Part 2: Implications for Physician Training
How, then, can we train physicians to appreciate the full humanity and individuality of their patients and themselves when EKGs, MRIs, CAT scans, and the whole battery of diagnostic tests and acronyms impose a detached view of the patient as a composite of numbers in a sea of statistics and of the physician/healer as a “health care provider” comparable to any other vendor?
How can we help physicians retain their initial idealism when the paper jungle of medical bureaucracy itself is so emotionally and psychologically distracting, even depleting?
By illuminating a range of responses to the human condition, the humanities are a ripe venue for personal and professional growth.
Discussions (written as well as verbal) of literature, film, history, philosophy, the visual and musical arts are opportunities to “recollect emotion [and events] in tranquility”, to borrow Wordsworth’s definition of poetry. That is, they are “a safe space” for self –reflection and sharing, for exploring one’s own values, strengths, hopes, fears, vulnerabilities, prejudices and expectations, and for listening to those of others.
An important correlative is often an appreciation of diversity and of team- work. Similarly, recording their own experiences can help physicians find a way of framing, organizing and making meaning of what they encounter. Such openness and self -awareness stimulates the genuine empathy, compassion, and trust- themselves acts of imagination - crucial for a healing bond between patient and physician. (In fact, in recognition of the narrative quality of the clinical encounter, Dr. Rita Charon began a Program in Narrative Medicine at Columbia University in 1996.)
On a very practical level, the study of the humanities and the use of narrative strategies of interpretation can nurture many of the skills characterizing good doctoring: effective communication; the analytic ability to correlate relevant patterns of data; the courage to see/seek connections among seemingly unrelated elements.
Whether fictional, factual or poetic, narratives- peoples’ stories- especially can prepare medical practitioners for the variety of personalities and situations they will meet, and expose the thoughts and feelings many patients cannot articulate. Armed with recognition, the physician can more readily fulfill his/her responsibilities: sensitively elicit and convey information; carefully determine the most suitable course of treatment “with” as well as “for” individual patients and their families; thoughtfully examine and, if possible, resolve ethical and emotional dilemmas; and, when necessary, bravely accept and help the patient accept death as a natural part of life.
In the most challenging circumstances, using perspectives from the humanities can support the physician in the struggle to endure uncertainty and failure and find/give comfort.
In short, whether as audience or creator, engagement in the humanities can better prepare physicians to truly care for the patient and for themselves.
Part 3 of the series (in the March 2004 Forum) will focus on the medical humanities at TJU.
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