Tell the experts: Medicine is still an Art

 In the evening, the family gathers in my room (I have the large TV) to watch movies. We have several movie channels (HBO, Fox movies) but too often they seem to be violent and nihilisitic, or else superhero nonsense, so instead I cast films from my computer, either from K drama sites or from Youtube, where you can actually watch a story with a plot and normal people.

Well, anyway, Joy loves "Hallmark" type movies, so last night we watch one of the Jean Oakes sagas, this one about a lady doctor. 

Big mistake: I rarely watch medical oriented shows, since they tend to be either so realistic that they bring back hard cases I treated, or more commonly ,they get medicine so wrong that I curse and shout medical advise at the screen.

This film was one of the latter: There is an epidemic in town, and the attractive lady doc looks down the throat of a sick child and immediately diagnoses Cholera.

Cholera? well maybe they left the part out about diagnosing it from the odor on entering the room and she was checking for dehydration, but the medical part went down hill from there: all those cholera patients being treated without her getting her fancy dress dirty. (and falling in love with a handsome cowboy of course). Yecch.

Poor Joy: she was quite startled after I cheered the town folks when they burnt down the orphanage which was the locus of the epidemic (although I suspect it was the orphanage outhouse contaminating the town water supply that caused the problem)...and after the film, I put this up to show her what was wrong with the G rated movie: 

Here is Dr Claire Frazer from Outlander confronting a similar epidemic on a British navy ship (actually the epidemic was typhoid, not cholera but you get the idea: Neither disease is pleasant to treat if you are a delicate lady trying to keep your dress attractive), and is more realistic.

go Claire!

Well, in a related subject, I just finished a book by Dr. Abraham Verghese "Cutting for Stone" about growing up with Indian physician parents in Ethiopia. Why did I enjoy it? Because I have worked in Africa, (albeit Liberia not Ethiopia, and 40 years ago), and found the description of overwork with limited resources and very very sick patients accurate... there is even a section about the fight to repair vesical vaginal fistula that is not for the faint hearted.

 But it's not just about the practice of medicine: It's the human story of those at the hospital: The nun who got pregnant, the physician parents who adopted her sons as their own, and were good and loving adoptive parents. The boys not only learned science and medicine,  but the parents also had time to teach them to dance and enjoy music and books. Then the plot changes when revolutions start, and the one son had to flee the danger because he knew someone who was on the wrong side of the revolution.

The son then flees to America and takes a residency program in a slum area that can't find many American physicians to work there, so hires doctors from India (been there, done that too, although most of my fellow residents were Filipinos and Iranians). and then an emergency: Fulminant hepatitis B requiring a transplant...

Oh yes: And he finds his birth father and reconciles with him: The father had fled into medicine as an escape from life, and became so enmeshed with medicine that he had no time to raise his son.

Yup. I've seen that too: Indeed, the first lecture that we medical students were given was about not making medicine a way to flee life, because being human is an important part of the art of medicine.

Yes, the art of medicine: Not just filling in blanks to get paid, not just asking the questions to satisfy the billing office, not being so engrossed in technology and the scientific approach to medicine that you don't sit down and get to know the patient.

This is also the theme of Dr. Verguese's other books: That medicine is in danger of descending into a dehumanizing mechanical approach:

......

so how does one teach medical students that the art of medicine is just as important as the science of medicine? 

by having good, humane teachers show you how to do it. And by having them learn about patients via literature and stories.

and here is an interview with him that discusses the importance of story, the importance of human connections, and especially the problem of making human contact while wearing a mask during the epidemic.

.......

sigh. Yes.

Years ago, I met the good doctor, and after his talk cornered him to say what younger doctors needed was to learn about ethics and illness by studying the classics, since too often what passed for such stories in the medical and ethical journals were closer to propaganda than reality, and what was worse these "stories" all seemed to assume the rational upper middle class individualistic approach aka "Autonomy" was the way to teach ethics. (something that is was no help for docs like me who worked with ethnic, immigrant or AmerIndian patients).

and he looked at me sadly, and said this had been done: The President's ethical council released a book using stories as a way to help students think about these problems. And indeed, I did manage to find it on Amazon.

alas, the book is out of print, and no one thought they should have made it into an ebook, but you can find excepts here. LINK

I'll use a short example: To discuss chronic pain, Emily Dickenson's poem is used:

In “Pain Has an Element of Blank,” poet Emily Dickinson shows us the problem posed by the constant intrusion of the body, in its most compelling form: pain. Pain is a direct experience that, according to Dickinson, seems to fill the present; nothing interposes itself between the poet and her pain.

 Pain has an element of blank;

It cannot recollect

When it began, or if there were

A day when it was not.

It has no future but itself,

Its infinite realms contain

Its past, enlightened to perceive

New periods of pain.~

something to remember the next time you read that doctors prescribe too much pain medicine for their patients...

and don't forget: A lot of sickness is from grief, anxiety and the sorrows of life. Listening is a big part of treating that too:

as Hopkings wrote: 

O the mind, mind has mountains; cliffs of fall
Frightful, sheer, no-man-fathomed. Hold them cheap
May who ne'er hung there.