Making Doctors Human: The Medical Humanities in Qatar and the Gulf
01 Feb 08:00 AMSector : Education Country : Qatar
By Dr. Alan S. Weber
Medical humanities attempts to address the sociological, economic, philosophical and ethical issues that doctors face
Humanities and arts may possess their own healing powers
Two years ago I rushed into the living room to find my Aunt clutching her chest and wheezing. “Auntie, where is your medication?” “Oh, I threw that out,” she replied between wheezes. “I didn’t like that Doctor,” she continued. “I’m not going to take his medicines.”
Similar scenes are played out across the world every day. We ask doctors to find out why we are sick, and to prescribe the proper medication. But do we need to like them? And they to like us? A growing body of evidence does indicate, in fact, that given two doctors with the same technical skills, a more personable doctor can foster better health outcomes. A humane doctor is essentially a better practitioner.
In order to develop more human-oriented physicians, an emerging field called medical humanities is increasingly being integrated into medical education internationally. The discipline attempts to address the sociological, economic, philosophical and ethical issues that doctors must face outside of the more technical aspects of medicine such as diagnosis, prognosis, and therapeutics. Traditionally this aspect of medicine has been called ‘bedside manner’ and was taught by apprenticeship. Medical students would shadow experienced doctors and watch how they interacted with patients.
In the Gulf, Qatar has been in the forefront of medical humanities education initiatives, beginning at Weill Cornell Medical College in Qatar (WCMC-Q) in 2002. The Cornell program teaches one course and one module in medical ethics, the most widespread medical humanity. In addition, communication skills, empathy, professionalism and seeing the world through the eyes of the patient are explored in the “Medicine, Patients, and Society” series of courses.
Students in the Premedical Program also take two First Year Writing Courses which not only teach effective writing skills, critical/analytical skills, and interpretation, but also often contain medical humanities content. Examples of Writing Courses related to medicine that have been offered over the years at WCMC-Q include Islamic Medicine, Islamic Medical Ethics, the Story of Medicine, and Healthcare Communications.
Other Gulf Cooperation Council (GCC) nations have also started experimenting with broadening their curriculum with medical humanities courses. In 2009, doctors Rabie E. Abdel-Halim and Khaled M. Al Kattan at Alfaisal Medical College in Riyadh, Saudi Arabia began teaching a series of medical humanities courses. The topics included Islamic Medical Ethics, Arabic Medical Poetry, and the History of Medicine during the Islamic Civilization. Abdel-Halim explains that the purpose of the poetry course is “to show how poets and poet-physicians have dealt with illness, pain, disability, birth, death and dying, and how the skilled imaginative exploration of these subjects increases understanding of the human condition, especially of human suffering and, thus, contributes to compassionate care.”
Going beyond the Hippocratic Oath
The “Medhumanities” group, a GCC-wide organization on social media websites Twitter and Facebook, has also recently been promoting and discussing the medical humanities. But outside of a few courses with humanistic content, much of the medical training in the Gulf is primarily technically based. Communication and ethics courses are taught along practical lines – ethics obviously to train physicians to comply with local laws and medical codes and the Hippocratic tradition, and communication skills to allow them to write accurate patient histories and explain treatments to families and patients.
Medicine prides itself on being evidence-based. It appears self-evident that providing doctors with knowledge about the history, languages, habits and world views of different cultures would help them to understand individual patients better. Common sense also dictates that the more broadly a physician is educated in different fields of knowledge, the better he will be able to solve complex problems using different cognitive approaches learned from those disciplines. But what is the actual evidence that the medical humanities makes better doctors?
In 2000, Peters et al. did a randomized controlled trial at Harvard University between traditionally educated physicians and a group who had followed a humanities-based curriculum called the New Pathway (NP). NP physicians demonstrated greater confidence in handling the psychosocial dimensions of patient illness than the traditionally trained doctors. Other empirical studies have suggested that when medical students are exposed to explicit training exercises in empathy, they display more empathy in their practices. However, as with all outcomes based on educational assessment, the factors that go into preparing a good and competent doctor are elusive.
There is also the added dilemma that most medical education programs are already highly intensive courses of study with little time for elective, non-required topics. A potential solution to this problem is to combine communications training, which is required by American, Canadian and British competency frameworks such as CanMEDS and the ACGME, with writing and discussion courses on medical humanities topics. This is one of the functions of the First Year Writing Seminars at WCMC-Q, which often teach skills like public speaking, small group work and other inter-personal and communications skills.
Communication, Art and Music Therapy
There is ample evidence that physicians with strong communication skills are less likely to be sued for malpractice. Also, patients who have a strong relationship with their practitioner are more likely to follow their doctor’s advice and return for follow-up visits, which results in better health outcomes. In a 2011 research study with my medical colleague Dr. Mohamud Verjee, we confirmed that patients in Qatar’s Hamad Hospital were more satisfied with their medical experiences when they experienced good communication with their doctors.
Finally, humanities and arts may possess their own healing powers. James Pennebaker and his colleagues at the University of Texas, Austin have demonstrated in numerous replicable experiments that when patients write about past trauma in their lives, they can improve their general health. Haifa Al Sanousi in Kuwait extended Pennebaker’s work and confirmed the effectiveness of expressive writing (letters, short stories, writing about dreams) in relieving stress in Kuwaiti women.
Art Therapists have long been using sculpture and visual art to alleviate a variety of psychological disorders including depression and Post Traumatic Stress Disorder (PTSD). In fact, music therapy was a central element of the medieval Islamic mental institutions called Bimaristans. Several studies from Iran indicate that guided poetry writing helps to decrease depression, stress and anxiety in women. Training in visual art may also hold promise in helping physicians develop the key diagnostic skill of pattern recognition, since they must learn to interpret complex diagnostic images including X-rays and MRI scans to distinguish between normal and diseased tissue.
The role of the humanities in medical education in the GCC will probably increase and receive more attention from medical school administrators and faculty. The direct evidence, although inconclusive, indicates that more research and innovation in this emerging area should be done since incorporating more humanities training into medical education could have significant benefits.