Putting the He (aling) art back into Medicine

1. Kay Mohanna Principal lecturer in medical education Staffordshire University Associate Dean for GP Assessment West Midlands Deanery Putting the He(aling)artback into Medicine

2. “Medicine is not only a science; it is also a healing art. It deals with the very processes of life, which must be understood before they may be guided.” Paracelcus Born 1493 in Einsiedeln, Switzerland • alchemist, physician, astrologer,and occultist

3. “Putting the heart back into medicine” • What is at the heart of medicine? • How can we align medical training to work towards this? • Where do art and the humanities fit in? • What is the role of the medical educator?

4. (Note to self… ….try to avoid teaching grandma to suck eggs)

5. Advice to a young student… “Aim for 51% in exams and 110% in life” George Wilson Upton Upon Severn 1982

7. news.bbc.co.uk/olmedia “Upton In Severn”

8. So what do we want from our trainees (and ourselves)?

9. Tomorrow’s Doctors… Should show respect for patients and colleagues that encompasses without prejudice, diversity of background and opportunity,language, culture and way of life GMC 1993

10. Tomorrow’s Doctors… Must have a recognition that a blend of scientific and humanitarian approaches is required, involving a critical approach to learning, open-mindedness, compassion and concern for the dignity of the patient GMC 1993

11. In addition…..

13. The thing is… ….Medicine is a difficult job

14. “For my entire career I have been convinced that general practice is the hardest specialty to do well, and probably the easiest to do badly. GPs deal in uncertainty all the time—the next patient could have schizophrenia or piles, unhappiness or cardiac arrest, anything and everything, and in no particular order. So the question of which specialty needs the best training and the best assessment is something of a no-brainer, as our neurology colleagues might say” David Haslam BMJ Career Focus 2005;331:151-152

15. “Healthcare professionals exercise their judgment based on skills and training, but they are also whole personalities, and quality as perceived by patients is determined by their whole approach. Holism is a two way street - the whole practitioner deals with the whole patient.” Jenkins 1999

16. Towards a philosophy of general practice: a study of the virtuous practitioner Occasional Paper 78. Peter D Toon.RCGP, 1999. ISBN 0-85084-252-2

17. Education…. Facilitates a change in an individual so that she or he may function fully Rogers 1983

18. Domains of learning • Cognitive • Psychomotor • Affective

19. [Art] has the power to remind us that we are hunters and gatherers of values. That our very solitude and distresses are creditable, in so far as they, too, are an earnest of our veritable human being. Seamus Heaney 1995

20. Back to Paracelsus “The universities do not teach all things, so a doctor must seek out old wives, gypsies, sorcerers, wandering tribes, old robbers, and such outlaws and take lessons from them. A doctor must be a traveller... knowledge is experience.”

22. “To be a good doctor you have to be a compassionate chameleon, a shape shifter - a shaman. Even if your adaptation to your patients' world happens at an unconscious level you should always work within their system of ideas, never against it...” Cecil Helman

23. “The shaman… …. journeys to meet her Spirit Helpers, who advise her and touch her through her Heart. She brings back the Power, and the essence of their Truth, to enrich our lives upon this earth…

24. …So how do we reach beyond the ordinary? It's when we create or laugh or are inspired.” Joanna Shipleyhttp://www.shaman.org.uk

25. “It is at the point where medicine and art collide, that doctors can re-attach themselves to the human race and re-feel those emotions which motivate or terrify our patients….Every contact with patients has an ethical and artistic side as well as a technical one.” Fairle J. www.bmj.com rapid response,November 1999

27. 1945 Dr Clarke-Kennedy ‘The Art of Medicine in relation to the progress of human thought’ The art of medicine is unique in that it alone seems to occupy a middle place. Medicine has to deal with human personality and human hopes, human fears and human failings, in conjunction with the material body which is liable to so many disasters in the physical environment of our existence….. so that a purely scientific education is inadequate for a profession which deals with so close a relationship between mind and matter’ ’

28. Pennsylvania State University College of Medicine “There is continuing concern that medical technology, and the need to keep abreast of current scientific developments, threatens to pre-empt medicine’straditional concern for human values.” 1967

29. This concern extends to assessments of learning in medicine too.

30. ‘In our over-eager embrace of the rational, scientific and technological our concept of the learning process itself has been distorted.’ Kolb, D. A. (1984). Experiential learning: experience as the source of learning and development. Cited by David Sales former nMRCGP Convener

31. “Video assessment in GP training risks leading to a gross distortion in learning the consultation process” Mike Deighan

32. Patient – “I’m bordering on serious violence” Doctor – “Are you still taking the hormone tablets?”

33. Doctor – “How are things at home?” Patient – “Okay - We went away for a last ditch attempt to sort things out.” Doctor – “So you’re quite relaxed?”

34. Patient (with headaches) “My husband says I should come up – just in case it’s something different” Doctor – “ What’s your job?”

35. Doctor - “Any problem?” Patient – “Just, Dad died” Doctor – “Any symptoms?”

36. Patient – “I’m going to be redundant in June” Doctor – “Are you all catarrhal?”

37. “You have to be careful with this thing about ‘responding to cues’…you can end up opening a can of worms and then you’ll never get finished in 15 minutes and you can’t use it.” GP Registrar, Spires Practice

38. The most basic skill is the ability to have comfort with uncertainty, to recognise it with humility, to be open to the ever-present possibility of the surprising and the mysterious and even the holy, and meet people there Rachel Reman, oncologist (in Suburban Shaman. Oscar London.)

39. The search for meaning “Living with chronic illness is not simply a physical affair .. it is our ontology, a condition of our being in the world.” R.F. Murphy, The Body Silent. (New York: Henry Holt, 1987.)

40. John McCann University of Windsor, CanadaLiving with chronic illness: subjective contributions toward a patient- centered ethic 1999 “Nothing so concentrates experience and clarifies the central conditions of living as serious illness. The study of the process by which meaning is created in illness brings us into the everyday reality of individuals like ourselves, who must deal with the exigent life circumstances created by suffering, disability, difficult loss, and the threat of death. Yes, chronic illness teaches us about death; but the process of mourning for losses is also central to healing”

41. Medical Humanities We define the term "medical humanities" broadly to include an interdisciplinary field of humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, personal narrative, psychology, sociology), and the arts (literature, theatre, film, and visual arts) and their application to medical education and practice. Literature, Arts & Medicine Database http://medhum.med.nyu.edu

42. Pennsylvania State University college of Medicine The Healing Arts Centre http://www.hmc.psu.edu/humanities The healing arts centre

43. The Healing Art Centre

44. www.ravenhousearts.com Blooming Soul: Lynda Hoffman-Snodgrass

46. The MAP Foundation Using the creative arts to express and communicate complex and painful issues relating to serious illness and dying http://www.mapfoundation.org

47. Michele Petrone “The illness stole a place and a time that should have been destined for better things.”

48. This illness has invaded my life, knocked me off balance and made me feel out of control. I no longer feel the strength and direction I once had, I'm just a passive passenger, being carried whichever way these arms take me. But I still feel a need to direct my life, to feel this life of mine is still mine, so please: "carry me this way". 

49. “I need to know that this body is my body. And I need to know everything that is happening to my body. But most of all I need to know that you know that within my body there is me.”

50. “The physical illness is visible and life threatening. The emotional feelings, the electrical impulses of my soul, cannot be seen. As they are invisible it is easy to pretend that they are not really there. They don't at first seem to be as important as the cancer on the microscope slide. Yet they can be just as life threatening as the visible cancer itself.”