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.