Lucy McLellan: Conference Report-Medicine Unboxed: Values in Medicine

Medicine Unboxed is an annual one-day conference which brings together an inspirational blend of expertise in health care, philosophy, ethics, law, sociology, politics, art, film, and literature. The aim of the this year’s conference, held in October,  was to explore medicine’s values through the lens of the arts and humanities; considering medical practice and policy within modern society, as well as experiential aspects of health and illness. In considering values in medicine, three main themes arose; the personal values of patients and medical professionals, societal values, and value for money within health care and the NHS.

Dr Sam Guglani, the clinical oncologist who organises this unique event, opened with a brief but gripping monologue which encapsulated the experience of health care from the perspectives of both doctor and patient. Professor Ray Tallis, followed this with an overview of the fundamental aims of medicine, its successes and its shortcomings. Whilst medicine has made unquestionable progress as far as factual knowledge and technical expertise are concerned, values in medicine are not attracting adequate attention. Professor Tallis introduced a concept which remained relevant throughout the day; that every life is infinitely precious, but in conditions of scarcity and finite resources, each life is in competition with others. Ethical conflicts are commonplace and extend beyond individuals, to the more political realm of health care within our National Health Service. The role of ethics and law in response to such conflicts was the topic of a lively debate later in the day by Sheila McLean and Richard Huxtable. Professor Tallis’ talk concluded with a reflection on the profoundest conflict in medicine; the view of illness as a malfunctioning physical body vs. illness as an experiential concept.

Havi Carel, author of ‘illness’ – a must-read book for health professionals – joined Ray to discuss the experiential aspect of illness. As someone who suffers from a rare respiratory disease, she described the disruption of fundamental personal values that occurs after diagnosis with a chronic or terminal illness. This first-hand account was incredibly moving as Havi described the importance of patients’ individual concerns, views and experiences. Clinical practice often prioritises technical, scientific, and conventional medical needs, over and above the experiential aspects of care and recognition of humanity.

So could literature provide the insight that health professionals require if they are to place higher value on patients’ experiences? Ishani Kar-Pukayasha, John Carey, Jo Shapcott, Michael Arditti and Paul Bailey opened up the discussion on literature as “a set of tools to think and feel with”. Following readings from all five of these authors, it would be difficult to doubt that literature can provide us with new perspectives, feelings and ideas, as well as encouraging us to reflect on and reconsider our personal values.

In case we were in danger of becoming too sentimental, documentary maker, Adam Wishart, and best-selling author, Lionel Shriver, offered us an insightful perspective on health economics and policy. We were urged to consider how society values life and how we justify the allocation of resources in our National Health Service. Lionel was brutally honest about illness, money and the social aspects of illness, stating that we need to get over our cowardly approach to dealing with disease. There was a call for more realism and a focus on quality of life, rather than obsessing over longevity and pushing nature beyond sensible limits. Their views highlighted the value of artists’ contributions to health care matters. Story telling through arts and humanities can illuminate, and engage people in, issues that are otherwise ignored.

Whilst all the speakers provoked interesting discussion surrounding values in medicine, the question of how to translate these views into medical practice and policy still remains to be answered. From my perspective as an undergraduate medical student, the answer lies in medical education. How can we expect medical graduates to place sufficient value on patient experiences and the perspective of the arts and humanities, when so little emphasis is placed on this throughout medical school? Our educational system encourages us to generalise about patients, place them into metaphorical boxes, and learn to understand and treat them in a way that enables us to achieve no more than a sufficient level of competency to pass exams. Attending ‘Medicine Unboxed’ taught me more about how to practice the art of medicine than any amount of communication skills training and bed-side teaching ever has. More importantly, it has encouraged me to reflect on, and challenge, my own values. If the fundamental values held by individuals and society are to change, then the discussions opened up here need to be taking place in universities and institutions all over the world, on a regular basis. If education can encourage medical practitioners to become thoughtful, caring, sympathetic practitioners of their art, then perhaps true progress can be made regarding the humanity of medical practice.

Tom Isaacs and John Bell had the final say; both speakers were funny and inspirational in equal measure. Tom, who has lived with Parkinson’s disease for 16 years, emphasised the need for bridging the gaps between; doctors and patients, medicine and health care, and science and society. Communication, he argued, is the key to achieving this necessary progress. John Bell reflected on the expectations of Western society; that there should be no fault lines within our bodies, and if there are, they should be fixed. He advocated the need for honesty, acceptance of illness, and living positively with the knowledge that we are imperfect. Healing is not just curing people, but enabling wholeness.

This exceptional event demonstrated that approaching medicine from the perspective of the arts and humanities can be an extremely effective means of building understanding, raising important questions, and provoking reflection. As health care professionals, we are faced with many challenges; working compassionately with patients who are all unique, acting with integrity within a wider society that has its own values and expectations, and practicing medicine sympathetically within the constraints of bureaucracy and policy. Being skilled in medical science alone is simply not enough.

For more information on this event, and updates on future events, please see:

http://www.projeqt.com/medicineunboxed/
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Twitter @medicineunboxed