Four Yale School of Medicine (YSM) MD students recently had the opportunity to study medical humanities at Oxford University. Dervin Cunningham (Class of ’20), Harry Newman-Plotnick (Class of ’22), Tara Torabi (Class of ’20), and Kevin Wang (Class of ’22) were among the 25 students from around the world accepted into this weeklong summer program. YSM’s Program for Humanities in Medicine (PHM) and Diversity, Inclusion, Community Engagement, and Equity Office together partially supported the students’ participation, with PHM director Anna Reisman, MD, associate professor of medicine, noting she believes they are the first YSM students to participate in this intensive course.
Top Oxford professors and visiting lecturers taught the program’s mixture of lecture-discussion and interactive workshops. The program focused on the connection between the art and the science of medicine, for example observation; illness narratives; language and communication; medical ethics; law; aging; diversity; and gender.
Wang describes how the week at Oxford reminded him “that there's so much to learn in medicine beyond the science of it. We were taught by world-renowned physicians and professors on topics from the art of communication to the complexities of ethics to the nuances of literature. It was invigorating.” Newman-Plotnick explains he had never before “spent a full week discussing nothing but medical ethics, life philosophy, health care management, acting, and countless other humanities both in and out of the classroom.” He is thankful that he did, “because it was a wonderful experience that provided me with a number of amazing opportunities to meet world- renowned professors and surgeons, as well as make some amazing new friendships with people from all around the world!”
Below, Cunningham and Torabi respond to questions about the program and their experiences.
Why you were interested in participating in the program?
Cunningham:
I’ve always had an interest in humanities, particularly as it applies to medicine and life. As I have continued to pursue my journey to becoming a clinician, I have felt that many of the answers on how to ameliorate human suffering and be of service to our fellow man actually lie outside of traditional scientific medical knowledge. My hope was that this program would provide me with a means to expand my thought process and expose myself to not only knowledge, but diverse people from a multiplicity of academic backgrounds so that I can become a well-rounded clinician, like many who came before me.
Torabi:
As a medical student, I’ve spent hours and hours on rounds, listening intently while the medical team discusses patient’s lab values, from the minute change in creatinine to the differential for hyponatremia. I’ve quickly learned the skill of taking histories and physicals – how to obtain the patient’s succession of family illnesses, number of surgeries, and list of current medications. Throughout my medical education, however, the question has often arisen: what can these histories and labs divulge about the individual beyond the identity given to him as a “patient”? We are taught to focus on pathophysiology and treatments, on test results and outcomes. Indeed, the science of medicine has a remarkable ability to tell us things. But what does it tell us about fear, loss, or loneliness? About poverty, prejudice, or privilege? This, I believe, is what studying the humanities – something which is unfortunately neglected in current medical education – may reveal to us. It gives us a different history, enabling us to view medicine as not only a science, but an art. This is why I wanted to participate in this program.
Which course most surprised you in how it made you think differently about your medical training/the practice of medicine – and why?
Cunningham:
The course that made me think most differently about my medical training was one taught by Dr. Ashok Handa on “Decision Making.” He told the story of a patient with arthritic pain: visit after visit, she would come back to her primary care provider seeking surgery, and refusing to comply with the medical management that was recommended. What struck me was that her physician never asked her “Why?” Why did she want surgery versus physical therapy and medication? If he had only asked, “why,” he would’ve realized that she was only doing what she thought was in her best interest. And in fact, when she was referred to her surgeon finally, it was he who asked these questions, connecting with her at her level. It was he who realized she was an avid gardener, who believed that only surgery would give her the ability to garden once again, as the pain had now limited her ability to do so. It was he who had the simple conversation so that three months later, with medical management, she was better and back to gardening!
Speaking with Dr. Handa about the case after the class, he replied that more often than not, we forget how to ask “why” when we finish our medical training. We often lose our curiosity to understand our patients and begin, unfortunately, practicing “bad medicine.” This reminded me that some of the best ways to become a great clinician, may be the simplest, which includes never forgetting to ask why, without judgement, when we do not understand the decisions of our patients.
Torabi:
One of our speakers, Dr. Papanikitas, led a lecture on the use of the word “we” in the medical system. “We” is often the pronoun of choice by medical professionals as in “We need to run more tests” or “We want you to start taking this medication after you leave the hospital.” But rather than promoting shared partnership with regard to medical decision making, “we” used in this way can often alienate and objectify the patient.
I realize now how important the language we use as health care practitioners—even something so seemingly simple as pronouns,—can have broader implications with regard to the way in which the doctor-patient relationship is constructed or, in this example, demolished, and how certain power dynamics in medicine persist. As medical students, there is a significant emphasis on improving our knowledge, but not as much focus on improving our choice of words. The reality is that from a patient’s perspective, both are incredibly important.
What are one or two things you learned that you think will impact your medical school experience and/or the way you approach the medical profession?
Cunningham:
Marcus Garvey once said that “a people without the knowledge of their past history, origin, and culture is a tree without roots.” I believe the same can be said about medicine. Exploring ancient historical text at the renowned Oxford Magdalen Library and learning about surgical operations that were based in the BC era reminded me that medicine is an ancient practice. As a result, I hope to not only attempt to stay abreast to new findings by reading scientific journals, but also do my part in trying to learn more about the rich history of medicine. I believe we often look back at earlier time periods with ideas of primitivity rather than appreciating the foundational knowledge that allowed us to evolve as a profession today.
Torabi:
On the last day of the course, we were given the opportunity to explore centuries-old medical texts at Magdalen College. Examining the works of Galen and Vesalius, I realized the extent throughout history to which the human body has been remarkably dissected, drawn, and objectified. Medical science has made enormous efforts to reveal to us the detailed landscapes which exist beneath the barrier of flesh and skin. We can’t deny how remarkable it is the extent to which our scientific knowledge of the body has progressed over time, allowing us to diagnose and successfully eradicate diseases.
But if there’s anything I’ve learned from the profound discussions had during this course, it is that in this precision of describing the body and the processes which occur when it is diseased, is an ignorance of the very imprecise aspects of illness and the personal meaning which applies to those humans who experience it. The moral, social, and political significance of disease – these are the elements on which science is vastly mute.
In studying the medical humanities, perhaps we can recognize these other dimensions of medicine, and become more critically aware of our roles as healthcare providers within a larger medical system as well as the way in which we treat patients. This could allow us to acquire a more compassionate and meaningful capacity to serve and take care of others.