Julian Sheather: Does art make people better doctors?

Julian SheatherRecently a colleague of mine, a GP, told me she was taking a three-month sabbatical. She was going to sit on an island in the Mediterranean and do very little more than read novels. Reading novels, she said, made her a better doctor. After I had shrugged off the spasm of envy, I started to think about what she had said.

While I could understand how a three-month holiday could make anyone better at their job, could the same really be said of a novel? What was it about novels, presumably ‘good’ novels, and perhaps other works of art, that could make someone a better doctor, and if it could, should all doctors be exposed to them as part of their training?

People often say that art makes us more human. Looking at the world refracted through art we can learn to extend our sympathies. We begin to see what the world might look like through another person’s eyes. In doing so we start to cultivate compassion, surely one of the key virtues in medicine. By exercising compassion doctors see not just a symptom but someone suffering. Clinical objectivity joins hands with empathy, and the conditions for healing are maximised.

This is a big claim for art. It is also a moral claim: art makes us, or can make us, better people. But is art, even good or very good art, as good as this? Famously, some of the concentration camp guards were said to have listened to Mozart to relax after the day’s killing. If art had widened the circle of sympathy, it had nonetheless failed to extend it to large parts of humanity. A more approachable example, perhaps because it is more easily recognisable, is Gilbert Osmond in Henry James’ great novel The Portrait of a Lady. Highly civilized, he is also a frozen and manipulative aesthete. Love of beauty, twinned with egotism, can lead us away from people, away from the mess of real life towards a cruel perfection. Hannibal Lecter, himself a doctor, was also fond of a good Chianti.

These tales may be cautionary but I am not sure I am completely dissuaded. Perhaps we just need to be more modest. Being a good doctor is difficult, but being a good person is more difficult still. Improvement, at least in my experience, is slow. There is a lot of good art, and some great art in the world, but there is also a great deal of room in the world for improvement. The media is full enough of stories about doctors who fall short of the standards expected of them.

If there is something that doctors can learn from novels in particular, then perhaps it has something to do with the way they have with stories. Being a good doctor will often involve compassionate judgement, but the complexity of human lives can make such judgement difficult. Novels can help shed some light on this complexity. They have at their best an uncanny ability to hold together many strands of a story, to present the world through a shifting variety of perspectives. At the very least they remind us of a number of simple truths: that human lives unfold over time; that people seek meaning in the shape of their lives, and that the search is linked to their wellbeing. In the end I don’t think we should ask too much of art, but if we are minded to extend the circle of our compassion, then I think it can help. Especially if we get to consume it on a three month holiday in the Mediterranean.

Comments? Have your say on the blog

Julian Sheather is deputy head of ethics at the British Medical Association.

