Summer is over, the swine flu is lurking and two guys just quit, putting the schedule in jeopardy. Morale is plummeting and everyone needs a break. Hey, how about hosting a medical humanities night? Have your colleagues over for a bit of poetry, prose and port and devote an evening to the discussion of the humanities as they pertain to the practice of medicine. Just wait a second, you say. Who the heck has time to read that fluff when I have stacks of unread New England Journals. Well, as a founding member of ACEP’s Medical Humanities Section (MUSE), and educator of young physicians I would argue that the occasional plunge into the world of medical humanities is not a frivolous jaunt but an opportunity for a serious reality check.
Edward Hallowell, a Harvard psychiatrist and respected author, has written much on what makes up “a good life.” Topping the list of ingredients is “personal connections,” which can be a special challenge for emergency physicians. After all, many of us choose jobs away from extended families and work in single-coverage EDs with limited exposure to other group members. Plus our interactions with other medical staff may be laced with conflict and our rotating schedules may adversely impact our ability to maintain outside friendships. Let’s face it, we need to get together as colleagues, away from work, in order to strengthen our relationships, improve group loyalty and promote individual wellness. While these get-togethers can take many forms, from sports to cookouts, an evening of medical humanities crosses gender and generational barriers, making it a great inclusive alternative.
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Medical humanities connect us to the ghosts of doctors past. It reminds us that potions, poultices and pills may come and go but that human nature remains relatively unchanged. There is a collective aura that has permeated the doctor-patient relationship from the beginning of time. Whether it is in the physician’s tenderness in examining a critically ill child in Filde’s painting The Doctor, or their irritation in dealing with a crotchety, over-demanding patient as humorously displayed by Johnny Speight In Sickness and in Health, there is wisdom to be gained in the realization that even our most intimate perceptions are redundant. They have already been experienced time and time again in muddy fields, thatched huts, fire-hearthed kitchens, death-ridden bedrooms and anywhere else a healer has ever touched a patient.
Medical humanities also connect us to our patients. It is always a challenge to balance our own boundaries with our patients’ needs but we are at our best when we see our patients as humans and not the embodiment of diseased organs. Ken Schwartz was a young lawyer who was diagnosed with terminal lung cancer in his 40’s. He strove, through his writing and his own personal interactions, to help providers see him and their other patients as fully human. Upon his death his family funded the Kenneth B. Schwartz Foundation to continue his legacy and promote authentic and compassionate communication between physicians and patients. It is hard not to get a little reinvigorated about patient care after you read his story.
Finally, the discussion of medical humanities lets us connect with each other and provides an opportunity for us to view each other in a new light. Our specialty is loaded with macho guys and cowgirls; if we had ER bumper stickers they might read, “Bring it on!” But with this can-do attitude comes an unspoken expectation that when difficulties arise we’ll suck it up and deal with it privately. Besides the occasional casual chat after sign out, there is little opportunity to discuss the collective experiences we share as physicians. Department meetings are usually bogged down by the details of systems and QI’s by the specifics of individual cases. And more often than not, most informal discussions at departmental functions lead into a scrappy competition of “one ups” of recent nightmarish cases.
At its best, a structured evening devoted to medical humanities can lead to a greater group connection as the presentation of individual pieces springboard into broader discussions. Through these dialogues we realize that experiences that have caused us individual confusion, shame or guilt, have also been experienced in one form or another by almost everyone else in the group. Take, for example, The Use of Force, a story in which William Carlos Williams describes a physician’s near fanatical determination to exam the back of a small child’s throat, even though the child’s mouth has started to bleed from his assault. This piece can lead to a discussion about what happens when you are doing a procedure and things start going wrong. What do you do next and what are the consequences of that decision? The simple recognition that we all carry these oversized pieces of medical baggage is a huge relief. I also feel that many physicians (especially those in the beginning of their careers) need a safe place to air their own struggles and to be given the opportunity to hear and learn from the experiences of more senior colleagues. A medical humanities evening provides a non-threatening atmosphere and an acceptable backdrop for these types of discussions and interactions.
Ok, so all of this sounds so serious. In reality these nights are a lot of fun. Thus far our group has had two medical humanities evenings and both nights featured a lot of laughter . . . and alcohol. The participation ranged from the singing of Bon Jovi’s Bad Medicine to the use of haikus and limericks to summarize Annals abstracts. One young colleague brought in beautiful goose eggs, hand painted by her grandmother who was recently diagnosed with cancer. Since she lived in Poland she was denied any cancer treatment options due to her age. This led into a discussion about cultural differences in end-of-life care.
According to experts, it takes 7 years for a landmark trial to impact most clinical practices. So let’s take a few moments and sprinkle our reading repertoire with a little food for our souls.