Why do we need the humanities in medicine?
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.232308
Source of Support: None, Conflict of Interest: None
Wherever the art of medicine is lived, there is also a love of humanity.'
Hippocrates (460-370 B.C.)
The word 'human' is derived from the Latin word 'humanus', used to signify being endowed with an inherent sense of right and wrong, based on reason. The final qualifying phrase is relevant, for the classification of actions into 'right' and 'wrong' is not arbitrary. It follows the dictates of sagacity.
'Humanity' has, as its stem, the Latin 'humanitas' for 'human nature'. As with the earlier word, human nature is characterized by kindness, affection, sympathy, empathy and harmony.
To be 'humane' implies acts of compassion, consideration for others, justice and an urge to help.
The 'humanities' thus comprise branches of learning such as philosophy, ethics, history, anthropology and the languages. They also embrace the arts – literature, visual arts such as painting, sculpture, dance, drama, films and much more. I like to believe that they also include a healthy sense of humour.
Humanities in medicine
The definitions referred to above make obvious the relevance of the humanities to medicine. Our goal, as doctors, is to help prevent disease and relieve the sick of their symptoms. Where possible, we work towards curing the ailments that afflict our patients. When the disease is incurable, we continue to work for our patients, relieving symptoms and caring for them at all times.
The humane physician; competent, ethical, inspired by the great doctors of the past and present, aware of human foibles, worries about each patient under his care, and strives to help the family as well. Such a physician is a blessing for the stricken.
Awareness of the fact that we could well have been in their shoes sharpens our instinct to do our best for them. Indeed, this is the crux of the golden rule: 'Do unto others as you would have others to do unto you.'
Sir Luke Fildes' The doctor
Born in 1843, the fourth of ten children, Fildes enrolled for art classes in the evening after attending school all day when he was 14 years old. He was brought up by his grandmother and he shared her concern for the poor. In the first edition of the magazine Graphic he provided a drawing to illustrate the lives of the homeless poor. Later, he illustrated works by Charles Dickens, other authors and several magazines. ,
We need to study carefully the painting labelled The doctor [Figure 1].
Dr. Jane Moore (Moore 2008) has analysed this painting well:
'The Doctor, depicts a Victorian general practitioner on a home visit. He is watching over an impoverished labourer's sick child; the bed is makeshift, two non-matching chairs pushed together; the cottage interior humble, befitting the labourer's status. The central figure is the imposing male doctor, gazing intently at his patient, while in the background, the father looks on helplessly, his hand on the shoulders of his tearful wife. The doctor is observing the 'crisis' of the child's illness, the critical stage in the pre-antibiotic days when the patient is no longer overwhelmed by infection. The breaking light of dawn on the child's face suggests that the crisis is over and that recovery is possible. Fildes' skilful use of light and perspective focuses the eye on the doctor, the patient, and the relationship between them.'
The presence of a table lamp casting light on the child and doctor suggests that the doctor has been attending to his little patient for several hours of the night. He betrays no impatience. Instead, the thoughtful visage demonstrates concern and a trace of anxiety for the welfare of his young charge.
Dr. Moore tells us that the painting may have been inspired by the death of Fildes' eldest son, Phillip, who died on Christmas morning 1877 in their Kensington home, attended to by Dr. Gustav Murray, who impressed Fildes with the care and attention he gave to his dying child.
It is of interest that the obituary note on Dr. Murray (Anonymous 1887) has, in its concluding paragraph, the following:
'Other qualities besides those purely professional endeared Dr. Murray to his patients and friends. He was ever most tender in his regard of his patient's feelings, and was untiring in his attention. He was always ready at the call of duty and never thought of his own personal convenience, his time or his health when there was a chance of being useful; and his kindness of heart was inexhaustible. Add, besides, to all these, his cheery manner and spirits and his sense of the humorous life and it will be easily and well understood why Dr. Murray was very popular with patients and with the profession and how he everywhere through life made many and fast friends.'
Dr. Murray's conduct reminded Francis Wells, cardiothoracic surgeon at Royal Papworth Hospital, Cambridge, of some earlier examples. '…the Jewish rabbi and physician, Maimonides (1135-1204), wrote: “May I never see in the patient anything but a fellow creature in pain. May I never consider him merely a vessel of the disease.” A generation after Fildes, the legendary physician Francis Peabody wrote: “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”… our patients, while demanding world-class therapies, deserve an approach summarised by the great French surgeon Alexis Carrel: 'To cure sometimes, to relieve often, to comfort always. ' “
Physicians as littérateurs
The dictionary defines a littérateur as a person who is interested in and is knowledgeable about literature.
History is replete with examples of such individuals who also excelled in the practice of medicine.
A search in Wikipedia (https://en.wikipedia.org/wiki/Physician_writer) yields in its 'partial list' over a hundred names from antiquity to the 19th century. Since then, numbers have skyrocketed.
We have an unique and rich heritage.
I shall leave you the thrill and pleasure of learning of each of the individuals listed and then to tracing and reading their works. When you realize that, among others, you will read the works of satirist and ribald author François Rabelais (1483-1553), the poet-philosopher-anatomist Oliver Wendell Holmes (1809-1894) and Sir Arthur Conan Doyle (1859-1930), you get a sense of the joys in store.
You might wonder why we have so many excellent physician-authors. The reasons are not far to seek. From the day we enroll as students in the medical college and enter the clinical wards, we are taught the art of taking a good history and writing it in the form of notes. Likewise, we are taught to examine patients, watch and eventually conduct operations and other procedures. We follow patients from the first time we see them to the time they are cured of their illnesses. In some instances, we witness worsening despite therapy, and death. At each stage, we record our findings, conclusions, reasoning for each step taken by us and an analysis of response to treatment.
Patients confide in us and tell us their innermost secrets, hidden from parents, siblings, spouse and children. They do so, confident that we will not betray them to anyone. We learn of events in their lives – tender, inspiring, tragic and hilarious. We watch their responses to pain, anxiety over tests and procedures, how they face financial difficulties, triumph over their handicaps, as well as how they live and die. We are provided opportunities granted to few others.
All that we need is sensitivity, skill in writing developed by training and an urge to communicate.
Similar observations can be made about physicians engaged in the fields of painting, sculpture, music, drama, films, philosophy, history, ethics…
Humane physicians are the need of the hour
We witness inhumanity, corruption and malicious behavior all around us. It appears that no section of the society – including the hitherto hallowed fields of religion, justice, defense of the country and the preservation of law and order – has been spared.
In such a milieu, we need to stand upright and serve as models of rectitude. We are equipped to do so.
We have been provided education of a duration and quality granted to few – over a decade in school, undergraduate education in our science colleges, a minimum of five-and-a-half years, and more often almost a decade, in the medical college. We are exposed to some of the finest minds during our training and granted access to the great thinkers from the earliest times through books [Table 1], journals and more recently, the media.
We have shown our ability to shape behavior in society through campaigns to prevent disease and promote health.
The evolution of the field of palliative care demonstrates our concern to help those who are beyond our abilities to cure, by continuing to care for them and keep them free from pain and in a state of equanimity.
Our leading physicians have access to those in the highest echelons of power.
In order to reach our full potential, we must start with cleaning our own Augean stables.
Once we have set our houses in order, we can turn to the task of healing the ills of the society.
We need not await the dawn of this Utopia as far as our individual patients are concerned. Through our individual efforts of treating them as we would ourselves like to be treated, we shall already be setting examples.
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Conflicts of interest
There are no conflicts of interest.