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Humanities in Medical Education

March 21, 2019

The following blog is authored by Carrie Barron, M.D., director of the Creativity for Resilience Program; David Ring, M.D., Ph.D., associate dean for Comprehensive Care and professor of psychiatry, surgery and perioperative care; and LuAnn Wilkerson, Ed.D., associate dean for evaluation and faculty development and professor of medical education.

The humanities — the study of how people process and document the human experience — are valued for teaching one how to think, question, critique, ponder, observe and intuit. Of particular importance in medicine, the humanities show us how to use ambiguity and puzzlement to advance understanding. In psychoanalytic training, which is considered a humanities discipline, one learns to honor and explore intuition and use it to hone clinical skill. If you are feeling unsettled in the treatment room, it may be that the patient is feeling unsettled and projecting this feeling. The inner sensation is a clue about how to make sense of the situation, say something that resonates and gain a greater understanding of the concern. Rather than memorization and application of material, humanities training involves exploration and critique of material. Conflicting information might arise. Writer F. Scott Fitzgerald said, “The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.”

The intuitions of both the patient and the seasoned clinician are useful tools. The gut feel, honed instinct and sense experience can inform decision-making. Attunement to emotion and intuition may improve the clinician’s ability to ask relevant questions, seed rapport and elicit a richer story.

The formulaic physician may ask the next question on the list (onset, duration, location, etc.). The narrative physician will be curious about the story, which can reveal concerns not covered on a checklist.

“So how are things going in your life?”

“It sounds like this has been a difficult time for you.”

The spontaneous interchange not only seeds rapport: It gives rise to details that can clarify diagnosis and the social determinants of a person’s health. Fluid conversation fosters a sensitivity to the inner life of the patient as well as our clinical instincts. This can change the direction of treatment.

In everyday practice the surgeon must be intuitive and creative when the anatomy is anomalous, when the facts don’t match the textbook. How does one learn to use instinct effectively, access an unnamable knowing bred of experience? We believe the serious valuation and study of humanities help us hone these skills.

In a data-driven, “evidenced-based” culture, with so much to absorb and sift through, we may neglect the relaxed and spacious mind that helps us appreciate the things that may be going unsaid, unnamed and unaddressed but are shared nonetheless. Aha moments, discoveries and helpful interventions can be lost. The inner click, as well as the outer, guides us and is the art of medicine. When one “is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason,” as poet John Keats wrote, it appears that quality and achievement are more likely.