Desmond O’Neill: Bicycle helmets and the medical humanities

Desmond O'NeillEmerson may have been right when he wrote that a foolish consistency is the hobgoblin of a small mind, but it always sets my teeth on edge when I see a family out on a cycle excursion with the children dutifully wearing bicycle helmets and the parents gaily unencumbered. Doing as I say but not as I do has rarely been an effective educational strategy, whether in road safety or medicine: indeed, one of the key challenges of medical ethics is to ensure congruence between what we teach and what the student sees in hospitals and GP surgeries.

A somewhat similar thought came to mind at my first meeting of the Association of Medical Humanities in Cork last month. The range of subjects was quite breath-taking, the scholarship of a high order, and the camaraderie and hospitality excellent.

In educational terms, however, the focus was virtually entirely on undergraduate students, and my first thoughts were that, just like the helmeted children on their bicycles, if our medical students do not see the medical humanities figuring on postgraduate educational programmes for the trainees, CPD events for specialists or the clinical lives of their teachers, then it is likely that this cognitive and professional dissonance will weaken the case for the medical humanities, a subject which already suffers from a lack of definition.

To be fair, the major generalist medical journals give a quite generous amount of space to material which falls squarely within the remit of the medical humanities, including the Perspectives section of the Lancet, Views and Reviews in the BMJ and rubrics such as the articles discussing the front cover, as well as A Piece of My Mind, in JAMA.

However, this is much less often the case in specialty journals, and although there is significant support in my own hospital for a fairly wide-ranging arts and health programme, an overt expression of the importance of the medical humanities was the exception rather than the rule in any other hospital where I have worked.

We need a better understanding of what the medical humanities mean, both in definition and content, to the full spectrum of our colleagues. While doctors read more than other professionals  and doctors who pursue cultural pursuits are more likely to display vocational engagement, I (and surely many others) harbor concerns that the subject is in danger of preaching to the converted, of those with a natural affinity for a particular palette of artistic activities.

Emerging research with medical students affords us some interesting clues into how those engaged with the medical humanities need to rethink their approach and their horizons. The students report concerns about three important aspects of their experiences of the medical humanities: content (perceived relevance and consistency), teaching (credibility of teaching staff and perceived personal intrusiveness) and positioning with related topics within the curriculum – Moss H, O’Neill D. Medical Humanities – serious academic pursuit or doorway to dilettantism? Ir Med J 2012  (in press)).

It is likely that these same factors, if not addressed, are hindering a wider engagement of our colleagues in what remains an important developing area of professionalism and practice. We need to undertake more research into what aspects of the medical humanities can be universalized, how to provide a more individualized approach, and free ourselves from a perceived dependency on high culture.

In this latter aspect, I am reassured by the interests of the trainees who pass through our department, a number of whom have submitted Medical Classics to the BMJ. With an emphasis on the importance of personal relevance of what they write, they have written on pop music (a song by the Verve), chick lit (The Notebook) and sentimental self-help literature (Tuesdays with Morrie) as well as the usual suspects such as the correspondence between Billroth and Brahms.

As ever, though, it is the conversations at coffee-breaks which can provide the best interchange of ideas, and so it was at the Association of Medical Humanities conference. Discussing the virtual absence of discussion about sport and exercise at the meeting raised the interesting comment from a classics lecturer that sport and aesthetics were close in the classical era. It struck me that engagement in sport and sporting activities would have much congruence with the missions and goals of good medical humanities programmes: from self-care, to reflectiveness to engagement in society.

Certainly, coming from a rather bookish family with little engagement with sports, I have been struck by the lessons that my children learn from engagement in solo and team sports. Dealing with weaker and stronger members of a sports team has many parallels with dealing with professional peers, and an understanding that the referee will only ever see a minority of infractions (and is fallible) a very useful guide to how organizations work and how life really works.

Yet, without it ever being overtly stated, one senses that there is an unconscious divide between the medical humanities and the sports constituencies in medicine, possibly an even greater one than CP Snow’s two cultures of science and the arts, with a mutual sniffiness about the activities and world-view of the other.

I have memories of a rather uncomfortable meeting of the medical students’ society in our university a number of years ago which had sports as its focus: those without a hearty interest in rugby were caricatured by a senior staff member using a photograph portraying them as bespectacled, weedy and (dare I say) bookish.

Exploring and bridging this gap would be a worthwhile focus for researchers in the medical humanities: comparing and contrasting these interests would help provide perspective on the importance and complementarity of both subjects, as well as promoting articulacy for the faculty and buy-in by colleagues.

Next year’s meeting of the Association of the Medical Humanities is focused on Global Medical Humanities and takes place in Aberdeen in July 2013 (find out more)  – definitely a date for the diary for all those with an interest in the medical humanities!

Desmond O’Neill is a consultant physician in geriatric and stroke medicine in Dublin, and chair of the National Centre for Arts and Health, Dublin