The Challenge of Humanistic Medical Education

In 1999, oncologist Dr. Letha Mills, psychologist Dr. Bernard Bandman, patient Patricia Barr and I, a medical humanist, were invited to present a lecture at Brown Medical School. The topic was “Humanism in Medicine.” Our intent was to identify barriers and solutions to the practice of humanistic medical care.


We began the day with a lecture to 1st year medical school students to address the tension of promoting humanistic care in a field driven by science and technology, which has been an issue for quite some time. To make that point, we referenced “The Care of the Patient” by Dr. Frances Peabody, an article that appeared in the Journal of the American Medical Association in 1927. Dr. Peabody noted, “the art of medicine and the science of medicine is not antagonistic but supplementary to one another.”


Dr. Mills explained how doctors often objectify patients and the effort it takes to step back and see the sick person is not only asking for medical care but compassion as well. Pat Barr shared her experience of being a patient overwhelmed by not having a road map and living with uncertainty about the future. Dr. Bandman discussed psychological issues that are often “normal” anxiety and depression when facing a life-threatening illness but nevertheless may need professional attention. I emphasized the need to bridge the communication gap between doctor and patient, recognizing that they are speaking different languages. The medical students appeared transfixed by what each of us had to say. Their comments at the Q&A suggested that they were intent on being doctors who would practice humanistic medicine.


We were also invited to a lunch meeting of 3rd year students who, in addition to classes, began observing clinical rounds at the hospital. After we briefly described the topic of our earlier lecture, there was a hush in the room. Then, one student bluntly told us that he was more interested in being the first to come up with a diagnosis than investigate a patient’s emotional life. Another student, with tears running down her cheeks, told her classmates that it was sad and disappointing that there was not an emphasis on caring for the whole patient. What we observed was a dramatic attitudinal shift in the 3rd year of medical education, which was aimed at teaching science and technology with no formal curriculum to support a humanistic approach to care.


Dr. Mills was not surprised but it was troubling to all of us. However, this experience catalyzed our determination to formalize a medical humanist program at the cancer center in Bennington, which we implemented from 2003-05. We believed then and now that those who have a calling to medicine were most often motivated by wanting to heal the sick.


So, even today, it is not unusual to hear 1st year students express a desire to practice humanistic medicine and how in subsequent years this approach is altered by a medical education system driven primarily by science and technology, which is very important but not all that encompasses healing.


What I learned in my role as a medical humanist is that doctors need to be reminded about what called them to a life in a healing profession. Patients who share their lived experience of illness can help do that, even as doctors face continuing pressures to keep up with new advances in science and technology.