of past present and future. Anticipating a future end, which determines our attitude toward the people, objects, and physical structures we are with now, and in the light of which we orient ourselves to what is already there. Implications: By describing the ontological (foundational) structure of care, we argue that care is the spirit of health care education. This unifying structure can be used to integrate phenomena that are recognized as important in health care education but are usually seen as separate. We use an example to illustrate how empathy, health protocols, and educational goals can be connected in one situation. Just as health provides a framework for patient management, care can provide this framework for education. This fundamental concept of care can be used in practice for reflection on anticipated ends in situations in which different modes of care seemingly conflict. Beyond our focus on care, we also illustrate how one can take an important concept in health care education and use philosophy to root it in a foundational understanding of that concept.