September 26, 2005
Student Scene
Literature as Path Toward Understanding Illness
Courtesy HMS Admissions |
The
Storytellers
Two mentors loom large in my introduction to the ‘medical humanities’:
Dr. Ronald Schleifer (professor of English) and Dr. Jerry Vannatta (professor
of Medicine), who co-taught a colloquium at the University of Oklahoma. Ours
was a consultation of literature as a way to probe the subtleties of the patient–doctor
relationship, including issues regarding professional ethics. An outline of
what we discussed and to whom we looked for guidance could be found in an anthology
such as On Doctoring, which is distributed to matriculating medical students
at Harvard and across the country. Just recently, both professors published
their own “anthology” in the form of an interactive DVD-ROM titled “Medicine
and Humanistic Understanding” (UPenn Press; see review in The Journal
of the American Medical Association, July 27, 2005). This compilation features
several notable people who are involved in teaching medical trainees about
the narrative form of the “history of present illness” and about
the empathetic competency necessary to relate to patients.
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While biochemistry and literature usually inhabit separate parts of the mind, it’s high time that they start enjoying each other’s company more often. |
Dr. Rafael Campo is one of the physicians interviewed in the DVD-ROM, and he teaches a seminar at HMS on “Literature, Arts, and Healing,” which I took with five other students in the spring of first year. At the same time I also took an elective on “Literary Narratives and Ethical Issues” led by Drs. Martha Montello and Maren Batalden, both HMS faculty members. There also were opportunities in Patient–Doctor I and the Mentored Clinical Casebook Project to discuss themes informing the patient’s explanatory model. Yet there seems to be a paucity of longitudinal experiences within the official HMS curriculum for a continued apprenticeship in the art of humanistic understanding. As the review of the DVD-ROM says, despite the increasing prevalence of medical humanities courses, their role in clinical education remains to some merely “a nice idea.”
Beyond Book Clubs
So how does reading literature help someone become a better physician? I
frame this question in the context of appreciating stories and translating
them into
vehicles of connection between patient and doctor. Literature provides one
interpretative path, but it is not alone. We all recognize the diverse experiences
of our colleagues, who draw on perspectives from fields such as economics,
fine arts, and the population sciences. As the Medical School plans for its
students to embark upon in-depth experiences, literature should be one of
the scholarly tracks officially recognized by our community as a complement
to
the medical curriculum (along with public policy, basic science, epidemiology,
religion, and business, to list a few). While the pursuit of a joint degree
would appeal only to a small number, there is much time after the first year
for focused, scholarly instruction in how to use literature to better comprehend
the patient’s story—the sine qua non for effective diagnosis and
treatment.
At the Bedside
William Carlos Williams says in “The Practice” that “the physician
enjoys a wonderful opportunity actually to witness the words being born.” The
bedside interview affords the privilege of having the patient—and not
abstract scribbles on a chalkboard—before everyone’s eyes. Demonstration
of exam findings is a key part of this process, but Frederick C. Shattuck
remarked in 1907 that “even when physical examination fully lays bare
the disease, it may tell us little as to the subject of the disease, and
our advice must
be given to the individual.” Literature can help us realize the interplay
between looking holistically and looking only at a single part (e.g., an
enlarged liver) as a substitute for the person. Much is gained by the astute
observer
who notes both the familiar paradigm of an illness as well as the nuances
of the particular situation. It is the master clinician who then asks the
apprentice:
what did we learn from this encounter that we didn’t know beforehand?
While biochemistry and literature usually inhabit separate parts of the mind, it’s high time that they start enjoying each other’s company more often. Are they not each an epistemological system for making sense of the story—whether the meta-narrative of human existence or the particular narrative of the patient in Room 11A?
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.
Copyright 2005 by the President and Fellows of Harvard College