The Art and Science of Medicine

by Marci J. Swede, PhD, Chair Department of Health Sciences

“The care of the sick unfolds in stories” – Rita Charon, MD, Ph. D. Columbia University School of Medicine
A teenage girl and her mother walk into the urgent care clinic. The teen is feverish with a sore throat. A quick exam and a throat swab and the results are clear: strep throat. The doctor reassures her, “It’s a common illness and with antibiotics you’ll be fine.” He then asks one follow-up question, “Are you on birth control pills?” Looking down at her chart, he is busy writing and doesn’t notice that she blushes, looks quickly at her mother, before mumbling, “No.”
She’s lying, of course.
What the doctor didn’t notice is that she’s embarrassed to admit in front of her mother that she got birth control pills while at college. What the teen doesn’t know is that antibiotics can reduce the effectiveness of the pill and she should use backup birth control. The doctor doesn’t pursue it because he missed the signs that her story wasn’t complete. She now runs the risk of getting pregnant.
Did the doctor do the right test? Did he make the right diagnosis? Will the medication cure her illness? All, yes. But did he deliver good medicine? Maybe not.
The field of medicine emerged from a desperate need to cure disease and treat injury, by focusing on the things that could go wrong in the body. Modern medicine is firmly rooted in the science and a deep understanding of the human body in all its complexity. We demand solid evidence and proof that medications and treatments are actually effective against the illness they claim to cure. Modern medicine is truly one of society’s biggest wins.
But over time it became clear that to practice truly effective medicine, medical professionals needed to learn how to look at more than just symptoms, pathologies, and diseases. They needed to pay attention to the entire person, and gather all the information they could about a patient. What might be going on in their lives that could get in the way of the treatment? What unspoken piece of information might make the diagnosis easier to get to? Doctors had to hear and see the whole story to deliver the kind of care that can truly transform lives. They needed humanity and empathy together with science. From this need emerged the field of Narrative Medicine.
Narrative medicine uses the humanities to complement the sciences, in order teach healthcare providers how to help patients and their families and to help even themselves give voice to their experiences. The goal is to ensure that everyone feels valued as human beings as they go through the medical process. Healthcare students study art, poetry, music, and literature in order to develop a deep appreciation for the human condition and to connect with their own sense of empathy. They read and write narrative so that they can learn to listen to the stories their patients tell. Students learn to pay close and careful attention to all parts of their patient’s story; to both what is voiced and what is unsaid. The humanities help students humanize medicine, and ultimately makes healthcare more effective.
Many medical schools and graduate healthcare programs embrace this idea. They are incorporating “patient-centered care” or “relationship-centered care” and are using narrative medicine as part of this curriculum. Unfortunately, by the time students get to these programs, they can be closed off to learning these humanistic skills. They struggle to build effective relationships with their patients and their colleagues. Here at Post, we are trying to remedy this. The BS degree in Health Sciences has incorporated relationship-centered care and narrative medicine into the undergraduate curriculum. Health science students take all the critical sciences, but they also take health sciences and social work courses that develop these humanistic skills. They get to write narrative, explore art and poetry, and learn listening skills, cultural sensitivity, and interprofessional team skills.
It’s paying off — our data shows that senior students have increased empathy skills after taking these courses. We are hearing that professional programs are impressed when Health Sciences students come to interview. Our goal is by combining the sciences with the humanities, we can combat social inequities through transformative medicine that sees and treats the whole human being.

Author

post.bottomline@gmail.com

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