Margaret Edson’s play, Wit, details the hospital life of Dr. Bearing, an English professor slowly dying of cancer. What is striking about the play is that her doctor, Jason Posner, is portrayed from Bearing’s perspective as an enemy: he is simply a man who uses his patient as a test subject for his barrage of medical knowledge. Though Posner is not intentionally rude, his poor ability to relate to patients makes him insensitive to pain as he undergoes a very intense chemotherapy treatment. To Posner, Bearing is not human but a patient, a subject of treatment, a set of data.1
The issue here lies not in how doctors are treating the disease, but in how doctors are treating the patient. This problem is not limited to this fictional work. Many of today’s doctors are merely applied biologists who are given the scientific knowledge to identify and treat diseases in an almost mechanical fashion: for a given condition, there is a certain set of treatments that they follow. But while this approach may be theoretically sound, it fails in the real world. Doctors trained in this manner take a very homogenous approach to treating a heterogeneous population, and this puts immense strain on the doctor-patient relationship. Doctors, untrained or very poorly trained in dealing with the heterogeneous set of ethical, cultural, financial, and social considerations patients have, focus solely on the biological aspect of disease because they believe their work is just to isolate the problem and treat it. Since these doctors aren’t addressing other concerns that may be just as important to their patients as the disease, patients feel detached and can’t put as much trust in doctors to take care of their well-being.
A case study presented by the Markkula Center for Applied Ethics at Santa Clara University in 2008 highlights this issue.2 In the case, an elderly Middle Eastern immigrant to the United States was brought to an emergency room and diagnosed with a malevolent lung tumor that presented a bleak prognosis. The doctor first put the patient on a medical diet, but the patient refused to eat the food, citing his religious beliefs. The hospital staff argued with the patient about the diet, but the patient still refused. Then, when the doctor addressed the patient about his cancer and stated that the best option would be to undergo an intense chemotherapy treatment, the patient, already mistrusting of the hospital staff after their earlier failure to understand his perspective, refused, again citing religious beliefs against being treated with such strong chemicals. The doctor unsuccessfully argued with the patient and did not know how else to proceed, leaving the patient in a critical condition.
Dr. Posner of Wit, as well as many modern doctors, experience a similar scenario: a doctor cannot relate to the patient as he is untrained in resolving ethical dilemmas, and the result is a very strained doctor-patient relationship—not to mention a potentially savable life left in danger. The 21st century’s rapid globalization and the increasing diversity of the population in the United States3 compounds this problem significantly: as people with more varied ethical, cultural, and financial backgrounds visit clinics, the homogenous approach to treating conditions presents a serious issue. With healthcare systems already under pressure to adapt to rapid health care reforms passed over the last few years, this issue puts even more stress on these systems and adversely affects the quality of healthcare delivery.
As this issue leaves many modern-day doctors unable to take care of patients’ entire well-being beyond just the medical condition at hand, the role of doctors needs to change; however, the fault lies not with them but in the education system training them. It’s obvious that studying the anatomy of the stomach doesn’t teach our doctors how to deal with a patient’s ethical concerns; what’s needed is a liberal arts education within the medical education system. As defined by the New York University School of Medicine, medical humanities are an “interdisciplinary field of humanities, social science, and the arts and their application to medical education and practice.” This field provides insight into the “human condition, suffering, personhood, our responsibility to each other, and offer a historical perspective on medical practice.” The goal is to strike a balance between the liberal arts and the sciences in medical school so that doctors have enough exposure to the humanities to develop “skills of observation, analysis, empathy, and self-reflection—skills that are essential for humane medical care.”4 Finding this balance would allow doctors to be not only well-trained in identifying and treating disease but also adept at maintaining healthy doctor-patient relationships. This in turn would have a cascade effect, since healthy doctor-patient relationships are the foundation for a high quality health care delivery system.
Essentially, a change is necessary and has definitely begun: a report published by the American Association of Medical Colleges reveals that about 80% of medical schools now teach ethics as part of an integrated course;6 and medical humanities and bioethics programs are being established at numerous medical institutions across the United States. The hope is that medical humanities become a more important part of a doctor’s medical education and that future doctors are just as well trained in treating a patient as they are in treating a disease. This way, the story of Jason Posner, of Dr. Bearing, and of Wit will never have to be retold again.7
- Edson, Margaret. 1999. Wit. London: Faber and Faber
- Peterson-Iyer, Karen. 2008. “Cancer: A Failure to Communicate.” Culturally Competent Care for Muslim Patients.
- US Census 2012 Press Release. “2010 Census Shows America’s Diversity.” CB11-CN.125
- Aull, Felice. “Mission Statement of the Department of Medical Humanities at the New York University School of Medicine”
- American Association of Medical Colleges Report: Curriculum Topics Coverage in Independent or Integrated Courses
- Image credit (Creative Commons): Ministerio Secretaria General de Gobierno. Inauguración de nuevo edificio del Hospital Luis Calvo Mackenna. Wikimedia Commons. JPG.
- Image credit (public domain): Leonardo da Vinci. Vitruvian Man. Wikimedia Commons. PNG.