The art, science and technology of medicine have co-existed relatively peacefully for many years; however, this situation is changing. Science and technology are advancing so fast that medicine risks being dominated by them. Nevertheless, there is increasing disquiet about leaving qualities like empathy and compassion, which constitute the art of medicine, tacit. Doctors are increasingly held to account for their art, which has resulted, for example, in a proliferation of measurement scales for empathy or Emotional Intelligece. Failures in Mid Staffordshire and the Winterbourne care scandal have led people to say that we should explicitly develop caring amongst doctors and the health professions. Ethicist Anna Smajdor went so far as to question if it is still possible for patient care to have an emotional dimension . Many people might, however, be appalled by her idea that healthcare cannot, under present conditions, be fundamentally different from the care we receive in a hotel. I, and my colleague Jonathan, amongst many others, think that there is an affective dimension to medicine, which society would lose at its peril.
Medical philosopher Kieran Sweeney argued that the tension between the humanistic and technical aspects of medicine goes back to the times of the ancient Greeks . He did so using a Greek myth where Hygeia stood for the promotion of health, whereas Panacea stood for medicine as the “warrior” against the state of disease. The Panacean view prevailed with the Medical Act of the 1858, which instituted the General Medical Council, establishing medicine as a profession assigned to defeat disease. This was the point where the science of medicine established dominance over the art of medicine, which I think is reflected in the way we deliver medical curricula.
Medical students confront professional dilemmas with an emotional impact  that influence their identity development; the need to address the “ever-present absence” of emotions in medical curricula has recently been raised by McNaughton . There is no doubt that medical education requires professional values to be made explicit, hence we (Jonathan and I) are attempting to contribute to the discourses of emotions and compassion in healthcare by exploring ways to cultivate an increasingly humanistic view of the medical profession in our future doctors. We have recently started a project, called “The Doctor as a Humanist: Humanities in Medical Education”, which will unfold in three phases. Phase 1 will be aimed at running a pilot educational intervention to groups of 4 to 6 medical students from some international Universities. The intent is to add an element of inter-cultural communication to hopefully further stimulate students’ reflection.
Through reading and discussing some relevant works of literature, the pilot will attempt to:
- Nurture students’ humanistic vision of the medical profession
- Cultivate students’ ability to use poems and literature to reflect on how they deal with medicine, disease and health
- Develop students’ ability to identify and effectively deal with cross-cultural issues in the medical profession
- Cultivate students’ capacity to observe and look into the complex socio-cultural dynamics of the medical profession
- Facilitate students’ discussion and exchange of opinions and experiences on the humanities with other students from different countries and backgrounds
The pilot will then be evaluated and discussed at a Symposium (Phase 2) in October, where one student representative from each participating Medical School will be invited, amongst a small group of educationalists and clinicians. The aim of the symposium is to further develop ways to include the humanities in the medical curriculum and to hopefully begin the design of a more established curriculum element (e.g. SSC or intercalated degree) to be implemented and evaluated in a 3rd Phase.
The following is Jonathan‘s description of the project:
In a recent book on Medical Humanities , the authors explain how the humanities can contribute to “cultivating personality, intellectual curiosity, emotional honesty, social awareness, and the exercise of sound judgement and moral imagination – virtues and skills indispensable to good doctoring”.
Likewise, our global project aims to reintroduce this humanistic vision to medical education, and thus to counteract the ever-increasing over-dependence on technology. It hopes to teach future medical doctors that a balance between the “scientific” and the “humanistic” is essential for their future medical careers. They will be treating humans and thus need to know as many aspects as possible of what it means to be human in the twenty first century, and this project believes that the teaching of works of literature will help them towards this goal.
Do let us know if you wish to be updated or involved in this exciting project!
- Smajdor, A. (2013). Reification and compassion in medicine: A tale of two systems. Clinical Ethics, 8: 11-118.
- Dixon, M, Sweeney, K. (2000). The human effect in medicine: theory, research and practice. Radcliffe Medical Press, Oxford.
- Monrouxe, L, Rees, CE, Endacott, R, Ternan, E. (2014). ‘Even now it makes me angry’: health care students’ professionalism dilemma narratives. Medical Education, 48: 502-517.
- McNaughton, N. (2013). Discourse(s) of emotion within medical education: the ever-present absence. Medical education, 47: 71-79.
- Medical Humanities: An Introduction, Thomas R. Cole, Nathan S. Carlin, Ronald A. Carson; Cambridge University Press, 2015.