Competing interests: None declared

  • Deborah Kirklin

    You raise an interesting question: can a broad liberal arts education, involving engagement with the arts and humanities, help doctors to rise to the human, rather than the scientific, challenges that being a doctor entails. You mention the impact such an education might- at least potentially-have on the ability of the recipient to understand the nature of the human condition. I agree with you that whilst such an outcome would be highly desirable it is by no means guaranteed. As someone working in medical humanities, I would go further and say that one thing exposure to the arts cannot do- no matter how appealing the idea might be – is to make doctors more humane. To somehow make good people from people who are less than good. By the time medical educators get to ply their trade, learners- young and older- are either fundamentally decent individuals or not. No amount of exposure to the arts and humanities is going to change that. The vast majority of health care professionals, whether they read novels or not, are caring already.
    Sometimes, however, even caring and competent individuals can end up doing a less than adequate job. Perhaps because they’ve failed to appreciate what the patient needs, feels and wants, what their priorities are. Or perhaps because they appreciate it all too well, and don’t know how to deal with the combined burden of the patient’s pain and their own. And that I believe is where literature, art and film can play a role. First, as you suggested, by helping doctors and other healthcare professionals to connect with, or appreciate, the perspective of all those affected by illness, but also by facilitating reflection on the individual’s own practice and sometimes- and I’m guessing this might be part of the story in your friend’s case-by acting as a source of support, both personal and professional.
    This approach to reading literature is sometimes described as ethical, with people like physician Robert Coles arguing that stories exercise and sensitise the moral imagination of those who engage with them, helping them to understand and care about what other people are going through. In some ways this is a fairly utilitarian way of thinking about literature, as somehow giving a necessary and useful workout out to medical moral muscles. The aesthetic approach to reading literature is more about poetry or prose for its own sake, as something inherently valuable, worthwhile and enriching. In this case it isn’t all about content, about the story being told, but instead about the way in which it is told, the way in which language is integral to the telling.
    Another, very important, benefit of careful and attentive reading, which is not sufficiently acknowledged within the medical curriculum, is that the more you do it the better you get at it. Which is very important for doctors and their patients because being a good reader, in the broadest sense of the word, is an essential part of being a good doctor. Doctors are of course by training and necessity consummate and highly skilled readers- readers of scholarly papers, of medical artifacts like CT scans, but also, crucially, readers of situations including clinical encounters and ethical dilemmas. Jacques Derrida described reading as the attempt to construct an intelligible reality from the variety of signs we receive about ourselves, others, and the world around us. He argued that we do this in order to try and make sense of the world we live in, and our place within that world. Reading involves an interpretation of these signs, and the way in which we interpret these signs will depend on where we, as readers, stand in the text. As no two readers can occupy exactly the same place in the text, no two readings will be exactly the same. It is on the basis of these unique readings that individuals construct equally unique versions of themselves and the world that they inhabit.
    Michel Foucault argued that a close reading of a text requires us not only to understand what is said but also to ask what is not said, to ask who is empowered to speak and who is not. So close and careful attention to language is important, both to the language contained in the text and the language doctors use as they make and support their own arguments, whether that text is a scientific paper, a clinical encounter, or public discourse about ethically sensitive developments in medical science. A doctor who is able to listen and learn, to analyse and interpret, to engage with texts- whether the text is their patient, the clinical encounter they’re part of or observing, or themselves- is, I would argue, a better doctor than one who cannot. A doctor who appreciates the importance of understanding the cultural, political and historical context of a text, whilst also understanding that each of us will make a unique reading of any particular text, is better placed to contribute to policy-making, research, and management decisions. And a doctor who is aware of the constructed nature of narratives, where what isn’t said is as important as what is said, and where it’s always interesting to ask who is empowered to speak and who isn’t, is better equipped to challenge the status quo, to look for a better way, and to help the patient’s voice to be heard.
    For more of this sort of discussion please visit the new blog for the BMJ journal Medical Humanities that will begin in June when I take over as Editor. Meanwhile, thanks to Julian for this interesting posting.

  • Jim C Moonie

    The short and somewhat cynical answer to the question is ‘yes, it would do if any of them knew what art was’, but, before I am lambasted for what I accept to entirely unreasonable stereotyping, allow me first to state my case.

    As an arts graduate who moved late to the world of medicine I have always felt like an outsider. Initially, I felt intimidated by the superior and seemingly effortless understanding of science amongst my colleagues, but later became shocked and distressed by what I perceived to be a large scale disinterest in the arts. This disinterest seemed to go hand in hand with an inability to see the human condition for what it is, an inability to understand what makes people tick and an inability to empathise. With all this comes an inability to maintain the objectivity that is surely central to the role of the doctor. Worse still an inability to empathise equates most often to a ready ability to criticise. ‘I just don’t understand why people smoke, drink, take drugs, ignore my advice, fail to exercise, eat unhealthy food, I really just don’t understand’. The extreme end of this spectrum is represented by those who talk of refusing treatments to those with self inflicted illnesses, a nonsensical idea and you only have to look at any cross section of patients to realise why (By this I do not mean refusing surgery on the grounds of high surgical or anaesthetic risk, a different issue, in principal, entirely). To err, after all, is to be human, although you wouldn’t think it from all the butter wouldn’t melt do-gooders that medical schools seem to turn out. This is clearly not the case across the board, but there are enough medical trainees who, casualties perhaps of the UK education system have no more picked up a work of literature than I had a science book in the eight or so years between completing my GCSEs and applying for medical school.

