UNC Health Talk

Developing the Doctor and the Person

Four years ago, as Jenny Shen assembled her medical school application, she worried she would have to abandon her interests in literature and creative writing; her dedication to the humanities couldn’t possibly coexist alongside medical education’s rigors.

“When you come to medicine from a humanities background, it’s difficult to see how the two can be complementary,” says Shen.

To her surprise, upon beginning the next phase of her education, she found at UNC an environment supportive of incorporating alternate perspectives of medicine. She was able to take courses that engaged elements of the humanities, worked with faculty who explored health and health care from humanities and social sciences angles, and discovered opportunities to work with Iris, the School of Medicine’s literary magazine. These experiences informed her clinical experiences by enhancing her listening and observational skills and differentiating between the standard medical questions and more idiosyncratic questions that explore a patient’s individual concerns. With time, these experiences also helped her better analyze clinical encounters and provided the tools she needed to navigate the early challenges of medical school.

“In retrospect,” says Shen, who plans to specialize in psychiatry, “I wasn’t making a choice of one over the other. I discovered that medicine and the humanities inform each other.”

Next year, the UNC School of Medicine’s long tradition of providing medical students access to the humanities and social sciences will expand as the Graduate School and faculty from across the university launch Literature, Medicine, and Culture, a new interdisciplinary master’s degree track that brings together medical students and graduate students to examine dimensions of medicine outside of the biomedical. Terrence Holt, MD, PhD, assistant professor of social medicine and geriatric medicine, will serve as director of the curriculum. Holt believes that formalized education in this area comes at just the right time for UNC medical students.

“We, as providers, find ourselves at a critical point in medicine.”

“We, as providers, find ourselves at a critical point in medicine,” says Holt, who received his PhD in English and his MFA in creative writing from Cornell. “In a lot of ways, our knowledge of best practice is coming up against the limits of what strictly quantitative knowledge can teach us. We have a changing health care system and an ever more diverse population of patients. We need to develop new ways of thinking about medicine that allow us to better understand what care means to today’s patients.”

A 30-credit hour curriculum designed to be available to medical students before, during, or after the “Application” phase of the new TEC curriculum, Literature, Medicine, and Culture will include courses taught by faculty from the Departments of Social Medicine, English and Comparative Literature, and Anthropology, History, Philosophy, Romance Languages, and Religious Studies, as well as the Schools of Journalism and Mass Communication, Public Health, and Social Work, providing new frames of reference for understanding the social and individual impacts of medicine and health care. Literature, Medicine, and Culture will complement TEC, which provides longitudinal experiences intended to improve patient care opportunities for students. Trainees will gain valuable insights into patient care through humanities and social sciences courses in such fields as narrative medicine, the practice and understanding of which are already popular with students in Chapel Hill as well as at the School of Medicine’s Asheville and Charlotte campuses. Graduates of such courses say they have helped them to gain insight into their vocation as physicians and given them a better understanding of the needs of their patients.

Beverly Taylor, chair of the English department, and various faculty members in the College of Arts & Sciences, worked with School of Medicine faculty to develop new courses and find existing courses to fit the curriculum.

“As students become more specialized and focused on their scientific studies, these courses will help keep alive parts of their human experience,” says Taylor, who serves on the curriculum’s advisory board. “That will be important for them as practitioners of medicine. Through literature, for example, they will delve into human psychology and the wide range of human experiences and hone an ability to analyze narrative and interpret text. This will help them when they see patients. They’ll need to be attentive and skilled listeners because often times there is subtext that must be attended to.”

One inherent challenge of medical education, historically, has been arming young medical students with the necessary tools to relate to patients who are facing significant medical challenges. Humanities training helps build those skills that are critical to answering clinical questions and producing compassionate care.

“You learn a lot about people through literature and the arts,” says Holt. “The only other way to gain that experience is through decades of clinical practice. Through the humanities, you learn intellectual tools that can be hugely helpful in framing questions that are vital to good diagnosis and good treatment.”

Barry Saunders, MD, PhD, associate professor of social medicine, is a member of the Literature, Medicine, and Culture advisory board. Saunders received his PhD in religion and culture from UNC, and his first book is a scholarly monograph on the ethnography and philosophical history of CT scanning. He remembers how the humanities informed his own medical education.

“For me, the humanities became a resource to think hard and reflect on life stages, including the final one, which medical students don’t have primary experience with.”

“For me, the humanities became a resource to think hard and reflect on life stages, including the final one, which medical students don’t have primary experience with,” Saunders says.

