After a 50 year absence, the humanities return to medicine

Medicine remains one of the fields that is defined by a hierarchy that would rival the world of Downton Abbey at its pinnacle. Over fifty years ago medical training lost track of the humanities and with it the ability to effectively connect with colleagues and patients as fellow humans.

The intensity of preparation for acceptance to a top medical school only deepens with competition for internships and residencies. Doctors in training represent the best and the brightest, but often not the top of the class when it comes to emotional intelligence.

At a time when college is increasingly defined as vocational prep, with students choosing majors based on perceived guarantees of post-grad employment, medicine is stepping back from its singular focus on the sciences and reintroducing the humanities to remove barriers created by hospital hierarchy, promote teamwork and improve patient communication.

Dr. Tara Narula, a medical contributor for CBS This Morning, reported Thursday on a program in Boston that “teaches physicians in training to use their eyes and ears to connect with patients and enhance the practice of medicine.”

“At the Brigham and Women’s Hospital, doctors, nurses and Harvard medical students are helping reshape medical education. By day, members of the integrated teaching unit, or ITU, focus on treating patients. But at night, they fix their sights on works of art.

At the Museum of Fine Arts in Boston, art becomes a catalyst to strengthen clinical and interpersonal skills, softening the hard science of medicine with creative expression.

Dr. Joel Katz designed the art curriculum at Brigham and Women’s, which has become a model for other hospitals.

Katz chose the art museum because it “allows everybody to focus on an external object in a way that I would say takes the personal aspects out and lets them solve problems together.”

Activities are carefully designed to enhance team-building, and to break down the hospital hierarchy, junior staff members are paired with more senior colleagues. Observing and describing art is used to promote problem solving, communication, thinking outside the box and appreciating other perspectives.”

Increasingly, schools of medicine are recognizing the need to ‘humanize’ medical practitioners, including Columbia University’s program in Narrative Medicine and Stanford University’s Medicine and the Muse program. And a quick review of the best seller lists over the past decade, will reveal an impressive list of physicians who have exercised their talents in the humanities: Adam Verghese, Atul Gawande, Oliver Sachs, Siddhartha Mukherjee, and this month, Paul Kalanithi.

“With this program, Dr. Joel Katz hopes to find some of the human interaction that has been lost in medicine.

In fact, as recently as 50 years ago, humanities were at the core of medical practice. While research into this program’s effects is still ongoing, there is strong anecdotal evidence that both patients and practitioners benefit.”

 

 

 

 

The Saturday Read – ‘When Breath Becomes Air’ by Paul Kalanithi

“I knew with certainty that I would never be a doctor.”  How many of us eliminated career options with such conviction in our final year of high school?

The Saturday Read is ‘When Breath Becomes Air’ by Paul Kalanithi. Although not intended as a ‘career’ book, the beautiful prose and compelling story will leave you reflecting on choices, time and values.

The book is a narrative revealed in two parts.

The first begins with the story of a college student making the most of his experience at Stanford, initially studying English literature, “…seeking a deeper understanding of a life of the mind” until his ultimate realization that “I was merely confirming what I already knew: I wanted that direct experience. It was only in practicing medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action…I was going to Yale for medical school.”

The unintended value of the book’s Part I is a tutorial on the process of career decision making: exploration, reflection, discovery, reality testing, trade-offs and identity.

“In the fourth year of medical school, I watched as, one by one, many of my classmates elected to specialize in less demanding areas…and applied for their residencies. Puzzled by this, I gathered data from several elite medical schools and saw the trends were the same: by the end of medical school, most students tend to focus on “lifestyle” specialties – those with humane hours, higher salaries, and lower pressures – the idealism of their med school application essays tempered or lost…Indeed, this is how 99 percent of people select their jobs: pay, work environment, hours. But that’s the point. Putting lifestyle first is how you find a job – not a calling.”

Part II, “Cease Not till Death” addresses an essential question of life and career, What happens when your sense of identity is shaken?

“Lying next to Lucy in the hospital bed, both of us crying, the CT scan images still glowing on the computer screen, that identity as a physician – my identity – no longer mattered.

Instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused.”

Before the book was published, Dr. Kalanithi wrote two articles a year apart. Elements of both appear throughout the narrative. The first, ‘How Long Have I Got Left?’ for The New York Times in January 2014 described his role reversal as he “traversed the line from doctor to patient” and reflected on his own mortality.

“I began to realize that coming face to face with my own mortality, in a sense, had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. Yet there is no other way to live.

Faced with mortality, scientific knowledge can provide only an ounce of certainty: Yes, you will die. But one wants a full pound of certainty, and that is not on offer.”

The second article, ‘Before I Go’ was published in the Spring 2015 issue of Stanford Medicine. Here he writes about time and career as the future “flattens out into a perpetual present”. 

“Time for me is double-edged: Every day brings me further from the low of my last cancer relapse, but every day also brings me closer to the next cancer recurrence — and eventually, death. Perhaps later than I think, but certainly sooner than I desire.

Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed.”

In the end, his illness brought him back to his love of literature and writing. His remarkable life informs this brilliant memoir. It’s a book for the new year, when resolutions are carelessly disregarded. The words, and Dr. Kalanithi’s legacy, reconnect us with the fundamentals of humanism.