    So what does it take to overcome this problem? Well, books actually, wouldn’t be a bad place to start. The bigger issue, though, is one of timing and the younger one takes an interest in the arts the better; trying to turn people on to the appeal of the arts once they have left university is arguably too late. A halfway house course in medicine in art might be a starting point, allowing those with a greater interest to intercalate in an arts degree. Going further back, a nationwide switch to the international baccalaureate would surely help to prevent closing off the avenues of intellectual interest too soon. Failing that, and artistic merit aside, a compulsory three month sabbatical could do no harm. The only downside of all this is that medical trainees might start to realising that there is more to life than medicine, the medical degree would become the ultimate degree, irrespective of intended career path and then we would be left facing another question entirely. Does it matter that medical graduates don’t get jobs as doctors? For that I shall refer you to ‘Comment’.

  • Roland Spencer-Jones

    An intriguing article. From Mediterranean to Morality ……lingering images.

    I agree completely – novels enhance the ability to see through others’ eyes, to enhance empathy not just sympathy.

    What we do with that enhanced empathy depends on morality. I cannot yet see the connection that allows Julian to step from “art makes us more human” to “art makes us better”. More human can mean more brutal – witness the concentration guards and Mozart. Or does he believe that human means “good”?

    I would rather ditch concepts of good or bad, and instead discuss concepts of effectiveness. If learners or doctors would like to gain more insight into their own or their patients’ perception of the world – and that little word “if” is the nub of the issue – then reading novels may allow them to do that. Full stop.

  • sheila om

    Personally i see the strong connection between arts,particularly music in medicine.Im a first year student in a med college in India and everyday,after a hectic and mentally excruciating hours of lectures,lying on the bed with the music on is surely the ultimate ease besides sleeping.Music has been a mental therapy and a friendly morning sound to my ears.Listening to the soothing melodies and creative rhythms of Norah Jones’s for instance just brings my mind to another world of serenity and tranquillity.

    Arts do play a big role in my life as a medical student.Histology demands quality drawing,colouring and shading,and since I quite enjoyed art classes back in high school,arts just gives me another reason to enjoy Histology.(besides getting the compliments of my drawings from friends)
    If most girls regard shopping as their retail therapy,well my retail goes to buying musical instruments and song books.They just give me the satisfaction of the day.I still remember the times when I had to take care of my late grandfather who was suffering from colon cancer.He was so weak even after medications and a few operations,but there was this one particular phrase from him that touched me so much,he said “Of all the pain killers I’ve taken to combat the pain,you playing the piano is the most magical one”

    Whether we like it or not,arts is everywhere,it’s in us,no matter where we go,the way we dress,or the way doctors do sutures,the way we arrange things on our messy tables,and by looking at this particular perspective,arts exist in each one of us.It’s a matter how you judge it.

  • Raymond Seidler

    Yes reading a story does help you cope with medicine bacause practice is replete with patient’s tales of woe and resilience
    And whenever doctors meet, these stories make their way into discussion. There is a sort of gentle competition to find the story with the most amazing outcome or catastrophic diagnosis. These makes doctors into good storytellers.
    Whenever I can, I encourage doctors to write down their stories and retell them to a wider audience. In my experience there is at least one per day in my practice that stands out.

  • P. Iannone

    This is really a good question.
    I believe the answer is yes, without a shadow of doubt!
    I found in the study of piano immense psychological and intellectual resources that have proved extremely useful in medical profession. At the same time I love literature, painting, history, philosophy and I dedicate to their study in every possible fragment of leisure. I think this is not time stolen to the study of medicine. These activities, on the contrary, in a mysterious way, feed our search for the “sense” the deepest of our profession, that you can not flatten into a simple technical skill. Some millennium ago a question like this was devoid of meaning, because the doctor was naturally an intellectual, a philosopher. As Hippocrates said: “iatros philosophos isotheos” [the doctor who becomes philosopher becomes like a god]. Warning: not wise [sophos] but lover of it. Friend of wisdom, not the keeper of wisdom. Only our crazy time has made us strangers from this profound unity and continuity that must exist between medicine, art, science, and life.

    P.Iannone, MD
    Imola, Italy

  • S Waldman, MD

    Yes, definitely.
    Medical School has an important flaw in that aspect: we are so focused on what is new that every reading material that is considered non medical, is put aside. And then during residency, time is so little and demands are so high, that we keep postponing that book pile.
    I come from a reading and art environment – so medical school and residency was a difficult time for me. But things can be changed.

