Can Embracing the Humanities Help Us Be Better Physicians?

Kathryn E. McGoldrick, MD, FCAI (Hon)

Professor and Chair of Anesthesiology, Emeritus
Advisory Dean, Emeritus
New York Medical College
Valhalla

Left Brain, Right Brain:

Charles Percy Snow (1905-1980), the esteemed British scientist and novelist, delivered the 1959 Rede Lecture in the Senate House, Cambridge, on May 7, addressing the controversial issue of "Two Cultures." Snow posited that the intellectual life of Western society was divided into two cultures—specifically, the sciences and the humanities—and this division was creating a major barrier to solving the world's problems.1 He lamented that experts in the humanities were often living within the confines of scientific illiteracy, and scientists were often unfamiliar with some of the masterpieces of literature and other arts. He argued that practitioners in each realm should build bridges to facilitate the transmission of knowledge and to ultimately benefit society.

The tension between these approaches to viewing the world and its peoples is not only unfortunate, it is counterproductive. More than a century ago, Abraham Flexner (1866-1959), generally considered the transformative father of modern medical education, identified the foundational role that ethics, the humanities, and more broadly, all the liberal arts have in medical education.2 The eminent bioethicist, Edmund D. Pellegrino, MD (1920-2013), aptly described medicine as "the most humane of the sciences, the most scientific of the humanities." Medicine sits at the junction, or intersection, between the humanities and science. The percipient neurologist and author Oliver Sacks, MD (1933-2015), celebrated intuition in medicine and precision in art.

We live in a digitally drenched environment, and I worry that social media have engulfed the current generation, displacing time for serious reading and reflection. Today, it has become acceptable to question the value of the liberal arts in a digital economy that prizes technical skills derived from studying science, technology, engineering and mathematics (the STEM fields), rendering graduates marketable in the contemporary world. There is a perception, fostered by the trend toward industrialization of medical practice, that some medical schools have become extremely costly trade schools committed to mass-producing narrow and shallow subspecialists with limited ability to relate to, or interact with, the patients they serve. Evidence suggests, however, that leaders in undergraduate and graduate medical education have recognized this deficiency and are aggressively modifying their curricula to remediate the problem.

What patients want from doctors is evidence of both personal concern and scientific expertise. What forces gave rise to the notion that skill and compassion are incompatible? The tensions between technical knowledge and compassion, between the sapient and the humane, have their origins in history.

Humanism reached its apogee in the 15th and 16th centuries, with humanism being an integral part of the larger movement, the Renaissance (1300-1600). Even in the 15th and 16th centuries, we can observe the conflict between the study of nature on one hand as scientific knowledge steadily progressed, and humanistic learning on the other. We may not want to apply the term "the two cultures" to the 16th century, but the seeds of separation were certainly extant and multiplying. Indeed, humanists today continue to emphasize the qualitative values of life, the specific and the particular, whereas scientists seek universals and quantification.3

What is the relationship, or lack thereof, between studies in the humanities and the inculcation of humane and humanistic attitudes? Is the future of humanism in medicine a matter of teaching humanities in college or medical school, or a matter of defining desired attitudes and determining ways to cultivate those attitudes, or both? It seems naive to assert that the humanities could make medicine more "humane" in the way that a topical ointment can cure a superficial fungal infection, but they are not irrelevant. Although the humanities are basically ethically neutral, it seems reasonable to expect that the humanities might stimulate critical examination of moral values.

To be effective clinicians, physicians must understand cultural context. It is imperative that we understand how social constructs, such as sex, race, age and socioeconomic class, influence our own medical decision making and how, in turn, patients receive care in highly diverse settings. This involves a deep knowledge of the social determinants of health, including poverty, malnutrition, illiteracy and violence—domestic or otherwise. Incorporating ethics, economics, anthropology and sociology into our curricula is critical to fostering this vital knowledge.

Physicians must also possess superb communication skills. Clearly, listening is a critical component of effective communication, and I would argue that studying literature, with its emphasis on context and nuance, can enable physicians to become better, more compassionate and empathetic listeners. When listening to patients, it is important to not focus exclusively on the plot. Instead, physicians should listen for the metaphors, similes and other imagery that patients use, as well as their body language, facial expressions, cadence and silences. One hopes that this type of immersive engagement will lead not only to more accurate diagnoses and better outcomes for patients, but also to more personal fulfillment and less vulnerability to burnout for physicians.

Reading great works of literature that involve complex, fascinating characters opens minds and hearts, expands our thinking, and fosters tolerance as we attempt to understand conflicts from many different perspectives. We learn that people do not dwell in an exact calyx, and it is foolish to attempt to pigeonhole them. Literature offers a means to better comprehend the self and the world, serving as a vehicle to help us connect with other minds, rather than being imprisoned in a hall of mirrors where we are exposed solely to our own distorted reflections. Indeed, one of the hallmarks of great literature is that it offers the opportunity for endless reinterpretation and reflection. Was Hamlet a vacillating, guilt-stricken, melancholic intellectual or a prototypical victim of an Oedipus complex? Arguably, he was all of the above—and so much more. Subjectivity is the coin of the realm in the republic of letters, and appreciating ambiguity, as opposed to deceptive certitudes, can be a valuable skill for a clinician.

The turbulence and change in contemporary health care are remarkable. We are surrounded by system consolidation, shifts in payment, accelerating technological advances, ethical quagmires, consumerism and widespread challenges to physician scope of practice. Moreover, we must think globally and be conversant with the political and cultural forces that can breed pandemics and bioterrorism. We must empower our trainees to navigate these thorny challenges without cognitive or tonal dissonance.

Much has been said of the dehumanizing effects of science on medicine. But it is not science per se that is dehumanizing; it is the manner of application of science to people, the perception of people as merely objects of scientific study that creates consternation. More than a century ago, the great physician Sir William Osler (1849-1919) remarked, "If it were not for the great variability among individuals, medicine might as well be a science and not an art." Clearly, medicine is both a science and an art. We would do well to inculcate in our trainees a healthy respect for the limitations of science, which tends to focus on things that can be seen and measured. Nonetheless, some of the most real—and meaningful—facets of life, such as consciousness, friendship and love, have eluded scientific encapsulation. By incorporating and embracing the humanities, and all of the liberal arts, into our curricula for training the physicians of today and tomorrow, we will be, at a minimum, partially ensuring that the art of medicine is not displaced.

Dr. McGoldrick serves on the Accreditation Council for Graduate Medical Education, Department of Institutional Accreditation, Clinical Learning Environment Review.

References

1. Snow CP. The Two Cultures. London, England: Cambridge University Press; 1959.
2. Flexner A. Medical education in the United States and Canada: a report to the Carnegie Foundation for the Advancement of Teaching. New York, NY: Bulletin Number Four, 1910:1-364.
3. McGoldrick KE. Humane approaches to the doctor-patient relationship. In: McGoldrick KE. Women in Society: Making a Difference. Great Neck, NY: Todd and Honeywell, Inc.; 1986:38-42.

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