‘See beyond the bleeding’
Medical humanities provide opportunity for doctors to reflect
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.