    Now I am chief resident and I have fought to dedicate a whole month to literature and disease. Few books are so clear on disease and death as The Death of Ivan Illich (which I made an obligation to read as part of the curricula).

    We don´t have to forget that the word art is in the definition of medicine.

  • Matt Johnson

    It all depends on what the novel, or art, is. I am certain that my reading of Marcel Proust has aided my ability as a GP, in the same way that reading Philip Roth has not, for instance. The music of Bach aids my ability to read through medical journals (and is thought to enhance retention), but Wagner, whom I adore, would be merely distracting.

    But anything that makes doctors less reductive amd more humanistic in their thinking must be a good in more general sense.

  • Mye

    Well I do Agree
    Art does have a good point in refreshing a Mind(a busy mind as well)

  • Heather

    I think literature, in particular, can make health-care workers more effective in what they do, by helping them to really understand others. In reading novels, you are presented with characters with whom you may not always identify, who may be different than you in their race, age, religion, education level, gender or sexual orientation. Of course, one must be willing to read widely and seek out protagonists who differ considerably from oneself. I know a lot of people choose novels specifically for protagonists they can identify with (the chicklit and Mommylit genres come to mind here), so readers have to be willing to move outside their comfort zone to learn from a protagonist who may be nothing like them. And then readers must be willing to empathize with a character they may not agree with, and understand that character, even if they can’t agree with the character’s beliefs or choices. For example, it takes a mature reader to read or watch Death of a Salesman and see Willy Loman as a tragic figure, instead of just as an obnoxious, self-deluded jerk who is the author of his own destruction.

    In my experience, this takes hard work and conscious effort, and it’s a skill that is not well taught in the North American curriculum, which tends to put the reader at the centre. I’m about 13 years out of high school now, but I remember the English lit curriculum as being very me-focused. We had to keep response journals documenting what we thought about the fiction, and answer questions like, “What do you think of the choices character X made? Would you behave that way in the same situation?” instead of “What factors in Character X’s upbringing and environment might have driven him to make the choices he did? Are our actions determined by our innate character, or by our upbringing, or by some combination of the two? Is it possible for a person to make great choices in one area of his life, and poor choices in another?” I recall writing a very mean-spirited essay about Willy Loman, whose mid-life crisis my teenage self was poorly equipped to understand.

  • Jose Luis Soto-Hernandez

    I’m an infectious disease physician, and I have worked at a neurological institute for the past twenty years. I will comment only about what I see as important in literature (novels) that makes doctors better readers of stories.
    As a reference point I will take a literary character, Madame Bovary from Gustave Flaubert. Emma Bovary, the wife of a rural physician practicing in the north of France about 1880s is frustrated and unhappy with her simple and routinely life, and her dull husband. She fantasizes with exotic travel, luxury and parties. She reads the pink novels of her time and dreams with an ideal love. She had two love affairs, spends the family resources and devastated by debts, guilt and unsupportive lovers, she commits suicide by poisoning.
    This carefully written masterpiece is about life and about persons, dreams, risks and responsibility from our own acts. I think that a young medicine student that carefully reads the history will be more comprehensive of the complicated human nature and conduct. I live in a society in which surgical treatment for HIV positive patients is still more difficult than for HIV seronegative persons, illict substances, only rarely utilized in my city fifteen to twenty years ago are now part of everyday life, with medical complications as cerebrovascular diseases of young people, right side endocarditis, kidney failure, HIV-AIDS and hepatitis C.
    For me, the careful reading of some novels opens our vision to a fast synthesis of life, always modified by the elaboration of the author. Fictional characters have many aspects common with the human beings that we face day to day as our patients in the office, the emergency ward or in the hospital, with chronic and sometimes incurable illness. The difference is that fictional characters are easier to understand, and we can revisit them from time to time and learn again. Each patients is a story, is own life story. During rounds sometimes residents and students do not catch the ¿who is this person?, ¿which is its story ? (of course many of them do and really care). The communicative skills to present comprehensive and clear medical information, useful for patients and relatives to understand diseases or to take decisions requires language skills and imagination, both are superbly enriched with novel reading. As we read more literature and novels, we are more tolerant and understand better our patients and ourselves.