According to Saunders, the humanities and social sciences also benefit medical students by giving them the opportunity to think more deeply about their future profession, expanding beyond the initial ideas that attracted them to pursue careers in medicine.

“Students work hard to get to medical school,” Saunders says. “They’re enthusiastic when they arrive, they want to help people, and they’re enchanted by the nobility of the calling and sometimes by the wonders of science. But the belief in progress, the belief in the ability to do good, tends to blind some students and make it less easy to reflect critically on difficult issues within the health care system and with doctoring. In the scholarly worlds of the medical humanities and medical social sciences, there are a lot of resources for thinking critically about health and illness and the systems and practice that address those things.”

Honing skills used during clinical encounters and expanding understandings of the health care profession are critical components of preparing medical students for the future. Research shows that humanities training also enhances empathy, and therefore leads to better doctor-patient relationships. Eric Tran is a second-year medical student at UNC. Tran received his MFA in creative writing and continues to publish poetry and nonfiction. “Reading nonfiction and fiction broadens your experiences,” says Tran, this year’s Alan W. Cross Social Medicine Paper Award winner. “The stories of others allow you to develop empathy without experiencing the circumstances yourself.”

Tran says that UNC, more than the other schools he applied to, afforded him the opportunity to maintain interests in the humanities, and that Literature, Medicine, and Culture will give students an even broader entrance into other perspectives of medicine.

“UNC gave me the most reassurance that I could continue writing,” says Tran, who plans to use a primary care specialty to serve underserved populations. “The reason I read and write is because it is someone else’s story. I want to reach out and touch that story. When you encounter a patient, when you hold his or her story, you understand it. The tools that you learn through reading and writing – and that students will have even greater access to – can help us as we try to understand our patients’ stories.”

Finding new ways of viewing issues related to medicine can be beneficial for medical students and young physicians, particularly as the pressures of the health care system weigh on them. Physicians can learn to cope with the challenges of losing a patient they’ve treated or of navigating an increasingly chaotic health care system, thereby sustaining longer careers and preventing or mitigating burnout. Amy Weil, MD, associate professor of internal medicine, also serves on the advisory board of the new curriculum. She is co-director of The Healer’s Art and member of the national advisory board of the Gold Humanism Society.

The forces in our health care system today threaten to prevent us from having the kind of relationships with patients that allow us to feel fulfilled as physicians.

“When you enter the medical field, whether as a student or a resident, you’re often optimistic about the profession,” says Weil. “But external forces too often cause that optimism to deteriorate. The forces in our health care system today threaten to prevent us from having the kind of relationships with patients that allow us to feel fulfilled as physicians. Humanities, in combination with things like mindfulness and other activities that foster well-being, can help us remain present when we’re with our patients and prevent those outside pressures from intruding on these relationships. They can inoculate physicians against burnout and help them sustain longer and happier careers.”

Among the criticisms of the American health care system is that students and resident physicians are becoming too specialized – that the single-minded pursuit of high-tech care has created distance between the physician and the patient. The UNC School of Medicine’s Department of Social Medicine – one of a handful of such departments in the nation – has been committed to exploring the intersection between medicine and society and developing physicians who understand the social dimensions of medicine in North Carolina and around the world. A leader in advocating for broader understandings of medicine, the department has been instrumental in the launch of Literature, Medicine, and Culture.

“There’s long been dissatisfaction with American medicine that we have a health care system that is strong on technology and technique but that doesn’t always pay attention to the social dimensions of medicine and to humanities perspectives on health and illness and doctoring,” says Jonathan Oberlander, professor and vice chair of social medicine, professor of health policy and management, and Literature, Medicine, and Culture advisory board member.

Oberlander sees a movement underway in American medical schools to encourage more attention to humanities and social science perspectives on doctoring, illness, and health.

“In a sense, many schools are trying to catch up to where the UNC School of Medicine is,” says Oberlander. “We have a great footprint and we’re looking to find ways to modernize and strengthen what we have. Ideally, you want to train physicians who are not just good technically but who understand the social dimensions of medicine, who understand illness and suffering and experience and have narrative perspectives on them, who understand how sociological and anthropological perspectives illuminate what doctors go through and what patients go through. We want to send medical students out into the world and into residency who have these perspectives.”

As American medical schools begin to look at medicine from other vantages, curriculum director Terry Holt is confident that Carolina will continue to set itself apart from the rest.

“Carolina is one of the few universities in the country that has a world class medical school and an internationally renowned College of Arts and Sciences within a ten-minute walk,” says Holt. “We have resources to advance work in this field that are available in very few other places in the world.”