March 10, 2003 Focus Upcoming Student Scene Spotlight

Annemarie Stroustrup Smith and Mauro Zappaterra Photo by Jeff Cleary Student Scene Learning the Healer's Art The Healer's Art, an elective course new to HMS, introduces students to the personal investment necessary for becoming effective clinicians and to methods of managing the stress and emotional toll that such an investment can entail. It was developed by Rachel Naomi Remen, a clinical professor at the University of California, San Francisco, where it has been taught since 1992. HMS is one of about a half dozen schools to bring it to their campus. Primarily for first- and second-year students, the course began here as a pilot in January and culminates this month. "Sitting around the table telling stories is not just a way of passing time. It is the way the wisdom gets passed along." --Rachel Naomi Remen The course is an extension of Dr. Remen's interest in the role of the spirit in health and recovery, which she has investigated for many years. It focuses on the role of the physician's spirit in countering "the growing loss of meaning and commitment experienced by physicians nationwide under the stresses of today's health care system." The beauty and brilliance of the course is its simplicity. The underlying principle is familiar, and best described by Dr. Remen herself: Everybody has a story. When I was a child, people sat around kitchen tables and told their stories. We don't do that so much anymore. Sitting around the table telling stories is not just a way of passing time. It is the way the wisdom gets passed along--the stuff that helps us to live a life worth remembering. Despite the awesome powers of technology many of us still do not live very well. We may need to listen to each other's stories once again. So, in the course, students and faculty are asked to take time for this activity that used to be commonplace in American society, but which has been lost, especially to those with the career demands of modern medicine. The Heart of Healing The Healer's Art was brought to HMS by Nancy Oriol, HMS associate dean for student affairs, and Mary Kraft, HMS instructor in anesthesia at Massachusetts General Hospital. The course meets for five three-hour sessions, each one exploring a topic such as sharing grief and honoring loss, allowing mystery in medicine, and caring for the soul. The first hour is a large group meeting in which Drs. Kraft and Oriol give a seed talk on the evening's topic. These presentations use personal anecdote, meditation, and thought-provoking activities to encourage students and faculty to explore their own experiences. For the remainder of the session, students and faculty gather in smaller groups for deeper and more intimate discussions. The elective provides an opportunity for small groups of students and experienced clinicians to come together, share their stories, and discuss how to maintain humanism in medicine. Conversation topics range from the intensely personal to the professional and back again. Advice is exchanged, fears are explored, and the anonymity of our great but impersonal hospital system dissipates. Students, for example, often feel that the wholeness they embodied coming into medicine is slowly masked by the persona of the physicians they are becoming. Since they are constantly evaluated on their performance, skills, and mastery of technique, it is difficult to remember that sometimes the greatest gift a physician can give a patient may not be based on knowledge but rather on humanity. The ability to listen and care can often be more comforting and healing than all our medical knowledge. Doctors as People The Healer's Art refreshes its participants by celebrating their humanity and imparting bits of wisdom to heal patients and doctors alike. It is a time for students to regenerate the part of themselves they do not want to lose during their intense medical training. The course reminds the students and faculty to give themselves permission to be human, to be true to their beliefs, and not to be held back by the expectations of others. It emphasizes living in the moment, experiencing miracles, and celebrating the art of healing. The session that focused on grief, for example, discussed the various ways to deal with this potent emotion. Often in the clinical setting, grief in the face of death is managed by ascribing blame, becoming angered or embarrassed by loss and sorrow, or by intellectualizing or internalizing it. The Healer's Art teaches that only by accepting and sharing grief can one begin to heal, and that "protecting ourselves from loss rather than grieving and healing our losses is one of the major causes of burnout." The intimate small groups of the course become a safe haven, a nonjudgmental sanctuary where students can talk about happiness, sorrow, worries, and concerns. Part of the Healer's Art is learning to take care of the healer, to be there for each other, and to provide for each other. Dr. Remen writes, "I do not think that we will be able to attain health for all until we realize that we are all providers of each other's health and value what we have to offer each other as much as what experts have to offer us." --Annemarie Stroustrup Smith and Mauro Zappaterra, both second-year students at HMS who are on the steering committee for the pilot Healer's Art course The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

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