  • Ronald McCoy

    With the arts and medicine, I think you either get it, or you don’t.
    I have no doubt that familiarity with literature, other languages and cultures enrichens your mind and humanity – so critical to medicine.
    But those poor souls who have not had this experience remain in the dark, ignorant of the blessings that the arts can bring to our discipline of knowledge. These doubters unfortunately hold great sway in medicine, and prevent the arts from taking their central place as part of our profession.
    I would urge those who have not experience the richness of the arts – not just for medicine but for their own sake – to try and broaden your experience. We all have patients who are artists or writers. Read one of their books , or see an exhibition that they have created and try and realte it to your patients life. Go to see an art exhibition by people with mental illness or see theatre by people with disability. It is a moving experience that changes you forever.
    Then you’ll understand what the arts and medicine people are talking about.

    Dr Ronald McCoy
    Melbourne, Australia

  • John Duley

    My wife is an artist (painting/drawing) (I’m a clinical scientist). My wife continually argues that drawing teaches you to SEE. In art, this is a dominant claim (or is it a dominant myth?), proposed by artists over the centuries – the claim was eloquently and widely expounded for example by Ruskin. Certainly my wife is excellent at spotting small things in nature that other walk past – going for a hike in the countryside with her involves my constantly reversing back to see the rare orchid or the unusual insect that I have just strolled past without noticing.

    This aspect of art is independent of the other major claims for the benefit of practicing art – namely, relaxation (meditation/ cocnetration) and self-expression.

    Seeing is presumably remains an important aspect of medicine – the ability to take notice of subtle signs or symptoms is often what still defines a good physician (the ‘Doctor House’ model) from an average one – or has medicine abandoned examining the patient for reading reams of print-outs of clinical tests? If seeing is still important then perhaps learning to draw is useful training.

    My wife might volunteer to set up a drawing course for medical graduates, if a royal college wants to undertake a study (presumably constructed as a blinded or a ‘non-seeing’ trial?).

  • Anna Donald

    Of course you need liberal arts to be a better doctor. But you especially need it if you are going to be a great scientist. My horribly clever mother, a McKinsey analyst, was appalled at my inability to reason analytically after 2 years of preclinical sciences and packed me off to do history and philosophy before returning to medicine. Medicine has always been a trade and has never purported to teach people how to work with high level concepts – to feel their limits, deconstruct them, relate them to others – which is crucial for conducting really good quality research. Over my lifetime in evidology/EBM I have seen the ghastly results of the lack of liberal arts training among doctor-scientists – more than 95% of medical research being discarded due to faulty logic, poor question setting, invalid measurements, avoidable biases (which haven’t been analysed properly); an inability to frame studies with the right level of question. Garbage in, garbage out. At vast expense to everyone: people’s desultory and melancholy PhDs and MDs, billions of taxpayers’ dollars worldwide, and participants’ wasted time.
    Researchers should have at least two years of philosophy and other liberal arts subjects that teach reasoning and critical deconstruction of concepts. I’m sure it would drastically improve the quality of research and prove an excellent investment. The questioning of the value of liberal arts in medicine always makes me laugh – if you don’t understand why you need it, you really need it! Rant over, for now 🙂

  • Jane Kano, MD

    I would propose that writing (rather than reading) about the human experience and emotions may be a more important way to increase compassion and make us better doctors.We write clinically every day, but our humanity is expressed when we can expand to how we feel about our experiences.

  • Haya Rubin

    I agree with Deborah Kirklin. I have heard that Rabbi Samson Raphael Hirsch in the 19th century, one of the founders of the Modern Orthodox denomination of Judaism, expressed his point of view that morality could be derived from a love of order in nature. How clearly the Nazis, with their order of “Aryan” purity and looks to define what is human, proved him wrong. Although a liberal arts education may help me be a better physician, art alone will not help to make me more humane, nor to see the universal spark in everyone. In some cases, as one’s artistic sensibilities evolve, it may even present a barrier between the physician and those perceived to be ugly or ignorant. Hence the pathologist at Auschwitz featured in sociologist Fred Katz’s fine book, “Ordinary People, Extraordinary Evil,” who after killing people in the morning, enjoyed fine classical music concert at noontime.

