Medical humanities and the search for meaning

I must admit that I’m surprised when I hear third-year medical students say they would like to have taken some humanities courses in the first two years of medical school. “Why would medical students want to take more classes?” I ask myself.

Then I quickly realize that it’s not the number of classes that matters but how they see the content enriching their lives and helping them to become better doctors.

Learning how to conduct a physical exam is obviously important. What’s not as obvious is the importance of humanities courses. Danielle Ofri, like other physicians and medical humanists before her, has an answer:

Medical students, residents, and attending physicians (not to mention nurses, PAs, and essentially anyone associated with direct patient care) need the humanities.

The study she cites as evidence for this view involved a survey of students who had been exposed to the humanities either through active engagement in painting and playing music or more passive immersion in cultural events. The  survey measured various personal qualities, such as wisdom, empathy, and resilience.

Three of the outcomes measured are of particular relevance to the practice of medicine in a large medical center: Tolerance for ambiguity, empathy, and emotional intelligence.

As it turns out, these are also capacities that can be developed through exposure to well-written works of literature.

Although clinicians strive to make decisions based on scientific evidence, the practice of medicine is filled with conflicting signs and symptoms, uncertain outcomes, zero sum games, tradeoffs and Hail Marys. It’s not an exact science by any stretch of the imagination.

Coping with this disarray requires not just tolerance for ambiguity, but an ability to hold multiple perspectives in one’s mind at the same time in order to discern which treatment plan is in the patient’s best interests.

Good stories have the ability to transport the reader into a character’s moral universe, which helps to build the capacity for empathy. For example, though there is ample medical literature on the grieving process, poetic descriptions of how grief manifests can illuminate this phenomenon and help physicians respond more empathetically to patients and their families.

Exposure to the humanities might also be able to address the ever-growing problem of burnout among healthcare providers. Studies indicate that medical students start to show symptoms of burnout around the time they start their clerkships, which continues into residency and may explain why so many residents report feeling burned out.

One of the symptoms of burnout is loss of meaning, which is often expressed as feeling like learners and practitioners aren’t making a difference in their patients’ lives. To help students reconnect with the arts and the humanities, I teach a class on narrative ethics as part of the ethics track at Baylor College of Medicine. I begin class each term by asking students to tell me their favorite story, whether it’s from a work of literature, a favorite song or a story they learned at their grandparent’s knee.

One of the proudest moments in my teaching career occurred when a student told me that she had begun to read for pleasure and enlightenment again after taking my class. She started with Fahrenheit 451 and has moved on to Jane Eyre.

Since very few of the readers of this blog will be able to take my class, I have compiled a list of recommended readings. These works may help you regain a sense of fulfillment in your practice, or simply bring you the joy of a good story.

Poem: Afternoon by Max Ritvo

When I read the first stanza of this poem, I couldn’t stop thinking about it all morning. It still gives me chills. In general, Ritvo’s poems ache with longing and tenderness, but his lines also seem to snicker derisively at his cancer and make mouths at death. They are postcards from the edge, written in the gleeful hand of the class clown.

Short story: Communion by Richard Weinberg

If anyone still questions the value of listening to the patient’s story, this short story by a gastroenterologist in North Carolina should set them straight. In his first awkward encounter with a withdrawn and anguished patient whom others had abandoned, the author rummages through his entire medical toolbox, but finds nothing there to help him. Yet, the patient keeps coming back.

Even shorter story: White Lies by Amy L. Christianson  

When written well, 55-word stories can be as moving and complex as much longer literary works. Christianson’s piece is devastating but nuanced in its description of a tragic motor vehicle accident. There are many ways to learn how to give bad news. This story presents one of the most challenging contexts for that kind of conversation.

-By Andrew Childress, Ph.D., assistant professor in the Center for Medical Ethics and Health Policy at Baylor