‘See beyond the bleed­ing’

Med­i­cal hu­man­i­ties pro­vide op­por­tu­nity for doc­tors to re­flect

THE (Times Higher Education) - - CONTENTS - Matthew.reisz@timeshigh­ere­d­u­ca­tion.com

The hu­man­i­ties may seem far re­moved from the typ­i­cal con­tent of a medicine de­gree. But they have a vi­tal role in med­i­cal prac­tice, and should there­fore play an im­por­tant role in med­i­cal train­ing, a lead­ing scholar has ar­gued.

De­liv­er­ing the Na­tional En­dow­ment for the Hu­man­i­ties’ pres­ti­gious Jack­son Lec­ture in Wash­ing­ton DC last week, Rita Charon ar­gued that ef­fec­tive doc­tors needed to see “beyond the bleed­ing and the seiz­ing” to “the com­plex lived ex­pe­ri­ence that per­sons come to us with as they face health prob­lems”.

Pro­fes­sor Charon, her­self a lit­er­ary scholar and an in­ternist as well as a pro­fes­sor of clin­i­cal medicine at Columbia Uni­ver­sity, said that, when deal­ing with pa­tients, doc­tors needed to be aware of “not just their symp­toms or their ab­nor­mal lab tests but rather their fears, their aware­ness of their own fragility. I am con­vinced, with ev­i­dence to sup­port my con­vic­tion, that study and prac­tice in the hu­man­i­ties is the most di­rect way for doc­tors to see this suf­fer­ing that sur­rounds them.”

Among many other ben­e­fits, “bridg­ing the chasms be­tween the arts and the sci­ences, be­tween lit­er­a­ture and medicine, [ can] quite re­mark­ably im­prove the care of the sick”, she said.

For­tu­nately, in Pro­fes­sor Charon’s view, med­i­cal train­ing in the US has be­gun to take on board such a per­spec­tive.

“More than 80 per cent of US med­i­cal schools”, she ex­plained, “seem to have some form of teach­ing of the hu­man­i­ties…At Columbia and other schools too, nar­ra­tive medicine is re­quired through all four years…This kind of train­ing in­creases the self-aware­ness of the stu­dents, it in­creases what they are able to learn and com­pre­hend and value about in­di­vid­u­als they are see­ing. It im­proves the func­tion of the health­care team, which is not al­ways able to work well to­gether. It de­creases the kind of dis­il­lu­sion, the burnout, the emo­tional ex­haus­tion that is driv­ing doc­tors and nurses away from prac­tice.”

So to what ex­tent have such ideals been adapted else­where?

Stella Bo­laki, reader in Amer­i­can lit­er­a­ture and med­i­cal hu­man­i­ties at the Uni­ver­sity of Kent, agreed that of­fer­ing op­por­tu­ni­ties for re­flec­tion was “vi­tal given that rou­tine and im­per­sonal in­ter­ac­tions fre­quently turn pro­fes­sion­als into au­toma­tons”. “How­ever, re­flec­tive work can be fa­cil­i­tated through other, not nec­es­sar­ily nar­ra­tive, means,” she cau- tioned. “Many med­i­cal hu­man­i­ties and med­i­cal ed­u­ca­tion schol­ars have en­cour­aged the field to en­gage with other art forms beyond lit­er­a­ture so that the em­pha­sis on ‘nar­ra­tive com­pe­tence’ can be com­ple­mented with mul­ti­sen­sory com­pe­tence. Th­ese de­vel­op­ments are shap­ing the cur­ric­ula of med­i­cal schools in the UK and else­where.”

Oth­ers be­lieved that there was still sig­nif­i­cant re­sis­tance to some of the per­spec­tives and ini­tia­tives pro­moted by Pro­fes­sor Charon.

Aye­sha Ahmad, lec­turer in global health at St Ge­orge’s, Uni­ver­sity of Lon­don, ac­knowl­edged that “there has been a com­mit­ment to take on board the hu­man­i­ties in the sense of recog­nis­ing the im­por­tance of the per­son as well as the ( bod­ily) pa­tient”, yet “the seg­re­ga­tion of med­i­cal ed­u­ca­tion” meant that “the aca­demic in­put of the hu­man­i­ties lacks ro­bust­ness”.

“Med­i­cal stu­dents are also un­der pres­sure to con­form to uni­ver­sal­ity and stan­dard­i­s­a­tion and there is not suf­fi­cient space to ac­com­mo­date the re­flec­tion or crit­i­cal anal­y­sis that the hu­man­i­ties de­mand,” Dr Ahmad said. “I have stu­dents who fear free­dom be­cause they do not know how to ex­er­cise their own thought in case it is ‘wrong’.”

Jane Mac­naughton, pro­fes­sor of med­i­cal hu­man­i­ties at Durham Uni­ver­sity, also saw an im­por­tant role for the hu­man­i­ties in “sup­port­ing doc­tors against burnout” and in “alert[ing them] again to the won­der of hu­man life and ex­pe­ri­ence”, yet felt that med­i­cal train­ing in the UK was cur­rently lag­ging be­hind the US.

“My own ex­pe­ri­ence is that a small mi­nor­ity of med­i­cal classes – a max­i­mum of 30 per cent – re­ally ‘get’ what med­i­cal hu­man­i­ties may be try­ing to do,” she said. “The dif­fer­ence may be that in the US medicine is a grad­u­ate en­try pro­gramme and stu­dents may come to this with some back­ground.”

There were signs of greater progress, how­ever, in what Pro­fes­sor Mac­naughton called “crit­i­cal med­i­cal hu­man­i­ties”, a field of re­search “more in­ter­ested in in­flu­enc­ing the clin­i­cal ev­i­dence base – which we think is the key to cul­tural change in medicine and health­care – rather than on in­flu­enc­ing the prac­ti­tioner”.

Many peo­ple will ap­plaud Pro­fes­sor Charon’s ideal of a doc­tor who “ask[s] the pa­tient not only ‘What is the mat­ter?’ but ‘What mat­ters to you?’” It is less clear how far med­i­cal train­ing fully pro­motes such an ideal.

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