    A liberal arts education may breed snobbery and disrespect for others, just as it may breed universalism and love of others. It is an empirical question how often it does which.

  • I think it is impossible to say yes or no to this – because it depends on the availability of the individual to think they can improve by engaging with non medical discourses. I am a Paediatrician who went part time to complete a BA in Fine Arts and found that whilst trying to use art to avoid medicine or provide an alternative to medicine I constantly cam back to using medicine in my work.

    The core of my work turned to ‘The Gaze’ – this is constantly debated in art circles because the ‘seeing’ is recognised as central to engaging with art. ‘The Gaze’ is also central to medicine – not just the seeing but the listening, examining, palpating, history taking, imaging, dissecting, healing etc- all of these are the medical gaze. I ended up writing my thesis about the medical gaze – how technology allows us to distance ourselves from the direct gaze but what we see is more invasive.

    The term’ the gaze’ which is so central to medical disciplines remain an unrecognised term in medical fields.

    Foucault is a great read for any Doctor.

  • Dare Oladokun

    I do believe art can make better doctors but it is quite limited in terms of improving moral skills or making a person more humane as it depends on how a person interprets the art in the first place and the interpretation is further dependent on an individuals schema and worldview. Seeing the world in another person’s eyes does not make us act in the same way as them.

    However, art can make better doctors in terms of problem solving ability and thinking skills. A common attribute of great doctors and scientists is a special dimension of thinking and great problem solving abilities. Often in medicine, diagnosis and treatment can be simple but sometimes the odd case comes along that challenges our aptitude and intelligence. Most people will agree that such cases sometimes require lateral thinking. in other word, thinking outside the box. However, you don’t always have to think outside the box if your box is big and rich enough in the first place and this is where art comes in.

    Many medical students and clinicians concentrate on updating their knowledge in science and medicine alone without considering other fields and areas. This basically gives limited resources to solve problems as they have similar arrows in their quiver and there is less variety in their approaches to problems. by indulging in art and other areas, doctors can become better as they become more creative and imaginative. These are important requirements for real ingenuity.

    Atul Gawande, in his book ‘better ‘, talked about a doctor who got the idea for the stereostethoscope while listening to a church choir. I doubt if years of trawling through medical journals could have given him such an ingenious idea. Art including reading engages the mind and make us think in alternate ways. This, I believe is one great contribution that art can make to medicine in addition to the fact that it is therapeutic and enjoyable. At the end of the day, we don’t lose anything by indulging ourselves in art.

  • I would propose that writing (rather than reading) about the human experience and emotions may be a more important way to increase compassion and make us better doctors.We write clinically every day, but our humanity is expressed when we can expand to how we feel about our experiences.

    Absolutely right!

    ____________________
    Marvin

    This is a comprehensive addiction portal focusing on topics of alcohol and drug abuse. http://www.alcoholaddiction.org

