A recent article in The Wall Street Journal reported a trend on teaching humanities in medical school to comply with a recommendation to teach compassionate care. While clinical acumen is important, empathy is a trait that really enables a physician to connect with his/her patient, thereby improving the healthcare experience of that patient. The argument for teaching courses like “narrative medicine” – where students write about their experiences – along with anatomy and pathology, is that exploring and understanding the human side of medicine will enable these doctors-in-training to grow into compassionate physicians.
Writing about medical training is not a new concept, however. I had a chance to sit down with physician-author Emily R. Transue, MD*, who started Mind, Body, and Pen, a creative writing class for medical students that is offered every winter (an ideal time for self-reflection in the Pacific Northwest). She has been teaching this class voluntarily for eleven years at the University of Washington Medical School. In fact, she has had to cap class enrollment to 15 students due to high interest and to optimize the experience for both herself and her students.
“Writing is about honing and maintaining skills for empathy,” Dr. Transue says. She argues that the vast majority of students who apply to medical schools are actually quite empathetic. However, during the course of traditional medical education, empathy can be “beaten out of them…. There is little opportunity for self-expression, and [medical students and residents] don’t have a sense of permission to be affected by experiences.” Dr. Transue’s class gives them that permission. It allows students to process some of the challenging aspects of becoming a doctor. By writing about the death of a patient or the strain on a young marriage, students have an avenue to help bring emotions and feelings “outside of their heads.” In addition, the medical students, who are notoriously competitive, listen to pieces written and read aloud by their peers and have to resist the urge to “one-up” each other. It encourages focused listening and reflection on another’s emotions.
If medical students are inherently compassionate, at what point are the skills for empathy being squelched? Dr. Transue feels the answer may actually be in the culture of residency. Medical residents are role models for impressionable medical students. Historically, the prevailing culture has been one of proving your worth as a physician. This means being a “gunner” at all costs. Not showing weakness. Being a sort of superman in the face of extraordinary circumstances (life, death, illness, sleep-deprivation, strained relationships, depression). Medical students are learning the ropes – more than just the clinical ones – from these residents and the cycle continues.
Humanities courses can allow medical students to maintain their already empathetic nature. But to continue to preserve it, exercises that allow for reflection of clinical experience in real-time would be valuable in residency, as well. It is during this stage that burnout rates are high and critical decisions are being made regarding specialty choice. One might argue that courses similar to Dr. Transue’s creative writing class could increase the likelihood of residents choosing to practice in primary care fields.
*Emily R. Transue, MD is the author of : On Call: A Doctor’s Days and Nights in Residency and Patient by Patient: Lessons in Love, Loss, Hope, and Healing from a Doctor’s Practice. She practices at The Polyclinic in Seattle, WA.