I Before We, When Before Thee

"We, (pron.; pl. of 1.) I and others; - denoting the person speaking and another, or others, with him or her. The word is frequently employed individually, as by authors, editors, &c., when speaking of themselves, in order to avoid the appearance of egotism in the too frequent repetition of this personal pronoun. The plural style is also characteristic of the utterances of kings and other sovereign rulers."

"... and, based on the latest CT results, we will have to order additional tests."

The old man, propped up amidst rumpled sheets, monitor leads, catheters and IV's, looked at me. "We?" he said.

Who indeed is this medical "we," and how did "we" allow him into our lives?

Graduating medical school, "we" all stood and repeated, deep within our private solemnity, a modern version of the Hippocratic oath. Nowhere is a "we" to be seen. Instead, "I swear... I will keep... I will impart... I will follow..." transitions us from students to practitioners.

Somewhere in our history, medicine became a team sport. Teaching rounds with students started at the end of the 19th century. The first certified specialists (ophthalmologists) appeared in 1916. With each passing decade, new layers of medical technology, and the specialists who control it, appeared at the bedside.

"We" cannot practice medicine without specialists, lab and radiology technicians, IT support, phlebotomists, ultrasonographers, and of course, the aids and nurses who truly do all the (literal and figurative) heavy lifting while tending to "our" patients. Indeed, they are not our (singular) patients any longer, as their covered lives are controlled by insurance companies who limit many of our (plural) choices.

Yet, to my mind and ego, I prefer the original, royal, capitalized "We," as the explanation behind my linguistic choice. Growing up, medicine was to be my profession. I was the young "prince" of the family, the chosen one. To be a doctor was noble, aristocratic, and titled. Back then, people (including nurses!) would stand when a doctor entered a room. Indeed, to be a physician was to be the sovereign ruler of a patient's fate.

Back at the bedside, the old man blinked, looked at the ceiling, then turned his tired eyes back to me. "Unless you have a mouse in your pocket, there's only two of us in this room. Who's this 'we' you're talking about?"

alan berkenwald, md