tipology:editorial

numero rivista e pagine: HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2010; 2(3): 157-159
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'A trouble shared is a trouble halved': how the Medical Humanities can help doctors to care while they cure

Authors: M. John*1, A. Zangrillo2

1Coordinator of Medical Humanities at the UniversitÓ Vita-Salute San Raffaele International MD Program
2Full Professor in Anesthesia and Intensive Care, UniversitÓ Vita-Salute San Raffaele, Milan, Italy

Corresponding author: * Corresponding author:
Prof. Michael John
Coordinator of Medical Humanities
UniversitÓ Vita-Salute San Raffaele International MD Program
Via Olgettina, 48 - 20132 Milan, Italy
E-mail: michael.john@hsr.it

In today’s frenetic, high-tech world, where medicine is evidence-based and focuses on spe-cialties of all possible kinds, doctors generally have little time to ponder the multifaceted pro-blems of their patients. Indeed, there are innumerable horror stories told by sick people that stem from the uncaring attitudes and the lack of sensitivity shown by many health professio-nals. Yet medicine should be seen as a caring profession that requires doctors not only to provide valid clinical assistance but, above all, to empathize with patients and their families when they are at their most vulnerable and in need of understanding.
Nowadays, medical school students are encouraged to interact with patients virtually from the beginning of their training and an increasing amount of emphasis is being placed on the tea-ching of social sciences, ethics and communication skills to help create a new kind of doctor. One way of doing this is by introducing the study of the Medical Humanities (literature, music, visual arts, psychology, sociology, philosophy, ethics, history, language, religion etc.) into an already crowded medical curriculum. These subjects require imagination, close observation and understanding, which are all fundamental characteristics of a successful and caring doctor.
How otherwise might a 20-year-old medical or nursing student learn about the complexities of the human condition? How would they be able to understand the reactions and feelings of someone with a terminal illness or a crippling disability, let alone a parent who has just lost a child? They certainly will not learn these skills from standard clinical textbooks, where the words fear and anguish do not appear in the index. Yet fear and anguish are at the very center of how a patient faces up to and lives with an illness.
The teaching of the Medical Humanities is considered a fundamental part of the medical cur-riculum in the USA and is becoming ever more popular in Europe. Our International MD Program at the Vita-Salute San Raffaele University is the first medical course in Italy to focus specifically on the Medical Humanities. Some of the areas examined by our multi-disciplinary team of experts, following the guidelines of the American Society for Bioethics and Humanities, are listed below:
empathy and patient-centered communication
team work and the ability to interact with colleagues and other health professionals
linguistics and use of language
truth-telling and the delivery of bad news
withdrawal of treatment
euthanasia and assisted suicide
treatment of violence and abuse
ethical and legal problems linked to medical errors
ethics committees
conflict of interest and relationship with industries
chronic illness
old age, death and bereavement
cross-cultural conflicts
alternative and complementary health practices
religion and spirituality
ethical problems linked to stem cells, organ donation and transplantation
re-pro ethics and new reproductive technologies
history of medicine and medical education

Books, films and music can help students to better understand the human condition in order to come to terms with these complex, even abstract, topics. The Diving Bell and the Butterfly (Jean-Dominique Bauby) tells the story of a man who suffers from locked-in syndrome after suffering a massive stroke and is able to communicate only by blinking his eye. C - Because Cowards Get Cancer Too (John Diamond) is a patient’s view of what cancer is, what it does, how it kills and how it can be cured. 
In the film One Flew Over The Cuckoo’s Nest (Milos Forman), a statutory rapist who enters a mental institution to avoid being sent to prison shows more humanity and understanding for the patients’ condition than does the hospital staff. The Doctor (Randa Haines) shows a successful surgeon with a terrible bedside manner who discovers he has cancer and begins to empathize with his patients when he too finds himself on the other side of the fence. 
Pink Floyd’s concept album The Wall is based on the causes and implications of self-imposed isolation brought about by trauma, overprotection, tyranny and abuse. 
Yet, who can teach these courses and how can we evaluate students? Clinicians, however cultured and sensitive they might be, would need to be part of a team made up of philosophers, psychologists, linguists and communication experts.
Evaluation would need to be given the same importance as that given to more traditional su-bjects otherwise students might not grasp the relevance of these teachings. 
You might argue that patients would prefer their doctors to concentrate on their diagnostic and technical skills rather than spend a pleasant afternoon studying the Humanities. Yet sick people are individuals to whom something unpleasant has happened and, as well as giving them the best treatment for their illness, doctors must at least try to understand their pain, fear and anguish. After all, patients are people and not just a mass of molecules.