Bioethics Discussion Blog: No “Gall Bladder Case in Room 213”: Teaching Medical Students Humanism

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Saturday, December 08, 2007

No “Gall Bladder Case in Room 213”: Teaching Medical Students Humanism

As I have previously noted on my threads, medical education is paying increasing attention to humanism, teaching students to remain aware that a patient with an illness is not simply an illness but is actually an individual human being who is incidentally sick. There is no “gall bladder case in room 213” but there is “Mrs. Roberta Jones, an 65 year old lady whose children live on the other side of the country and this is her first hospitalization since her husband died of pancreatic cancer a year and a half ago and when Mrs. Jones’ pain first started she began to think of the similarity to her husband’s pain and then recalled his wretched clinical course leading to his death and she thought if she has a disease like that how is she going to cope since although she was able to take care of herself in the past one and half years it was because she was healthy and vigorous and had always been able to care for herself but now with this pain she may be becoming weaker and more dependent and now she was alone and …” For students and physicians to ignore all that is going on in room 213 and pay attention simply to a pathologic gall bladder represents a true failure to fully evaluate and understand the patient as a person and not just a disease.

So..how can one educate students about humanism and keep them tuned in to this important part of being a medical professional but also an attentive and caring human being? For teaching rashes, the technique has been for the dermatology teacher to gather students in front of the sick patient to inspect the patient’s rash. Teaching pathology, students along with a pathologist gather over a large white pan bearing a severely diseased cirrhotic liver specimen, teasing the specimen open with the patient, himself, nowhere to be seen. Medical educators are now considering using the arts and literature to teach not only humanism but also stimulate skills for observation and interpretation. For example, the students gather with a teacher as facilitator in front of a painting and then, communicating together, begin dissecting the entire painting into its personal impression and its personal meanings. Hopefully, this exercise will provide training for the student, when standing in front of the patient, to look fully at the patient beyond just the rash itself and to consider, as an example, the patient’s body movements as signs of distress from the itching or burning. This is all part of looking at a patient and not just looking at a disease.

As I have stated previously, though medical education is not ignoring the importance of teaching humanistic behavior in our students, our concern is that what we teach them is preserved through their further clinical years despite the forces directed at diminishing this essential way to think and behave as a doctor.

I would be interested to read my visitors comments about what they think might be the value for students to have the arts and literature as a part of their medical education. ..Maurice.

ADDENDUM 12-16-2007: Here is an example of how we might use a painting to teach a more fuller understanding of the patient beyond simply the symptoms presented. This use might help in training the students to really look at the patient beyond the routine inspection for pathology. I presented Edward Hopper's "Room in New York" to my second year medical students and asked them to study the painting and then tell me their scenario of what is going on with the persons in the room. Their responses were varied but this led to a discussion of the views and we all learned from each other. What is your scenario? ..Maurice.

6 Comments:

At Sunday, December 16, 2007 3:51:00 AM, Blogger eryn said...

Dear Dr Bernstein,
I am a final year medical student in NZ and find your blog really thought-provoking.

We had limited teaching in humanities and ethics during preclinical years. During humanities students could choose to study literature, drama, sociology, politics, art history and law- these subjects were taught in a medical context. For example, i did drama and we studied the play "Wit" which is about an english professor dying of cancer. I found it enjoyable and a welcome break from path and pharm and biochem but i would not say it taught me humanism. I viewed those tutorials separately from what we actually experieced at hospital.

My recommendation to really prevent the "gallbladder in room 213" scenario is for consultants and attendings to teach by example. I have had some consultants supervising me who were incredibly compassionate and empathic towards patients and their families. They inspired me to follow their example.

thanks,
eryn

 
At Tuesday, December 18, 2007 7:52:00 AM, OpenID dskmd2be said...

I am a medical student in Philadelphia and enjoy your blog.

I agree with eryn. While medical school allows, and in fact encourages, pursuits into the arts, these seem incongruous with my medical education. I am a married student, no children yet, and my wife is in education. I think that what helps me connect with my patients on a human level is my reminder every day that I am more than a doctor: I am a husband, a son, a church member, and perhaps a father someday. When I discuss my experiences with family, I realize that I must not come off as uncaring, because these are the people outside of the "establishment" that approach their health care with a preformed bias. And my "humanism" speaks for more than just my own character; it speaks for the character of the medical profession.

Mentors have also been positive and negative models of humanism in my education. While I agree that they should be role models of humanism, I also agree that the arts can have a significant role. A few simple reminders (whether in formal lectures, class meetings, or from our role models) to students to stay grounded, would go a long way in encouraging students to pursue the arts (reading, theater, movies, etc.) personally. I think it takes personal initiative, and not a formal class requirement, to keep one's humanism in check.

 
At Thursday, December 20, 2007 2:43:00 PM, Blogger Maurice Bernstein, M.D. said...

It would be of interest to see if medical students would agree that the use of art or literature in medical education could be more significant to the teaching process than simply a "break" from the classic medical school didactic and clinical routine. Could the students see the potential, though the process of analysis of art or literature, a means to further develop analytic skills in more humanistic terms? It was with this motivation, whether valid or not, for my use of the Hopper painting in my small medical student group. ..Maurice.

 
At Monday, June 09, 2008 10:44:00 AM, Blogger K said...

Thanks for the information on medical humanism.

We recently wrote an article on doctor ethics on Brain Blogger. Doctors face so many different ethical questions that sometimes have no clear-cut answer. What if a doctor was out at dinner and got a call that a patient that wasn't in a life-threating situation needed his help? Should he go or should he stay?

We would like to read your comments on our article. Thank you.

Sincerely,
Kelly

 
At Monday, June 09, 2008 11:37:00 AM, Blogger Maurice Bernstein, M.D. said...

Kelly, that is the issue which brings us back to the title of this thread the "gall bladder case in Room 213". A doctor is called and told by another doctor or nurse that there is a patient with a traumatized hand in the E.R. which is not an emergency, the doctor on call can look at the call as for a "traumatized hand which is not an emergency" or look at the call as a request for help by a human patient who needs the attention of the doctor called. One view of the call relates only to pathology, the other view of the call relates to humanism. The doctor should go and first see and relate to that patient and then analyze the pathology. Once doctors think only in terms of pathology and not in terms of the needs of the patient, the doctor becomes simply a technician and no longer a physician. ..Maurice.

 
At Thursday, December 16, 2010 12:14:00 PM, Blogger Last Remaining Light said...

I couldn't agree with you more. I'm not a medical student yet (hopefully will be next year) but I have done pretty extensive shadowing through the Mayo Clinic. I've viewed a large number of surgeries and a few specific comparisons come to my mind.

The first surgeries I observed were with an orthopedic surgeon... He had me meet him in the OR once the surgery had begun. He had a resident explain the case to me, and they operated --efficiently but somewhat without interest-- until the procedure was complete. At this point the surgeon left the room without much of a goodbye, and told me I "could follow him if I want."

Another doctor I followed had suffered from testicular cancer in his youth, and he never forgot how difficult the experience was. He was an anesthesiologist, and I saw him comfort patients as they went under-- he wanted me to be in there before the patient even came in-- telling them jokes, holding their hands, doing anything to make them feel more comfortable. After the first patient fell under the anesthesia he looked over to me, still holding the patient's hand, and said "A good doctor doesn't treat diseases; a good doctor treats people."

Perhaps a lesson that taught me more about medicine than most of my undergrad courses put together.

 

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