Welcome

Welcome to Medicine on the Boundary. What does this title mean? The title of the blog is a reference to Paul Tillich’s autobiographical work, On the Boundary, in which Tillich describes his life in terms of various “boundaries.”1 In another book, The Interpretation of History, he writes:

It came to me that the concept of the border line might be the fitting symbol of the whole of my personal and intellectual development. It has been my fate, in almost every direction, to stand between alternative possibilities of existence, to be completely at home in neither, to take no definitive stance against either.2

The boundaries that Tillich uses to define his life include the boundaries between two temperaments, reality and imagination, theory and practice, and religion and culture.1

For now, however, my point is not to highlight the boundaries which Tillich used to define his life, but to focus on the idea of the boundary itself and why it matters. The essence of Tillich’s idea of a “boundary” is that it expresses the state of being perpetually pulled between competing notions. Living on the boundary, therefore, entails living in a dialectical tension. It is from this tension, however, that arises important questions, struggles to find answers to those questions, and ultimately, insight and meaning. Boundaries imply a sense of imbalance, the unfinished, and a need to wrestle with unanswered questions, but such a tension is necessary for it is through it that all personal growth is possible. As Tillich writes, “the border line is the truly propitious place for acquiring knowledge.”2

If the idea of “boundaries” in the field of medicine is still confusing, it would perhaps be most helpful if I provide some concrete examples of boundaries in which health care providers live. One of the fundamental boundaries in the field of medicine, for example, is the boundary between the mindset of functionality or scientific analysis, which requires one to view a patient as object, and the competing mindset of pursuing authentic personal relations with patients, which requires one to view them as subject. From a Buberian perspective, it is the tension of viewing a patient as “it” vs “thou.”3 Both of these attitudes have a place in medicine and are necessary in order for one to be a good physician, but neither should be allowed to completely overshadow the other.

Other examples boundaries in medicine include the boundary between scientific application (clinical) and discovery (laboratory research), instructing and listening, career and family/personal time, emphasizing a patient’s quantity or quality of life, life and death, using your skills for personal or societal gain, and between the competing roles of a physician as friend, teacher, motivator, and medical care provider. The questions, insights, and opportunities for meaning when one chooses to wrestle with and live on these boundaries are limitless. Furthermore, I am certain there are many more boundaries that I have not yet thought of.

The point of this blog, therefore, is to provide an opportunity to identify, reflect on, and discuss the various boundaries that exist in the field of medicine. In doing so, I would hope that this would help to make us better health care providers and encourage us to embrace living in a “healthy” tension. As Tillich writes,

As fruitful as such a position is for thought, since thinking presupposes receptiveness to fresh possibilities, it is difficult and dangerous for life, which steadily demands decisions and thus exclusion of alternatives. From this disposition and these tensions have come both destiny and task.2

I look forward to seeing where our individual journeys of becoming physicians takes us, and I hope this blog can help guide us through the process together.



1. Paul Tillich, On the Boundary: An Autobiographical Sketch (New York: Charles Scribner’s Sons, 1966).

2. Paul Tillich, The Interpretation of History (1936). (published online at http://www.religion-online.org/showbook.asp?title=377)

3. Martin Buber, I and Thou, translated by Walter Kaufman (New York: Charles Scribner’s Sons, 1970).