Closing the circle—medicine re-engages with the humanities

When Howard M. Spiro, M.D., envisioned bringing the humanities to the School of Medicine in 1983, he wanted to encourage students and faculty to think beyond science and medicine. The humanities had long shared a link with science—Galileo used watercolors and engravings to show the craters that scarred the moon’s mountainous surface. Darwin, who is remembered as the father of evolution, was also a talented artist and a writer who excelled in communicating scientific concepts. Spiro, a professor of medicine and a renowned gastroenterologist, wanted to close the circle and bring the humanities back into medicine.

Between Galileo and Darwin on one hand and Spiro’s generation on the other, medical education had become highly technical and focused. In 1910, the Flexner Report commissioned by the Carnegie Foundation for the Advancement of Teaching concluded that advancing scientific knowledge to fight disease was the primary goal of medical education. That view prevailed for much of the 20th century, but during the past 50 years, medical schools have returned to the earlier tradition of including the humanities as a vital tool for students learning to become physicians. By 1967, Penn State College of Medicine had created the first department of medical humanities. Today, out of 141 surveyed American medical schools, 126 had either elective or required courses in medical humanities, according to the Association of American Medical Colleges.

Since Spiro created the Program for Humanities in Medicine in 1983, it has evolved from attendees sipping sherry at erudite lectures to interactive classes and student-led programs. Students have the opportunity to take part in live figure drawing classes at the School of Art, perform in the Yale Medical Symphony Orchestra, and refine their observation skills with curated art exhibits.

Richness of doctor-patient encounter

As medical students prepare to enter the world of medicine, they shoulder the responsibility for the patient’s life. “There is probably no greater drama than the interaction between physician and patient,” says Thomas P. Duffy, M.D., professor emeritus of hematology, who took over the humanities program upon Spiro’s retirement in 1999. “Whatever richness one brings to the patient enriches the encounter. The humanities are the source of that enrichment.”

The program, Duffy says, was never intended to create writers, artists, and musicians. Rather, it is an outlet for the creativity that already exists among medical students, residents, and faculty. The term “humanities” is intentionally broad—to foster any type of creative work. The idea is to help students harness those interests and apply them to medicine. Storytelling in particular is a powerful way for students to connect with their patients. “Doctors deal in stories—we are part of patients’ stories,” says Nancy R. Angoff, M.Ed., M.P.H. ’81, M.D. ’90, HS ’93, associate dean for student affairs. “We are, in fact, creating our own life story through the work that we do, through the people we connect with, through the experiences we have.”

Other medical humanities programs on the medical campus, such as the Yale Internal Medicine Residency Writers’ Workshop, encourage residents to reflect on their own experiences or on a particular patient’s story. Anna Reisman, M.D., associate professor of medicine and director of the writers’ workshop (Lisa Sanders, M.D. ’97, HS ’00, associate professor of medicine, is the workshop’s writer-in-residence), says that stories invite connection and establish empathy between patients and physicians. “We are, after all, training to take care of human beings,” says Reisman, who became director of the Program for Humanities in Medicine in 2015. “We are not training to just take care of diseases.”

Taking the time to hear a patient’s story is becoming harder in the context of a 15-minute doctor’s appointment. The fast pace of the clinic combined with the responsibility of facing death and illness regularly can often lead physicians to ignore their feelings—Angoff worries about burnout among doctors. “I think what feeds the doctor’s soul is relationship—relieving suffering within the context of a relationship,” says Angoff. “The humanities act as a way to recover from a loss of empathy and to reclaim one’s self, to feel again.”

Angoff knows what it is like to work closely with patients who are facing death—she has spent her career working at the heart of the HIV/AIDS epidemic. Although AIDS is no longer a death sentence, she acknowledges that, like so many things in medicine, it is still distressing to her patients. Humanities, she says, provide refuge for herself as a lover of the written word and former middle school English teacher, and for her patients. “There’s a sense of immortality in a story that has to be told,” she says.

Creativity stifled

There’s another reason for incorporating humanities into a medical student’s curriculum—medical education emphasizes the mastery of such detailed technical information as the anatomy of the human body and the biological mechanisms that cause disease. The humanities allow students to exercise another part of their brains and their personalities. The medical school prides itself on the eclectic makeup of the student body—many come with backgrounds in humanities or an interest in writing, music, art, and history. “In medical school, I think sometimes people get bogged down in science and facts,” says Kristina Klara, a second-year medical student and an editor of the student literary magazine, Murmurs. “A lot of us came in with this creative side that can feel a little stifled.”

While the humanities provide a means to celebrate our own experiences, they also can teach us about our biases and perceptions of the world around us. A class in health justice developed by medical students Robert Rock and Tehreem Rehman uses art to reveal the implicit biases that physicians may have against their patients. In a collaboration with the Yale University Art Gallery and the Yale Center for British Art, students in the U.S. Health Justice course observed and discussed paintings that explored questions of identity and power dynamics. The tour featured such paintings as “Untitled” by Kerry James Marshall, which shows an African-American woman painting a self-portrait, that got students thinking about what type of person they imagine when they hear the word “doctor,” just like what they imagine when they hear the word “painter.”

The tour also included a painting called “Whispered Words” by Paul Gauguin, which sparked a discussion about electronic medical records (EMR) and who decides the content of a patient’s story. “It challenged people to think about who are the arbiters of history,” says Rock. “A patient has to tell his or her story over and over again. But the story that a physician puts in the EMR gets carried forward with them and very often can be filled with words and subjective interpretations that bias future providers in terms of what to expect.”

Rock says that having the art in front of the students gives them a tangible way to voice their opinions and thoughts. It allows for discussion of such sensitive topics as race and privilege in the context of medicine. Cyra Levenson, Ed.M., former curator of education and academic outreach at the Yale Center for British Art, now at the Cleveland Museum of Art, takes it a step further—she argues that communicating through images is part of being human. “We tend to relegate the visual arts to a small domain of experts,” she says. “But it’s fundamentally human to make images, explore images, think through images, and communicate through images.”

In the fall of 2015, Levenson, Reisman, and medical student Siyu Xiao created a mini-lecture series called Learning to See, coordinating with the Program for Humanities in Medicine. The series explored the connection between our experiences and our perception of the world around us. “We think we all know how to ‘see,’ because we’re very fluent in taking in information, processing it quickly, and deciding what it means,” says Levenson. “Clinicians are using their senses when they engage with a patient. It seemed worthy of exploration.”

Like storytelling or writing, art can facilitate connection and help people gain insights about others’ experiences. Appreciating a work of art is like peering back into a different time when a moment of life was captured. “There’s this broad swath of human history that’s encapsulated in these objects or images that people made,” says Levenson, “and made for the express purpose of sharing some bit of experience.”

The humanities program has expanded over the past 20 years and is likely to continue doing so. Reisman and medical students are always looking for ways to integrate the humanities directly into the curriculum. And while it sometimes feels as if they are innovating and reviving the way schools teach medicine, Levenson directs attention back to such early scientific thinkers as Leonardo da Vinci, the painter, inventor, and mathematician. “We’re not making a case for something new,” she says. “We’re making a case to reinvigorate something that’s always been there.”