  • Dr. Ravi Shankar

    I agree with the author that art can be helpful in creating better doctors. In South Asia at present, art does not play an important role in the training orientation of future doctors. In Nepal and most other South Asian countries students enter medical school after twelve years of schooling. It is mandatory that students study science subjects in the last two years of school. Admission to medical school is on the basis of marks obtained in an entrance examination concentrating on the science subjects. Scholastic ability is the only component measured in these examinations and there is no weightage for the ‘soft’ skills. There a few seats reserved for candidates on the basis of their extracurricular achievements but this is just a token. A token interview is conducted by many schools but has no role in candidate selection.
    Due to the tremendous academic pressure during the last three or four years of school students stop participating in extracurricular activities and are solely involved in their academic pursuits. The student body at the time of admission to medical school may come from diverse cultural and linguistic backgrounds but are very much alike scholastically. In the west, these days students from a diversity of cultural, social and educational backgrounds are admitted to medical school. This is not the case in Nepal and South Asia.
    In South Asia, due to various reasons, among them the British colonial legacy, English is the medium of instruction in medical schools. The majority of the textbooks and other teaching material are from a Western context. The majority of learning takes place in English from a very early age. English medium schools are becoming common in which the various subjects are taught in English and the national language and the mother tongue are only taught as second or third languages. I believe this serves to create a barrier between the English educated elite and their native countrymen.
    In Nepal, the undergraduate medical course (MBBS) is of four and half years duration followed by a year of rotating compulsory internship. The basic science subjects are taught during the first two years with regular clinical contact and this is followed by the clinical years of training. I had conducted a voluntary Medical Humanities module for interested students at the Manipal College of Medical Sciences, Pokhara, Nepal. I had used literature and art excerpts, case scenarios and role-plays to explore various aspects of the medical humanities. The module was started following the observation of medical students, faculty members and members of the community of a decline in the humanistic values of doctors and the felt need for a certain amount of teaching of the Medical Humanities (MH).
    The module introduced the students to the concept that art and literature can have a role in the training of future doctors. The learning was fun and the participants were free to exercise their creative faculties. Faculty and student participants learned together and explored various aspects of the doctor-patient relationship. Regular feedback was obtained throughout the module and through a focus group discussion with the participants at the end of the module. The participants were of the opinion that the module had helped them to become better doctors and had offered them a perspective about patients which is rarely stressed during medical; training in South Asia.
    Hard evidence for the fact that art is helpful in the creation of better doctors was lacking but indirect evidence supports this proposition. The participants of the module have started interacting with patients in a more empathic manner and have begun to consider the patient’s illness in the larger viewpoint of his/her family, community and society according to their clinical supervisors.
    In the west there have been studies which have shown that various student characteristics, especially empathy improved after a MH module. We plan to measure participant characteristics including empathy before and after a MH module in the future.
    At present the author is conducting a MH module for faculty members, doctors and dentists at the KIST Medical College, Imadol, Lalitpur, Nepal. The module has been well received by the participants.
    Thus indirect evidence seems to suggest that art has an important role to play in creating better doctors. Also as stressed by various authors learning is MH is an enjoyable pursuit and does not add to the stress and strain associated with medical school. Medical Educators in South Asia should realize that art and the humanities should be an important part of the curriculum like it is in the west.
    Dr. P. Ravi Shankar
    Department of Medical Education
    KIST Medical College
    Imadol, Lalitpur
    Nepal.
    Phone: 00977-1-5201496
    E-mail: ravi.dr.shankar@gmail.com

  • Jim C Moonie

    It was with delight and disbelief, in equal measure, that, less than two weeks after first writing on this blog, I realised my suggestion to introduce intercalated arts degrees to the medical curriculum had already happened. Not only that, it had happened at Bristol, where I trained and not only had it happened, but it had happened two years ago. Good thing then that I was so bored this evening that I happened upon those hallowed pages of Black Bag, the Bristol University Medical School Journal that I once edited (in the days before it went online) and read an interview with Dr Trevor Thompson, the ‘then’ new consultant senior lecturer and discovered that my suggestions had become fact. Not only that, they had become fact before I had even suggested them. Such is my power of perception. I feel like Marty McFly in Back to the Future with his copy of an old sporting almanac, or Nostradammus. I can, it seems, predict the future. I could have told you, for example, that the ST system would not be popular and I can tell you that Obama will be the next president of the United States. I can even tell you, so long as you live in the UK and I live in New Zealand, what happens in Neighbours for the next three months and when I next write I’ll tell you when the world ends so you’d better watch this space.

  • GEORGE CALDWELL

    If General Practitioners take three months off to go and sit on a desert island then they should not be General Practitioners or even doctors.

    The best way to make “better doctors”, more understanding and communicative doctors, is to let the young sprogs out, as of old, at the end of their Finals Examinations and join a well-regulated partnership of their peers in General Practice. They will come to no harm, do no or little serious damage and will learn how to communicate with their patients.

    This will stand them in good stead in those future years when they will be dragooned back into hospital as cheap labour and an economic unit of the NHS.

    Art? Now what exactly do we mean? Un-made beds in the middle of a Gallery? Music? Primary School stuff noise that is so popular as “art” with the BBC? Twanging, groaning and drumming?
    Painting?

    If you are a busy doctor, and how many can claim to be that today with their shorter working hours and high salaries for doing nothing, you need time for thought and time to think about what you are painting, in oils, poster-colour, etc.
    Sculpting?

    Come now!
    Your patients, and art are going to suffer if you have to break off what you are doing, reluctantly to go out on a call.

