Thursday, October 8, 2015

On the Value of Humanities in Health Care, or Surfing the Waves

Caveat - I extoll the virtues of an undergraduate degree in English Literature in this post to the point that it may seem I am saying that the only good doctors are former English Majors.  While in some ways I do think that, I'm willing to concede to a broader point - that an interest in and a study of the humanities is vital to good doctoring. 

This week I had the great pleasure of participating on a panel which spoke to a group of pre-health undergrads at Northwestern University about the value of an undergraduate education in the Humanities.  I was invited to sit on the panel by my medical school classmate, Paul Checchia.  Paul and I met during the first week of medical school in Lindegren Library when we were both trying to check out All The Books, because the first wave of being a humanities major (in our cases, English Majors) in medical school had hit us.  

That first wave is the obvious one: what was review for many of our classmates was new material for us.  I remember standing in the gross anatomy lab slowly realizing that there were many holes in the base of the skull through which nerves ran.  It made sense – how else would the brain extend into the rest of the body? – but these holes had names – crazy, hard to remember names.  I said something about this only to find that my lab partner had a master’s degree in Anatomy.  He already knew all the names.  He went to a bar that evening and watched the ball game.  Me?  I studied.  

That first wave was pretty bracing, but it wasn’t a surprise to me that I was going to have to study in medical school.  I think it was only in retrospect that I realized how much more I had to cram in than some of my classmates.  I also realize it was only like that for a few months.  We were all in the realm of knowing nothing very quickly, which brings me to the second wave, which was the wave that buoyed us up.

It is my sad (but somewhat gleeful) duty to inform you all that the realm of knowing nothing, which you reach at some point during the first year of medical school, is where you shall remain for the rest of your life.  There will be times you think you know something, but these times will be followed by stark illuminations of the exact dimensions of your delusion.    Knowing nothing makes medical students really crabby, because they have tried so hard for so long and they are used to achieving things and not used to having doubts about their abilities.  It is really awful to score 100% on your microbiology final and then walk into a hospital, see a patient who doesn’t speak English with a high fever who is crying uncontrollably with two babies by her side and not know the first thing about what might be wrong with them or what you might be able do about it.  It is disconcerting to be someone who researches oncogenes and then walk into a room where a patient is dying of cancer and wants to discuss physician aid in dying.  One begins to wonder what the point of all that studying was. 

And that is the wave that lifts up the humanities major.  It is not news to someone who has read Beckett that very important events in life may feel profoundly meaningless.  It is not a shock to someone who has played in an orchestra performing a Beethoven Symphony that something can be blindingly beautiful and devastatingly tragic at the same time.  Someone who has acted in Hamlet understands that the same person can be both very good and very bad.  A student of history is not confused when she discovers that her African American patients don’t trust the medical system.  Students of the humanities are primed to encounter the incredible spectrum that is the human condition.    They are comfortable with ambiguity and with all sorts of perspectives and points of view.  Through the humanities, they have experienced a myriad of worlds unseen.  When they finally see it in person as medical students, it’s not strange.  It’s familiar and comfortable.  It’s home.

Patients notice this comfort.  They start saying things.  “Thank you.  No one ever bothered to explain that to me before.”  “ You talk to me like I am a person.”  “Please remember to be like this when you are a doctor.  Remember to be real.”  “Thank you for not treating me like shit.”    Doctors notice students who seem to just naturally belong in the clinical setting.  “Good Clinical Acumen.”  “Fantastic rapport with patients.”   And my favorite: “This student just somehow ‘Gets It.’”

Humanities majors are not somehow “getting it.”  They have made an active decision to “get it” – they have made a commitment to “getting it.” They are determined to “get it” and they succeed.  I read hundreds of medical school application essays that talk about dreams of becoming a doctor and helping people.  Well, to help people, you have to understand them and appreciate them and see the beauty in them, even when they are complicated and contradictory and different from ourselves.  And the people who have deliberately taken on that challenge – who have been willing to look what it means to be human right in the eye – well, these are the poets and painters and dancers and philosophers and historians and – well, you see where I am going.  These are the people who have chosen to pursue a foundation in the humanities.  

Doctors with strong backgrounds in the humanities have the ability to surf the magnificent third wave, which I suppose I might broadly label “empathy.”  A contradiction I think about a lot is the fact that all my medical students write these beautiful application essays about wanting to help and heal (and I believe that in some way or another they are all being very truthful when they write these things) juxtaposed with the fact that doctors are perceived by the public as arrogant, uncaring and obtuse.  How does such a wonderful group of intelligent young men and women get transformed into a bunch of brutish beasts?  The simple answer is that although doctors care, they don’t always know how to show it.  But let’s drill down further.  Why don’t they know how to show it?  What gets in the way of them showing it?

If you think about what’s behind the closed crossed armed body language, the use of jargon instead of plain English, the stony mien, the judgmental attitude, it comes down to two things.  Fear and anxiety.  Not fear and anxiety about their knowledge of science and medicine – remember, these people have studied like mad and passed metric tonnes of tests – fear and anxiety of interacting with other people.  And you can either embrace that feeling and display curiosity and search for connection, or you can shut down.  A grounding in the humanities gives you the courage to embrace the other, because you know that as nervewracking as that can be, it’s where the good stuff happens. 

Medical knowledge without true connection with a patient or a community is worthless.  You can’t just take science and paste it onto people because it’s for their own good.  I mean – you can, but it won’t work.  Knowing the diagnosis means nothing at all if you can’t partner with your patient to find a treatment that fits them.  Deciding to put up posters about cancer screening in a community where children go to school hungry is the epitome of the type of “not getting it” that is so rampant in the medical system. The ability to get past the fear and anxiety that happens when you encounter a person who is quite different in looks, world view, religion or social status and truly partner with them to solve a problem takes an expansive and curious nature.  That’s the attitude that studying the humanities inculcates, and it’s also the path to the kind of empathy that leads to healthier patients as well as healthier doctors.  

That’s the thing about figuring out how to surf the empathy wave.  It’s exhilarating.  You can really help other people out and use your knowledge to improve people’s situations.  Doing what you actually said you were going to do when you were 19 is extremely validating.  You’re making good on a promise you made to yourself when you were young and that is a life triumph that many people never achieve.  I actually think that I get more out of trying to have an empathetic stance with patients than they do.  The patient gets help with their problem.  That’s great, that’s what they expected, and that’s my job.  But I have to say I think I have become a much better person through my interactions with patients, and that wouldn’t have happened if I’d pursued a career outside of health care.

In health care, you can’t walk away.  Even if you really want to.  It’s your job to help whoever shows up in the ER, the clinic, the hospital.  You have to find a way to provide a healing experience for anyone who needs it, and that means you’re forced to find connections and ways to partner with people you’d normally never encounter or more importantly, actually go out of your way to avoid.  The guy who I know beats his wife since she’s my patient, too.  The prisoner shackled to the bed.  The woman who I admit to the hospital every month for the same self-inflicted problem.  I cannot choose to avoid them.  I must find a way to understand them.  That means I have to get to know them.  And because I have felt my profession obligated me to do so, I have realized a great life lesson:  we are all the same.  There are no “those people” or “people like that.”  There is no one you can’t understand, because they are you.

Medicine forces you to confront the fact that we are all in it together.  Some people find this frightening, and build walls.  Others find it liberating and validating, and do amazing work as physicians and healers.  I am no longer surprised that when I encounter a really happy, successful doctor I can count on finding out that they have a strong background and interest in the humanities.  I have gone from thinking that being an English major was something distinctive about me to knowing that it is the real reason I’ve been able to evolve into being a good doctor.