Monday, January 31, 2011

Poetry, Painting to Earn an M.D. - WSJ.com

The course list for medical students can be brutal, including old standbys like gross anatomy, cell biology and organic chemistry. Now, aspiring doctors can add to that poetry and painting.

Medical schools are placing a growing emphasis on the humanities, including courses in writing, art and literature. The programs aim to teach students "right-brain" insights and skills they won't learn dissecting cadavers or studying pathology slides. Schools hope the programs help to turn out a new generation of physicians better able to listen attentively to patients, show emotion and provide sensitive personal care.

At Brown University's medical school, a reflective-writing program assesses students' ability to express feelings about experiences such as witnessing their first death or dealing with a difficult patient. A humanities track at the University of Iowa Carver College of Medicine requires students to submit creative works or review submissions to a new literary journal, "The Examined Life." New York University School of Medicine launched a division of medical humanities last month offering a wide range of arts programs to foster appreciation for the human aspects of medicine. It showcases student works in "Agora," an arts journal.

"Emotional reasoning and clinical empathy isn't about be-nice-to-the-patient. It's about understanding the significance of illness and how it takes place in the context of their life, and any physician or caregiver who doesn't have a sense of that cannot be effective," says Felice Aull, founding editor of the literature, arts and medicine database at New York University.

The Accreditation Council for Graduate Medical Education in 2006 began requiring residency programs to demonstrate how effective they are in teaching compassionate care along with mastery of medical knowledge. Studies show that patients are more satisfied with doctors who show empathy, and are more likely to follow a doctor's orders, as well as file fewer malpractice complaints.

"We ask about chest pain and shortness of breath, but the discussion rarely gets to what is going on in their lives and their experience of being a patient," says Paul Gross, a family medicine physician at Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx, N.Y. Dr. Gross holds a monthly session in narrative medicine, which encourages writing stories about patients to understand all the factors that affect them. He also edits a medical literary journal called "Pulse: Voices from the Heart of Medicine."

Dane Jacobson, a fourth-year student at the University of Iowa, says that during his first year he had to sprint from a class dissecting cadavers to a writing workshop. He says he found it comforting to write about his experiences, from a reflection on the person that once inhabited the cadaver's body to a poem on his feelings of dismay and horror after caring for an infant who had been burned by boiling water.

"I think if you write a lot of reflective pieces or emotionally charged pieces you do become more in tune with other people," Mr. Jacobson says. "When I wrote a reflection on a patient I didn't really like, putting it down on paper made me start to see things from their perspective."

Many of the new humanities programs are offered as electives. But some U.S. schools are making the courses mandatory, following in the tracks of some programs abroad. Medical students at the University of Bristol in the U.K., for instance, have since 2003 been required to submit creative works for a course called "Whole Person Care."

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http://online.wsj.com/article/SB10001424052748704680604576110240337491446.html

Excerpts from works written by medical students in programs that use humanities studies to improve empathy and communication skills:

* * * * *

From a doctor's perspective, her tale was quite ordinary and straight forward. For the medical student, it was just another story, just another day at work. From the patient's perspective, she will always remember it as the night she almost killed herself followed by a day that was more horrifying for her than any horror movie. For her, this was without a doubt the scariest day in her life.

From 'Just Another Day at Work' by Robert Fakheri

New York University medical school, class of 2011

* * * * *

At first, ya know, I thought the patients would depress me.

The dying and the pain,

I thought it'd be impossible not to take that home,

no matter how hard I tried.

Then I found out that these are some of the nicest,

most grateful patients & families you'll ever meet.

From 'Per Diem' by Noah Rosenberg

University of Massachusetts medical school, class of 2012

* * * * *

I cannot think I can think. I cannot write I can write. I stand by their bedside. They lay. I think.

I am young. They are old. They think.

We meet at 50. That is old. That is young.

Where do they go when they think.

I go to my past. They go to their past.

I go to their past with them.

They have suffered. Have I.

They have triumphed. Have I.

It is dusk. It might be dawn. It is neither. It is cold outside.

Where are your friends. Some are warm. Is it warm in the night. Is it dark.

From 'Bedside Manner' by Kevin Efros

New York University medical school, class of 2012