Medical Humanities

Detail from Vanitas Still Life by Simone Renard de Saint Andre

by Danielle Ofri
Slate Magazine

For years, I prowled the medical wards of Bellevue Hospital, the pockets of my white coat stuffed not only with my stethoscope and prescription pad, but with poems, essays, and short stories. If I happened upon unsuspecting medical students or interns, I’d press some elevator reading onto them—an Ed Hirsh poem, a Chekhov story, a Sontag essay, something from our own Bellevue Literary Review. If I was feeling less bound by social mores that day, I’d hop on the elevator with them, extolling the virtues of the photocopied literature I’d dispensed to them.

It wasn’t always artful, and more a few students thought I’d sprung a cerebral leak, but I was convinced that our medical trainees needed literature. They were up to their ears in renal tubular acidosis and eosinophilic esophagitis, after all. If there was anyone who needed a stat dose of alliteration, or an emergent infusion of metaphor, it was these medical trainees.

Of course, we in medicine have been burned numerous times doing things that we are convinced are correct, only to be bitten by clinical trials that prove us wrong and then wrong again (think estrogen replacement therapy). So it’s good to see some data supporting the role of humanities in medical education. The studies will never be as grand as the multinational mega-trials for cardiac interventions (not much interest in Bulgakov from Big Pharma), but the trickles of evidence that are coming in are heartening.

A detailed survey of more than 700 medical students attempted to quantify the level of these students’ exposure humanities (on a scale of 0 to 40). Researchers found that the higher the humanities exposure, the higher these students scored on measures of empathy, wisdom, tolerance of ambiguity, resourcefulness, and emotional intelligence and the lower they scored in signs of burnout.

Of course a survey cannot reveal if the exposure to the humanities created these laudable traits, or whether medical students with these traits were simply more likely to seek out the humanities. But I’m not sure if this distinction is necessarily relevant. As the authors suggest, “The humanities might actually provide an indispensable language for exploring that strange, nuanced, and often nonsensical land called the human condition.” We should be actively selecting more doctors-to-be who have been steeped in the humanities, and offer the steeping for those who haven’t.

Another study tried to assess how this steeping might work, and showed that students who took humanities electives during medical school scored much higher on measures of empathy. Although the chicken-and-egg question arises again, I don’t think it negates the idea that doctors ought to engage with the humanities (there isn’t really a downside to this, after all). And if you’ve been a patient, you know this even more powerfully.

If you’ve ever been seriously ill, or have shepherded a loved one through a major illness, you quickly realize what you need in your doctor. Yes, you want a doctor who is smart, but such knowledge is increasingly easier to obtain now that we have extensive digital libraries of medical facts. Having a doctor who is wise—well, that’s a horse of a different color. In moments of medical crisis, you need a doctor who can help you navigate uncertainty. When your body threatens mutiny and you are peering into the abyss, you want a doctor who has contemplated mortality in a deep way. You want a doctor who is unafraid to wrestle with ambiguity and nuance.

These features don’t typically make their way into standard medical school curricula of pathology and genetics, but patients need them just as urgently.

Humanities are not always an easy sell. My students and interns weren’t uniformly thrilled when I tried to leaven vasculitis with villanelles. There were more than a few blank stares as I tried to elicit thoughts on a William Carlos Williams poem.

On the other hand, I was amazed to see the outpouring of audience reaction at a recent presentation of drawings related to the upcoming Art & Anatomy: Drawings book, where students converted NYU’s anatomy lab into an art studio. [I contributed the Foreword to the book.] Ginny Bao, a fourth-year medical student, shared drawings that she made after her rotation in the ICU. The visceral drawings depicted the tension between the patient’s perspective and the doctor’s perspective in the high-stakes world of critical care, and the art facilitated thoughtful and spirited discussions among in the observers.

Walking out of the presentation, a fellow faculty member commented to me, “Why don’t we have conferences like that more often?” This is a question that many medical educators wrestle with. Why don’t we do this more often? Despite the data, humanities is viewed as an add-on frill to the real meat of medical education.

But the truth is that much of what medical students learn in their coursework and clinical hours—and much of what we doctors do in clinical practice—could be easily replaced by computers. Much of the basics of treating hypertension, pneumonia and diabetes could be done with computer algorithms. Many surgical procedures could be done by robots (as, frankly, could much of hospital administrative work!)

The reason that we still want actual doctors instead of—or, to be honest, in addition to—digital resources, is that they are human. We need human thoughtfulness to help us make sense of the readily available facts. We need human wisdom to help us wrestle with the complex decisions illness forces us to make. To me, this is biggest argument for including humanities as a bedrock part of medical education.

As patients, we all want the best medical care. Except for a few digital die-hards, most of us probably wouldn’t want to be taken care of by our smart phones or an algorithm. It’s not just that we want hints of human emotion when we are sick. It’s that we want—and need—the ability to grapple with nuance and ambiguity that is inherent when our bodies and minds fail.

Writer Anatole Broyard observed the frustration and loneliness of being ill: “My friends flatter me by calling my performance courageous or gallant, but my doctor should know better. He should be able to imagine the aloneness of the critically ill, a solitude as haunting as a Chirico painting. I want him to be my Virgil, leading me through my purgatory…”

Being sick is indeed hell and every patient deserves a Virgil. Infusing the medical training with a bit more Virgil just might be the key.