Why are medical humanities relevant in an era of technologically-driven healthcare?
Although Hippocrates famously proclaimed “wherever the art of medicine is loved, there is a love of humanity,” the rationale for incorporating the humanities has always been contested in medicine (Nazario 2009). Many view medical humanities as a “soft” science, or irrelevant to the dominant “genes and molecules” approach to medicine (Belinda 2015). Understanding the study or usage of the medical humanities may be perceived as an elusive concept lacking an educational or clinical purpose (Coulehan 2008). Scholars agree medical humanities include traditional disciplines and social sciences such as philosophy, art, history, ethics, sociology and psychology (Coulehan 2008; Purtilo 2015). Proponents believe that immersion in the humanities can open the hearts of doctors to a culture of medicine that reinforces empathy, respect, altruism and self-reflection. Coulehan (2008) argues that at the very least, if medical humanities do not produce more empathetic and ethically committed doctors, they may assist students in resisting the negative forces of egoism, cynicism, and a sense of entitlement.
Some commentators suggest the overarching goal of medical humanities in deepening the doctor-patient relationship, and by extension, facilitating person-centered care, is a transitory practice that will be replaced by technological breakthroughs in real-time, artificial intelligent-driven systems. In this scenario, the physician may be replaced by a computer utilizing an efficient diagnostic algorithm, thus relegated to a quality control inspector (Banja 2018). For some, this scenario conjures up a working tricorder, the portable tool used by Bones in Star Trek to diagnose patients without touching or talking to them.
The good news is there are an increasing number of health professionals who do not envision the future of healthcare in this way. From a practical standpoint, Dalbert (2011) argues the state-of-the art scientific knowledge and techniques learned in medical school have a limited shelf-life; and mastering the humanities provides tools for extending it by affording the student the skills to foster resilience and promote reflection and lifelong learning. According to Jensen (2011), we must ask ourselves, what is knowledge that counts, and more specifically, what counts as knowledge in clinical practice? Years ago, Aristotle (translated 1953) described the importance of phronesis, or practical wisdom, which integrates knowing-in-action. Clinicians using phronetic knowledge combine evidence-based practice with reasoning which considers the context of care and practical issues affecting care. Clinical decision-making is impacted as clinicians consider how, why, and when it is best to use a particular intervention. This includes ethical knowledge which entails the consideration of the relational aspect of clinical practice that may be judgmental and value-laden. Some refer to this way of thinking as wisdom, and the question is whether computers exhibit wisdom beyond algorithmic evidence-based diagnosis and decision-making? The computer program AlphaGo can now achieve unprecedented levels of mastery purely by teaching itself; and some argue that Watson, the famous IBM computer, is able to act as a guide at the side of inexperienced doctors and make wise decisions about patient care as experienced physicians do (Siegl, 2012). Perhaps this is possible, but I remain skeptical that true patient-centered care is taking place. How can computers demonstrate compassion, empathy and vision? How can they create the emotional salience of patient encounters and capitalize on the influence of touch that helps develop patient trust? Can computers understand the difference between disease and illness? I would argue that sitting in front of a computer screen may not be the most productive way to develop ourselves as healthcare professionals.
This is not to suggest that technology does not play a critical role in medical care. It certainly does. However, physicians, other healthcare providers, and their respective professional programs should ask – what elements of patient care constitute best practice? Patients may view practice guidelines based on computer algorithms as eliminating personal autonomy and reciprocal decision-making – a return to paternalistic medicine. These types of technological interventions could lead to reduced patient access to physician care, the industrialization of medicine, and the development of physician technocrats who tend to measure the success of healthcare by looking at aggregate data effects on populations rather than individual patients. Finally, person-centered care works both ways. While the physician gets to know the patient better, the patient gets to know the physician.
The integration of humanities in healthcare recognizes and emphasizes the dynamic interplay of disease with the resulting impairments that have personal and environmental features. The causal relationship of diseases, impairments and function are contextualized within domains of social, personal and environmental factors. As such, healthcare professionals focus on persons who have migrated to what Susan Sontag (1977) calls the “kingdom of the sick.” In many ways, illness, particularly if it is chronic, results in an ontologic assault on our very sense of being in the world. The isolation and suffering associated with the existential experience of illness, especially chronic or life-changing disease or injury is almost impossible to imagine, and it is hard to envision how computer-driven technology can address these personal and inherently human experiences. Conversely, research has demonstrated that clinical empathy can be taught through medical school humanities (Neuman et al 2009; Shapiro and Lloyd 2003), and that physician empathy has a positive effect on patient care and outcomes (Drksen F, Bensing J, Lagro-Janssen 2013). Although social sciences, such as psychology and sociology, have found their way into many health professional educational curricula (Banaszek 2011), and have in no small measure helped to explore and explain psychosocial issues of care, we still need to go further if, “the messy particulars of lived human experiences are invited into the encounter” (Purtilo, 2015). And what are these messy encounters – they are the hopes, dreams, fears, uncertainties, vulnerabilities and values of all those who have a stake in the process and outcome of care. The humanities, as Purtilo points out, offer this opportunity in spades.
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