  • It has been very interesting to follow your debate about whether reading a novel, or art in general, can make better doctors. I firmly believe so. This belief, however, is not limited to doctors alone. If one is perceptive towards the artistic expression and ready to make a reflection on its effect, one is, as well, sensitive to the value of different fields of communication and ways of understanding the world.
    Saying this, I must confess at this point that I speak as an Art Historian, not as a doctor. As such, I wanted to add another dimension to the discussion. I have been commissioned to organise workshops for Alzheimer patients where the aim is to see if art and cultural expressions can help the scientific investigation in slowing down the progression of this degenerative disease. That is, we are asking artists to join us in the fight, using their experience and approach of working with the language and memory to see if the information it brings can provide facts to the surface about the development of the disease that otherwise would be concealed. During the evolution of the workshops, there is a constant process of evaluations on the part of the doctors, neurologists and psychologists.
    One of the things that art can teach us is to look for links and connections between the past and present, between elements that at first glance seem completely irrelevant. Art arouses the mind to look at different possibilities and value points. In that sense, it is healthy for all of us.
    Halldóra Arnardóttir, PhD Art Historian

  • Julian Sheather

    I have been reading through the rich and varied responses to my posting on art and medicine. The question, broadly, was whether exposure to the arts could make someone a better doctor. Some of the responses helped me clarify my thoughts, and exposed some of my less-than-fully articulated assumptions. As Deborah Kirklin says, it is to the human rather than technical challenges of medicine that art is invited to speak. Setting to one side the pleasures that art can hold as an end in itself, we seem to be unable to let go of the possibility that art can also be good for something, that it can serve some higher purpose.

    As Roland Spencer Jones writes, another of my assumptions – and an assumption it will have to remain, as the claim surely lies beyond the reach of proof – is that it is a good thing to be made more human. The last century has seen a sustained intellectual and cultural assault on the idea of the human, where ‘human’ means something like a morally self-regulating individual with a discrete and irreducible essence: the human subject of liberal political theory. The last century has also seen us humans at our most savage and inhumane. My point here was really a straightforward one: that as human beings we can improve morally, albeit slowly, and that in small ways the arts can assist, where improvement means that we are better able to recognise the real needs of others, to recognise that their claims on the world are equal to ours. ‘More’ in this sense just means better. Predictably of course the world is not short of counter-examples. A glimpse at Philip French’s recent biography of VS Naipaul, The World Is What It Is again shows that a great artist can coincide with a questionable human being.

    Another theme in the responses is the old problem of the tension between the arts and sciences, the ‘two cultures’ that CP Snow made famous in his 1959 Rede lecture. Many of the respondents suggest that the tension is alive and well at med school and that medicine is in the scientific camp. Jim Moonie, who moved from the arts to medicine clearly feels the divide strongly and suggests, I think, that there is a danger that science alone can dull the senses to the human context of medicine, and, presumably, disfigure the therapeutic encounter. The pity in this is that medicine, so clearly situated at the juncture of the scientific and the human, should be ideally placed to dissolve this outmoded distinction.

    One comment that I made that has been picked up in some of the responses relates loosely to the usefulness of a narrative approach to medicine, to the idea that an understanding of the contexts in and through which patients move, and out of which illnesses emerge, can deepen the therapeutic relationship and lead to better outcomes. This is the point at which, perhaps, the strongest claims can be made for the sympathy between certain, narrative based art forms and the practice of medicine. In her fascinating response, Deborah Kirklin goes so far as to describe patients as the doctor’s ‘text’. I have to admit to misgiving at this point. I take it the usage is metaphorical, but I am wary of seeing human beings as a tissue of signs – it is too easy for the human to leach out from among them. Human beings use signs and symbols in complex and fascinating ways, but I am not sure they can be reduced down to them.

    In my original posting I made a modest claim for the arts, and, in addition to the enormous pleasure that art has obviously given to so many of the contributors, many share this view. There seems to be agreement that only those already interested in change will take up the possibilities that art can offer. Although this still feels right, even here I would be cautious. Our moral capacities are vulnerable. Put me under too much stress and I lose the ability to empathise. Art may make better doctors, but overwork can undo them.