SECOND OPINION:Doctors can do much to ensure they listen on all levels, writes DES O'NEILL
SARDONIC HUMOUR and the medical profession have a long association. The French playwright Molière had a long and complicated series of illnesses during his life: his unhappy encounters with doctors engendered in him a particular fondness for pricking their self-regard. A typical line from his play l'Amour Médecinasks why four doctors had been called for the patient: would one not have been enough to kill him?
Ambrose Bierce continues the tone in The Devil's Dictionary, which describes a physician as one upon whom one sets one's hopes when ill, and one's dogs when well.
The acme of such commentary is surely the foreword to The Doctor's Dilemmaby GB Shaw, in which a profession is described as a group of people who band together to hide their shortcomings.
Joining the chorus is the splendidly insensitive Dr Hibbert from The Simpsons,Dr Kelso from Scrubsand the whole cast of Green Wing.
Against this background, last week’s survey showing high levels of trust among Irish people in their doctors is reassuring, but should not breed complacency in the profession. One constant challenge is to try and develop a very real sense of listening not only to patients, but also to the personal, professional and societal currents that influence our dealings with patients.
I was reminded of this recently when running a medical humanities module with medical students. This newly developing field is not some tokenism to the liberal arts, but takes as its core the concept of multiple dialogues inherent in the practice of medicine.
As described by Rita Charon, one of the pioneers of the field, at least four dialogues are running simultaneously during a consultation.
That between the patient and the doctor, requiring empathic engagement, is obvious. Less apparent is that between the doctor and his peers – standards, audit, conscious and unconscious rationing – requiring the development of due professionalism.
The third discourse is the doctor with himself or herself – fears, prejudices, uncertainties, past experiences – mandating reflective practice.
Finally, there is the dialogue with society – stigma, rationing, ethics, support or lack thereof – an awareness of which is critical to the development of trust.
Transmitting such complex ideas is often best served by the insights of artists, and many art forms can serve as excellent metaphors for the messages, frustrations, and the need for both emotional and intellectual articulacy to absorb and work with these complex currents.
The assignments for our module requested the students to write about artworks that conveyed these meanings, but also had a personal impact on themselves.
Working with the director from our National Centre for Arts Health at Tallaght Hospital, we were bowled over by the responses. Their chosen topics included popular music ( Cancerby My Chemical Romance), film ( Flatliners), poetry (one of Eliot's Four Quartets), art (paintings by a blind Turkish artist), architecture (the new Birmingham Children's Hospital) and personal narrative (Beethoven's Heilgenstadt Testament on his deafness). The range, content and quality should provide reassurance to future generations of patients and society.
Key to the success of such programmes is the active engagement of practising doctors, liberation from the straight-jacket of classic literature (as Mark Twain would say, which everyone talks about but nobody reads), an emphasis on personal relevance for the student, and sustained partnership with academically informed partners in the humanities.
This partnership helps avoid the danger of dilettantism, and is central to ensuring academic rigour for such courses.
A part of this rigour requires an active research agenda and zero tolerance for feel-good but overzealous claims.
One particularly toxic canard that surfaces occasionally in arts and health circles is that the arts make you a “better person”.
Reference to Radovan Karadic, the poet, psychiatrist and war criminal, or Céline, the anti-semitic physician and novelist, usually damps down this line of argument effectively.
If we can instead concentrate on ensuring that doctors develop sensitivity to the various currents, perceptions and realities of daily practice, and a sense of their immediate relevance to them, their patients and their practice, perhaps even Molière might find that art and science of medicine have got just that little bit closer.
Narrative of Health, Illness and the Lifespan, an international conference on medical humanities, arts and health will be held at the Royal Irish Academy in Dublin on June 15th and 16th, 2011. See artshealthwellbeing.ie