Hippocrates, the Essences of Euripides, and their Impact on Clinical Efectiveness

Medical humanities education illuminates the human condition, creates more effective clinicians

by Steve Goldstein

In the film 50/50, based on a true story, a 27-year-old writer is blindsided by a cancer diagnosis and struggles with the disease, as well as the bewilderment of his friends and family. James L. Scott, M.D., former dean of The George Washington University’s School of Medicine and Health Sciences (SMHS) and a professor in the Department of Emergency Medicine, teaches this movie in a film and medicine course. “It portrays living with cancer in a way we don’t normally think about, with a young man dealing with it through black humor, with friends making fun of it, living with it in ways that wouldn’t occur to most people,” says Scott.

And it fits in with the goals of humanities education at SMHS, which is aimed at using the arts to deepen the understanding of the human condition. Or, to put it another way, adding the essence of Euripides to the ethos of Hippocrates.

Vice President for Health Affairs and Dean of SMHS Jeffrey S. Akman, M.D. ’81, G.M.E. ’85, an avid supporter of the program begun by Scott in 2005, and himself a former English major at Duke University, says: “I think the arts and humanities give us particular insights into the human condition that are relevant to being a physician. I want to support my students, residents, and faculty so that they think about people in a complex way, and arts help us to do that. I think that’s what drives people to medicine — the notion of humanity”.

GW holds a unique and prominent place in medical humanities education in the United States. Although a majority of medical schools offer some courses in medical humanities, only a relatively small percentage offer as robust a program as SMHS, according to Therese Jones, Ph.D., interim director of the Center for Bioethics and Humanities at the University of Colorado, Denver. And the emphasis at GW is growing.

“Medical humanities” is typically defined as an interdisciplinary field of humanities (literature, philosophy, ethics, history, and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice. Apart from providing insight into the human condition, studying literature and the arts helps to develop and nurture skills of observation, analysis, empathy, and self-reflection — skills that are essential for humane medical care.

Linda Raphael, director of the medical humanities track curriculum at SMHS, emphasizes the interdisciplinary nature of the program. “When any discipline sees itself as separate from all other things, it tends to suffer,” she says. “Medical education is very vigorous and demanding. The humanities offer an opportunity for students to think and talk about what they’re doing in a different language and through different perceptions. It takes them a little back into the world they’ve come from".

At GW, medical humanities electives are offered in the first, second, and fourth years. In the third year, Raphael leads one to three sessions in all of the clerkships — psychiatry has three, for example. So even if a student chooses not to take any electives, he or she will attend humanities sessions in the clerkship year. “By the fourth year, the number of students exposed to classes in medical humanities is at least one-third of the 170 students in each class,” she says. There are also those who choose the humanities track for all four years, although this cohort is small.

Raphael, who teaches a course on graphic literature involving medicine called “Commix,” recalls a neurology track student who was particularly moved after viewing a film meant to stimulate discussion about the distinction between sympathy and empathy. “She said it meant a lot to her to have an opportunity to talk about these things,” Raphael says.

Another innovation at SMHS is a Theater in Medicine program, developed by Charles Samenow, M.D., assistant professor of psychiatry and behavioral sciences and director for medical student education, and GW visiting professor Jeffrey Allen Steiger, who directed a theater program at the University of Michigan. A team of actors, some of whom have a background in health care, use common issues such as personal relationships, stress, and competitiveness among practitioners to highlight theories of professionalism.

Psychiatrist and philanthropist Assad Meymandi, who received his M.D. from GW in 1962, has been a vocal supporter of humanities education at his alma mater. “The most important thing for me is to bridge the gap between basic sciences and the humanities and the arts,” he says. “I see so many humanists who don’t know anything about science and so many scientists who know nothing about the humanities. I want to bring the two bodies together.” Meymandi says he’d love to add a course to the humanities curriculum about “what it means to be a human.”One performance called Milestones”, is a dynamic, interactive multimedia production focused on professionalism, burnout, and disruptive behaviors. Samenow believes that information delivered through the medium of theater — “a safe learning environment” — resonates with students and faculty, and makes lessons on communications, conflict resolution, and teamwork more vivid and, often, longer lasting. Feedback from students and professionals has been very positive.

Humanities education at GW is not restricted to medical students. Christopher Bayne, a urology resident, is chair of the Arnold P. Gold Humanism Honor Society chapter (see page 32). “The Gold Foundation and others like it are trying to bring the human element back into what is almost algorithmic care”, he explains. “Medicine used to be a very personal interaction; now it’s not”.

Akman spends significant time speaking to alumni and potential donors about supporting the humanities education program. He is proud of the humanities history at the school, which he says actually began with popular professor Frank N. Miller, B.S. ’43, M.D. ’48, GW professor emeritus of Pathology, who originated a Medicine in Literature course way back in 1967.

Akman himself teaches a course with Raphael. A theater buff, he was momentarily overwhelmed with ideas when asked what play he would teach. “Angels in America by Tony Kushner”, he reasons. “It deals with HIV/AIDS, and he builds an epic play around a medical illness.

“If I could have medical students see one play, that would be it”.