Humanities and the Physician
By Richard P. Holm, MD
After 40 years as a doctor interacting with patients, in the last two and a half years the tables turned, and I’ve become the patient. Although most are good, I’ve found some doctors are detached, some are too quick, some would rather be somewhere else, some are even angry; but, when a physician who cares walks into the room, and I’m not exaggerating, the day becomes better, the pain becomes less, and hope fills my heart. Scientific knowledge is important, but the ability to convey honest concern, human thoughtfulness and compassion is equal in importance in this healing profession. So, how do we select pre-med students for that, or teach compassion in medical school?
There are studies that show those interested in humanities or taught disciplines that explore how people tick, do better in the compassion department. These disciplines include history, literature, religion, ethics, anthropology, psychology, cultural studies and the arts of theater, film, painting and poetry. Some explain that the humanities give us the very reason to learn science and mathematics.
Several studies support the value of humanities in medicine. Seven hundred medical students were surveyed about their lifetime exposure to the humanities and the results indicated that those who had more humanities knowledge had more empathy, tolerance to ambiguity, resourcefulness, emotional intelligence and less burnout. Another study found that a med student’s ability to recognize diagnostic clues increased by more than 35 percent after taking a visual arts class. Another study found practicing improv theater helped med students learn to prepare for unexpected questions and conversations. A fourth study showed how writing exercises helped med students have foresight into what a patient may be experiencing. Clearly, an exposure to the humanities makes a better doctor.
I believe that care providers who have had a well-rounded humanities education have a better chance of understanding about how it feels to face pain, nausea, loss of bodily functions or even a cancer diagnosis. Those steeped in good literature or art have a better opportunity to tap creative juices to problem solve and tolerate a life that can be ambiguous and unpredictable. Those who are knowledgeable of history, ethics, cultural ways will find it easier to know when it is time to stop aggressive care and move toward comfort.
This is a call for all students to become readers, to find time to enjoy the humanities, to exercise your caring and compassion muscles; so, when you come into the room of a person suffering, it makes their pain less and day better.
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Imaging with a Little Help from My Friends
By Richard P. Holm, MD
The world of radiology began in 1895 when a European physicist Wilhelm Röntgen noticed fluorescence behind heavy cardboard when a cathode tube was activated nearby. Röntgen used his wife’s hand to demonstrate for the first time how these unknown rays, or X-rays, could penetrate the soft tissue of her hand and illustrate the bones that lay within. Röntgen generously refused to patent his discovery which allowed the explosive growth and development of a new industry.
Unfortunately, researchers were unaware of the dangers of too much X-ray exposure and during the early years harm was done, even causing death of some experimenters before safeguards were established. Over time, as technology advanced and more X-rays were utilized, interpreting the images became an increasing challenge and the field of radiology developed. Physicians trained in interpretation helped care providers make better clinical decisions.
I was a first-year resident at Emory University Hospital in Atlanta in the fall of 1975 when the hospital purchased one of the earliest computerized tomography (CT) scanners. It was called an EMI scanner named after the British company that took a huge financial risk in order to develop the technology. Electric and Music Industries (EMI) had signed with the Beatles as their recording company in 1962 and having amassed a fortune from the exponential rise of Beatles popularity, EMI was able to fund the theoretical work of Godfrey Hounsfield which took X-rays of the head from all directions while a computer compiled the results. When all other funding resources said “no,” Hounsfield’s brainchild happened, “with a little help from his friends.”
I was rotating through neurology when the results of the EMI scans started making an impact. We were amazed how they showed tumors, blood clots and lesions inside the skull. We thought it was going to change everything, and indeed it did!
Jump to the present and see how interpretive radiologists have expanded into intervention. Now, instead of simply identifying a tumor or abscess with ultrasound, X-ray, CT, or MRI, radiologists, under the guidance of an imaging modality, can pass a needle into a deep tumor and take a biopsy, drain an abscess, open-up a blocked tube and much more. Procedures that, in the past, would have required open abdominal or chest surgery, now can be done with minimal trauma and pain with quick recovery.
As a patient who has benefited under the expert image-guided hands of an interventional radiologist, I too can sing loud and clear, “I get by with a lot of help from my friends.”
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