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Merging the humanities with the science of medicine

From the January-February ACP Observer, copyright 2006 by the American College of Physicians.

By C. Anderson Hedberg, FACP

Sir William Osler, MD, once wrote, "The practice of medicine is an art, based on science." In practicing the art of medicine, we must combine science with the humanities if we are to truly treat the patients who come to us for help. History teaches us that doctors who lack science are incompetent, while physicians who ignore human interests and values can be monstrous.

We all know how to stay current with the science of medicine through medical journals, books, online materials and conferences. But how do we keep in touch with the much broader study of human values and needs? First and foremost, we must foster a humanistic approach to our patients, making sure we are compassionate, altruistic and culturally sensitive, as true healers should be. We must use our privileged perspective to expand our knowledge of both our individual patients and the human condition. The more insight we have into all facets of our patients' lives, the better we can serve them.

Finding inspiration

In addition to learning through professional experience, we need to maintain ties to the humanities, those great works of literature, music, art and philosophy that can inform and inspire us. Unfortunately, this can be a challenge in a world dominated by technology, constant time pressures and sound bites that pass as culture.

Faith T. Fitzgerald, MACP, a former ACP Governor as well as a master clinician and teacher, commented on this dilemma in last year's "Creative Healers: A Collection of Essays, Reviews, and Poems from The Pharos 1938-1998." She proposed this marvelous solution:

"My students almost invariably fear that the intensity of their medical studies will abridge their Renaissance humanity," Dr. Fitzgerald wrote. "The compulsion to do only medicine to the exclusion of all else generally arises from a sense of guilt we all share. It may be overcome by simply expanding the definition of medicine, as is proper, to encompass all human experience."

Many excellent commentators have suggested ways to use the humanities to achieve that comprehensive definition. In a remarkable essay published in the Aug. 23, 1979, issue of the New England Journal of Medicine, psychiatrist and social ethicist Robert Coles, MD, stated that physicians can gain insight into their own work and nature by reading books by great novelists who "are interested in exploring a kind of medical ethics that has to do with the quality of a lived life."

Dr. Coles singled out George Eliot's "Middlemarch," F. Scott Fitzgerald's "Tender is the Night," Sinclair Lewis' "Arrowsmith" and Walker Percy's "Love in the Ruins" for the way those books examine "the trials and temptations that intervene—in a doctor's life."

These titles are part of a large and accessible literature about the medical world that also includes works by Anton Chekhov, William Carlos Williams, Oliver Wendell Holmes, Lewis Thomas and many others. For a broad sampling of great writing on medical themes, I highly recommend the 2001 edition of "On Doctoring," an anthology of stories, poems and essays about the practice of medicine.

The aforementioned "Creative Healers" is another superb compendium of works mainly by physician writers. At the same time, Clifton R. Cleaveland, MACP, a former College President, has explored the lives of both patients and physicians in two books published by ACP: "Sacred Space: Stories from a Life in Medicine" and "Healers and Heroes: Ordinary People in Extraordinary Times."

And Michael A. LaCombe, MACP, an internist and writer for more than 20 years, has advanced the field of medical humanities through his editing of "On Being a Doctor" and "On Being a Patient," two longstanding series in Annals of Internal Medicine. The College has published two collections of works from those series.

Using our own creativity

Keeping in touch with humanistic activities outside the world of medicine can also expand our knowledge of the human condition as well as our enjoyment of the world and our profession. One constant source of delight is the remarkable scholarship of M. Therese Southgate, MD, who has for decades been the cover section editor for the Journal of the American Medical Association, presenting us each week with a classic work of art accompanied by a fascinating analysis.

Many of us go beyond appreciation to actually participating in the arts. My father-in-law, John H. Gratiot, MD, a surgeon who practiced for 40 years in Monterey, Calif., was also an accomplished landscape painter. Several times a week, he found great enjoyment and a respite from a busy practice by painting in his home studio. Those endeavors earned him a medal from the American Physicians Art Association, an organization founded in l936 to stimulate physician artists in all forms of visual arts, including crafts and design.

Others choose music, a favorite avocation of many physicians, some of whom even become professional performers or composers. Many enjoy participating as soloists, in chamber music groups or even in large community symphony orchestras.

Even more of us find listening to music to be a profound source of relaxation and wonder. I have fortunately been able to enhance my own love of music by serving for 27 years as tour physician for the Chicago Symphony Orchestra.

As a symphony physician, I have learned that the fields of music and medicine have much in common. Both are hard-earned endeavors that require dedication, life-long study and continuous practice.

And both are arts that probe deeply into the human condition. My life has been greatly enriched by the opportunity to serve wonderful musicians, hear music played by a superb orchestra and see the positive effects that music has on the human spirit. Those experiences have also greatly added to the compassion and joy I feel in the practice of medicine.

We have many avenues we can choose to stay close to the humanities and enhance our personal and professional lives. Given our hectic schedules, it is important to find such an oasis, and I hope you have found your own means to reaching that end. "The great power of art is to transform, renovate, activate," the poet Denise Levertov wrote. "If there is a relationship between art and healing it is that."

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