Democratising Healthcare Through Medical Education: In Conversation with Alan Bleakley

Interview by Pragya Dev and Binod Mishra

Cover pf Alan Bleakley's Medical Humanities: Ethics, Aesthetics, PoliticsThe field of medical humanities has gained more attention in recent decades, particularly within medical institutions, where it was introduced to bring a more humanistic approach to medical practices. This interview with Professor Alan Bleakley expands on the relevance of medical humanities and addresses the challenges facing this field of study. Bleakley also discusses his recent book Medical Humanities Ethics, Aesthetics, Politics, which handles issues of ambiguity, ethics, aesthetics, and humanities research in medical institutions.1

One of the key figures shaping and establishing medical humanities as a field of study, Alan Bleakley is Emeritus Professor of Medical Education and Medical Humanities at Plymouth University Peninsula School of Medicine. He practised clinically as a psychodynamic psychotherapist and has authored/co-authored/edited sixteen books, numerous research articles, and book chapters. With a diverse academic background spanning zoology, psychology, cultural studies, psychotherapy, and medical education, Professor Bleakley brings thought-provoking ideas to the field that are deeply rooted in practical application.

In the introduction of your latest book, you argue that, while information can lead to cure, meaning fosters care. How far do you think we have come in finding cure with care?

As a psychologist who has worked clinically as a psychotherapist, I know how the body, mind, and emotions are intimately associated. All physical illnesses have a psychological impact. My worry about current medical education is that it is increasingly focused on producing mere technicians, privileging information over meaning. Capabilities are reduced to competencies. Medical students become focused on syllabus (content) issues of memory and assessment of information, which deflect from the wider curriculum (process) issue of “what kind of doctor am I becoming?” The latter embraces the core values of a humanistic education: becoming an ethical, aesthetically sensitive, and politically aware practitioner who is also aware of the wider values of gaining meaning in life as a key element of health.

How should we differentiate between medical ethics and aesthetics?

Ethics is about moral activity—how we choose to act with others for the good of the whole (individuals, community, the planet)—and, of course, what defines the “good.” Aesthetics is about quality and form. For example, Pernkopf’s infamous anatomy textbook—used for many years in medical education—was based on the bodies of executed victims during the Nazi era.2 The aesthetics, the quality of its illustrations, was exquisite, but the moral choice was deplorable. A surgeon carries out a beautiful, well-crafted operation but fails to fully explain to the patient a serious, potential longer-term complication from the surgery. Here, aesthetics is satisfied, but there is an ethical problem.

According to you, how should young medical practitioners and readers interpret “tolerance of ambiguity”3?

We have known for many years that improving teamwork in healthcare also improves patient safety. This process of democratizing healthcare is key to medical humanities in medical education. At the core of this is the tolerance of ambiguity. Authentic democracy requires a high tolerance of ambiguity, as does medical care generally. In short, intolerance of ambiguity is a mark of an authoritarian personality (preferring hierarchies to democracies), but this trait also leads to premature closure in clinical decision-making (and then medical error). How, then, can we teach tolerance of ambiguity or foster its development? The best way is to read literature (there are many studies on this).<sup?4 For busy doctors who resist, we should encourage them to “read” their patients’ stories as literature and not just as technical information. A story has meaning and purpose—a plot—and draws on metaphors to make meanings.

What constitutes the non-technical face of medicine? How can it be championed by a medical practitioner?

The “non-technical” is a rather cumbersome term referring to the “human face” aspects of medicine: communication with patients and colleagues in team settings. Medical students (mostly) already know how to communicate effectively. They are human beings living their lives! But transforming medical work from authority-led practices to democratic teamwork is essential for improving patient care and safety. Doctors need to champion facilitative kinds of communication, and this needs to be formally encouraged early in medical school education. I think that all medical students should be taught psychotherapeutic capabilities.

Medical humanities has gained significant attention as a research topic in departments of humanities worldwide, often more so than within medical institutions. Given that medical humanities primarily addresses the needs of medical practitioners, though humanities departments most often conduct the research, how relevant is such research to medical institutions?

The problem is that medical schools with their medical education departments and humanities departments in universities that take medical cultures as their topic of study (anthropology, history, ethics, philosophy, psychology, etc.) do not talk to each other. They have separate conferences and journals. Their funding streams are different. In the UK, humanities departments studying medical cultures certainly have little interest in medical education—they have no formal interest in the pedagogy of medicine as a humanities discipline. This is a shame because the curriculum reconceptualization movement is so humanities-oriented and has so much to offer to medical education. William Pinar’s work has been a great influence on my own work.5 I have spent many years of my career trying to get humanities departments of universities to work with medical schools’ medical education departments, but with little success, I am afraid.

Thank you, Professor, for your valuable insights! Your observations offer plenty of material for readers, medical practitioners, and scholars to reflect upon and develop further. It seems to us that medicine, in its letter to humanities, is reverberating Keats’ words, “Illness is a long lane, but I see you at the end of it…”6

 

Pragya Dev is a senior research fellow in the Department of Humanities and Social Sciences at IIT Roorkee, India. Her doctoral thesis explores care and vulnerability studies at the intersection of medical and health humanities. She may be contacted at pragyadev79@gmail.com.

Dr. Binod Mishra is a professor of English in the Department of Humanities and Social Sciences at IIT Roorkee, India. His areas of interest include Indian writings in English, folk literature, and professional communication. He may be contacted at binod.mishra@hs.iitr.ac.in.

They welcome comments from readers via email or through BMJ’s social media channels.

 

References

[1] Alan Bleakley, Medical Humanities: Ethics Aesthetics Politics (Routledge, 2023).

[2] Eduard Pernkopf, Atlas of Topographical and Applied Human Anatomy (W. B. Saunders Company, 1963).

[3] Alan Bleakley, “When I Say … the Medical Humanities in Medical Education, Medical Education 49, no. 10 (2015): 959–60, doi:10.1111/medu.12769; Bleakley, Medical Humanities, 44.

[4] Alan Bleakley and Shane Neilson, Poetry in the Clinic: Towards a Lyrical Medicine (Routledge, 2021); Shane Neilson, “The Idea of Medicine as Poetry: Alan Bleakley’s ‘Keats’ Lexicon,’” BMJ Medical Humanities Blog, January 12, 2024, blogs.bmj.com/medical-humanities/2024/02/01/the-idea-of-medicine-as-poetry-alan-bleakleys-keats-lexicon/.

[5] William Pinar and Madeliene R. Grumet, Towards a Poor Curriculum (Educator’s International Press, 2014); William Pinar, International Handbook of Curriculum Research (Routledge, 2014) William Pinar, What Is Curriculum Theory? (L. Erlbaum Associates, 2004).

[6] Keats, John. Letters of John Keats to Fanny Brawne, (1878; Project Gutenberg, October 5, 2019), www.gutenberg.org/files/60433/60433-h/60433-h.htm.

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