Thinking about those stories led me back to the humanities. By the humanities we usually mean the visual and musical arts, literature, history, philosophy and theology, psychology, anthropology, and sociology. That is where empathy, humility, intuition, and hope, a few of the emotions that define our humanity, can remind doctors to treat the person as well as the disease.
Younger readers might smile at my insistence on the primacy of the person. "Pre-meds" are canny enough to recognize that majoring in molecular biology or genetics trumps study of English literature or philosophy for getting into medical school. Many studies confirm how they lose their empathy during the first years of medical training.
Science and technology underlie much that modern doctors do and more than we understand. In the 1940s physicians gave penicillin, which was newly discovered, to patients with pneumonia and watched the pneumonia vanish even if we did not know how it worked.
I am uncertain whether clinicians need to know how infectious agents, most recently the gonococci, marshal the genetic transfers to withstand new antibiotics. I am fascinated by the new knowledge about bacterial ecosystems and what they mean. However, I am sure that of the people who come to a family doctor’s office, more require understanding of their lives than will benefit from scrutiny of their organs. How that will change with fecal transplants I do not know.
Modern medical practice relies on logic and reason and far less on intuition. I think of reason as coming from the brain and intuition as springing from the mind and growing with experience. Reason and intuition; one is visible, and the other more mythic. Current medical practice counts on reason alone. It is no longer acceptable in academic medical circles to talk about intuition, that other way of comprehending. In part, that is because the Enlightenment of the 18th century chose mathematics as the "science of sciences." Clinical practice largely followed that route, which Isaiah Berlin labeled "The Scientific Fallacy," the belief that all human problems can be solved by reason and logic. Medical students are taught to discard other ways of knowing, intuition that comes unbidden, without conscious thought, because it cannot be measured.
As the popular phrase puts it, we humans encompass body, mind, and spirit; our inner life counts. However, in clinical practice today science is the authority, even in human ways that depend on cultural choices that we cannot always explain, which might be one reason why reading the romantic poets so grabs many college students.
At Yale Medical School in the 1920s, Dean Milton Winternitz had a grand vision to bring Yale’s law school and divinity school down to the medical school campus. His temple was to be the Institute for Human Relations, a grand vision incised in stone at the entrance to the medical school, but one that did not long endure.
With protocols from evidence-based medicine, robotic surgery, and genetically based therapies, current medical students ask what will be left for them to do as practitioners. I tell them that so far no computer has taken the place of a person who comforts the sick. The nurse practitioner who listens to the patient can comfort far more readily than any laptop doc. Clinicians more than ever must learn to act as mediators between the machines and our patients. To understand them, wider humanistic learning, more intuition, will be helpful.
The trouble is that physicians have lost confidence in themselves. They no longer consider it professional to help patients by their words, by their person, or by their presence, or they are embarrassed to try. Yet here is where a caring physician comforts so much more than a computer.
Restoring the patient-doctor dialogue is one goal of programs in the humanities: to pull the attention of physicians and nurses – all the caring professions – back to people, back to our patients – and to ourselves.
Physicians can look up to the heavens to find constellations or the Creator, or they can look down deep into the body to find cells and the twists and turns of amino acids. However, cytokines suffer no pain; lysosomes do not laugh. Physicians bring science to people who sometimes might need comfort more than cure.
Acknowledgements
This article was adapted from the Buffmire lecture, which was given on January 14, 2011.
Dr. Spiro had no relevant disclosures.
