CASE STUDIES

Perhaps Medicine Is One of the Humanities?

Comment on “Shanachie and Norm” by Malcolm Parker

Miles Little

Received: 5 February 2014 /Accepted: 24 April 2014 /Published online: 17 May 2014# Springer Science+Business Media Dordrecht 2014

Keywords Humanities inmedicine . Communication .

Practical wisdom .Medical education

Why on earth should literary skills, or even a love ofliterature, make for a better doctor? Gribble (1992) hasargued that encouraging literary critical skills sharpensthose specific skills but has no benefits that flow intoother cognitive areas. Nussbaum (1995), per contra, hasclaimed that literature does indeed allow imaginativeparticipation in situations that are ethically challengingand therefore encourages the development of phronesis,or practical wisdom. Robin Downie (1994) taught animmensely popular course on medicine and the arts inGlasgow. Osler (1948) listed the great works that everymedical student should read. And so it goes, one author-ity after another telling us that education in the human-ities makes for better ethics, communication, empathy,humanity, understanding, and so on in medical practi-tioners, while in the background is a small voice sayingthat such things as literary skills promote only literaryskills.

Behind the propaganda that underpins humane med-icine is an assumption that there is something seriously

wrong with modern medicine. But whose standards,whose norms decide what is wrong with modern med-ical practice, and what should be done to address theseissues? Movement after movement has set out to “re-humanise” medicine, to make it more attuned to humansuffering, more appropriate in its responses to grief andfear, more trustworthy and honest in its communica-tions. We have had empathic medicine, patient-centredcare, person-centred medicine, narrative medicine,mindful practice, and so on and on. Yet evidence-based medicine, which doesn’t deal with the humanities,has been the only reform movement to have lasted thedistance, even though it has had to modify its demandsand relax its standards for the recognition of what con-stitutes evidence.

Patient assessment of medical performance is oftenhostile, if we judge by media reports and the complaintsof patients and their representatives. Yet, if you talk topatients, over and over again we hear respect and trustexpressed in doctors. If you talk to doctors you will hearrespect for virtues, particularly practical wisdom, and anawareness of the nature of suffering (Little et al. 2011a,b). But both groups agree in their criticisms of “thesystem” that is health care. It is impersonal, inefficient,underfunded, understaffed, overloaded, and bureaucrat-ically top-heavy. There is no time free to discuss the artsin the medical consultation. But the medical consulta-tion itself is a process of narrative engagement, a de-mand for interpretation, judgement, and action. A sen-sitive listener, a person skilled in language, can read thecontent of a consultation, whether she has read Shake-speare, Jane Austen, or the Bible, whether she enjoysopera, poetry, or theatre, whether she know a Vermeer

Bioethical Inquiry (2014) 11:265–266DOI 10.1007/s11673-014-9537-0

The original article byMalcolm Parker, published in the Journal ofBioethical Inquiry 9(2): 215–216, can be located at DOI 10.1007/s11673-012-9356-0.

M. Little (*)Centre for Values, Ethics and the Law in Medicine (VELiM),University of Sydney,Building K25, Sydney, NSW 2006, Australiae-mail: miles.little@sydney.edu.au

from a Jackson Pollock. The practice of medicine is itsown form of art, its own literary experience. To assim-ilate the everyday in medical practice is to engage withhumanity in its living, breathing, speaking form.

Reading literature may supplement reality, may pro-vide intellectual stimulus and ethical reflection—but notfor everyone. If doctors seek an out-of-work satisfactionfrom the arts, then I believe strongly in doctors’ orches-tras, travel groups, discussion groups, book clubs, andeven more strongly in the private enjoyment of all thearts if they find pleasure and personal growth in thesesources. Awide education on which to drawmakes for amore pleasant dinner party for the other guests, but givesno guarantee of fine doctoring in the practitioner’s officethe following day.

I’ve known very good doctors who had few artisticinterests, and some widely read practitioners who werefrankly more entertaining than skilled. There is no con-vincing argument for compulsory education in the hu-manities. We can argue endlessly whether it is possibleto teach empathy, whether “communication skills” canbe taught, and whether practical wisdom can be learned(Cooper and Mira 1998; Tannenbaum 1998; Brownet al. 1999; Morris 2000; Klitzman 2006; Helmichet al. 2011). Sick people seek out doctors in the reason-able expectation that doctors will have the knowledgeand the skills to provide appropriate and (hopefully)effective treatment. Patients tell us that usually theirdoctors show professional interest in them as individualsand provide reasonable care (Little et al. 2011b). Wecould all do better, of course. But I have yet to beconvinced that adding humanities to an already over-crowded curriculum will eliminate the abrasions andmisunderstandings inherent in human interactions.

References

Brown, J.B., M. Boles, J.P. Mullooly, and W. Levinson. 1999.Effect of clinician communication skills training on pa-tient satisfaction. Annals of Internal Medicine 131(11):822–829.

Cooper, C., and M. Mira. 1998. Who should assess medicalstudents’ communication skills: Their academic teachers ortheir patients? Medical Education 32(4): 419–421.

Downie, R.S., ed. 1994. The healing arts. Oxford: OxfordUniversity Press.

Gribble, J. 1992. Literary education: A revaluation. London:Routledge.

Helmich, E., S. Bolhuis, R. Laan, and R. Koopmans. 2011. Earlyclinical experience: Do students learn what we expect?Medical Education 45(7): 731–740.

Klitzman, R. 2006. Improving education on doctor–patient rela-tionships and communication: Lessons from doctors whobecome patients. Academic Medicine 81(5): 447–453.

Little, M., J. Gordon, P. Markham, W. Lipworth, and I. Kerridge.2011a. Making decisions in the mechanistic, probabilisticand scientific domains of medicine: A qualitative study ofmedical practitioners. International Journal of PersonCentered Medicine 1(2): 376–384.

Little, M., J. Gordon, P. Markham, L. Rychetnik, and I. Kerridge.2011b. Virtuous acts as practical medical ethics: An empiricalstudy. Journal of Evaluation in Clinical Practice 17(5): 948–953.

Morris, D.B. 2000. How to speak postmodern: Medicine, illness,and cultural change. The Hastings Center Report 30(6): 7–16.

Nussbaum, M.C. 1995. Poetic justice: The literary imaginationand public life. Boston: Beacon.

Osler, W. 1948. Aequinimitas, with other addresses to medicalstudents, nurses and practitioners of medicine. London: H.K.Lewis & Co.

Tannenbaum, S.J. 1998. Say the right thing: Communication andphysician accountability in the era of medical outcomes. InGetting doctors to listen: Ethics and outcomes data in con-text, ed. P.J. Boyle, 204–223. Washington, DC: GeorgetownUniversity Press.

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