Global and Historical Perspectives and the “Architecture of Serendipity”

Katherine D. van Schaik, MA, MD PhD Candidate (Harvard Department of the Classics/ Harvard Medical School)

In his work of the last ten years, legal scholar Cass Sunstein has investigated how the internet has affected human interaction, from individual social relationships to global politics. He has used the phrase “architecture of serendipity” to characterize a means of redressing the increasing social division and ideological isolation brought about by what has been termed “the internet echo chamber.” In brief, the phrase, “internet echo chamber” describes a phenomenon in which social media enables us (or even drives us) to create increasingly insular communities that are populated by people who share ideas that are very, very similar to our own. The problem with these communities of like-minded individuals, Sunstein argues, is that they tend to foster narrow-mindedness among their members. When we all see the world exactly the same way, we are supported in our assumption that ‘our’ way is the best way.

The remedy for these insulated communities is, Sunstein argues, an “architecture of serendipity,” by which we are encouraged to encounter and to consider, seriously and sincerely, unanticipated difference. His argument about the importance of serendipity in our lives – the conversation that turns to an unexpected topic, the chance meeting, the book we pull off the library shelf while in search of another volume, the lecture we attend on a whim even though it has no obvious bearing on what we study or do for work – emphasizes how these moments are often the ones we consider especially life-changing.

Academics, researchers, physicians, anthropologists, and other specialists are prone to their own kind of ‘silo-ing,’ often gathering in sub-specialist groups to debate the finer points of their particular fields. There is, without doubt, unequivocal value in gatherings of experts who seek to establish the pertinent, pressing questions and answers that they are most qualified to pursue – but there is also indispensable benefit in interdisciplinary dialogues that occur alongside such focused conversations. The recent symposium “Doctor, Doctor: Global and Historical Perspectives on the Doctor-Patient Relationship” was one such interdisciplinary gathering that possessed an architecture carefully and enjoyably designed to foster productive, thought-provoking, and powerful serendipity.

Participants approached the topic of the patient-physician relationship from many backgrounds: historians of ancient and modern contexts with wide-ranging and diverse linguistic and cultural research foci, GPs, specialist physicians, psychologists, anthropologists, patient advocates, and scholars of literature contributed to the discussion. Participants include graduate students, members of the public, independent researchers, and established physicians and scholars who came together from eight different countries, all in order to present ideas about the patient-physician relationship. I found the resultant lectures and conversations inspiring.

Anna Elsner’s keynote address about Simone de Beauvoir’s A Very Easy Death preceded, among other talks in the three parallel sessions, Jane Macnaughton’s presentation focusing on the balance of ‘subjectivity’ and ‘objectivity’ in the patient-physician encounter, and how acknowledgement of such mental code switching might be taught to students. The panel at which I served as a moderator grouped together presentations about conceptions of empathy in modern medical practice (Riana Betzler), medical writing and the patient-physician relationship in First World War Britain (Tracey Loughran), and communication between patients and physicians in modern clinical settings (Paul Dieppe). Modern physicians’ militaristic metaphors for bacteria and antibiotics (Katharina Rynkiewich) and the expectations of modern French and Mexican patients regarding elective cosmetic surgery (Eva Carpigo) preceded my own paper on medical decision making in ancient Greco-Roman and modern contexts.

As a student who is simultaneously in the final year of a PhD in ancient history, and in the final year of a post-graduate MD program, I was familiar with some of the ideas that were presented, but I certainly do not possess expert-level knowledge in most of the specific sub-fields that were represented at the conference. Moreover, I had never explicitly considered these ideas alongside one another before, much less in the kind of collegial environment afforded by the conference and the dialogues that emerged in the question-and-answer sessions, over lunch, during breaks, and over dinner. As the day concluded, I found myself wondering about, for example, the classical Greek and Latin correlates of the English word ‘empathy,’ to the extent that correlates exist; the shifting psychological and social pressures associated with elective medical intervention; how much the fundamentals of ‘medical training’ change, or remain constant, over time; how people of different cultures and time periods express, in literal and metaphorical terms, their struggle with ill-health; among other questions and themes.

Just as important as these questions and themes, if not more so, are the new people I had the pleasure and privilege to meet. Conversations begun will continue through future collaborative projects, and the words spoken will echo in encounters with patients and colleagues for years to come. Conference coordinators Sarah Jones and Alison Moulds succeeded in creating precisely the productive architecture of serendipity for which Sunstein advocates.

Physicians, archaeologists, and historians of medicine alike might sometimes wish that the individuals they treat and study were more readily classifiable than they typically are. Humans – and their natural and social history, on the spectrum that runs from the individual to the whole population – are serendipitous creatures. Sometimes we can predict or explain the behavior of our species with admirable clarity and consistency. Yet just as often, we surprise those who would seek to classify us, our circumstances, and our behavior. Indeed, we ourselves can often be surprised by our own behavior, from the ferocity of human violence to the individual, unexpected, unsolicited act of kindness or moment of deep self-sacrifice in pursuit of a higher moral or spiritual aim.

This multi-faceted messiness and unpredictability of human life is, I believe, one of the chief reasons why the intrinsically expansive and interdisciplinary field of ‘medical humanities’ is vital for academics, physicians, researchers, care-givers (in the broadest sense), healers, and patients – in short, for everyone. Conferences like “Doctor, Doctor” provide the opportunity for encounters between and among those who study, wonder at, and experience all aspects of human existence: an architecture of serendipity that is surely to prove lasting and inspiring.