HUMANITAS Readings in the Development of the Medical Humanities Perspectives in Medical Humanities Perspectives in Medical Humanities publishes scholarship produced or reviewed under the auspices of the University of California Medical Humanities Consortium, a multi-campus collaborative of faculty, students and trainees in the humanities, medicine, and health sciences. Our series invites scholars from the humanities and health care professions to share narra- tives and analysis on health, healing, and the contexts of our beliefs and practices that impact biomedical inquiry. General Editor Brian Dolan, PhD, Professor of Social Medicine and Medical Humanities, University of California, San Francisco (UCSF) Recent Titles Health Citizenship: Essays in Social Medicine and Biomedical Politics By Dorothy Porter (Winter 2012) What to Read on Love, Not Sex: Freud, Fiction, and the Articulation of Truth in Modern Psychological Science By Edison Miyawaki, MD, Foreword by Harold Bloom (Fall 2012) Patient Poets: Illness from Inside Out Marilyn Chandler McEntyre (Fall 2012) (Pedagogy in Medical Humanities series) Bioethics and Medical Issues in Literature Mahala Yates Stripling (Fall 2013) (Pedagogy in Medical Humanities series) Heart Murmurs: What Patients Teach their Doctors Edited by Sharon Dobie, MD (Fall 2014) www.UCMedicalHumanitiesPress.com [email protected] This series is made possible by the generous support of the Dean of the School of Medicine at UCSF, the Center for Humanities and Health Sciences at UCSF, and a University of California Research Initiative, Grant ID 141374. HUMANITAS Readings in the Development of the Medical Humanities Edited by Brian Dolan First published in 2015 by the University of California Medical Humanities Press UCMedicalHumanitiesPress.com © 2015 University of California Medical Humanities Consortium 3333 California Street, Suite 485 San Francisco, CA 94143-0850 Designed by Virtuoso Press Cover photo courtesy of the Wellcome Library, London. Colour photograph showing an anatomical model advertising a pharmacy in Delhi, India. The model is behind glass and surrounded with bottles. The pharmacist’s name, Kaviraj A N Roy, BSc, MASFRMP, is written on a label at the top left of the glass case. A man, the pharmacist, sits reading a book. Library of Congress Control Number: 2015937544 ISBN: 978-0-9889865-7-2 (Print) ISBN: 978-0-9963242-0-5 (ePub) Printed in USA “Not many students today perceive the value of a rigorous education in the cognitive elements of traditional humanism. Some will perceive them later in life, when medicine itself becomes so routinized as to verge on boredom.” —Edmund D. Pellegrino, MD This book is dedicated to all the students who desire to pursue humanitas – education in humanism – to broaden their perspectives on the art and science of healthcare. Contents Preface & Acknowledgments vii 1 One Hundred Years of Medical Humanities: A Thematic Overview Brian Dolan 1 2 The Importance of the Study of the History of Medicine (1904) Eugene Cordell 31 3 Imagination and Idealism in the Medical Sciences (1910) Christian A. Herter 47 4 The Role of Medical History in Medical Education (1947) Erwin H. Ackerknecht 70 5 The Humanities in Medicine (1958) Henry Borsook 82 6 The Medical Curriculum and Human Values (Part I) (1969) Casey Truett, Athur Douville, Bruce Fagel, Merle Cunningham 105 7 Human Values and Curriculum Design (Part II) (1969) Edwin F. Rosinski 118 8 Human Values and the Medical Curriculum: An Educator’s Response (Part III) (1969) Edmund D. Pellegrino 124 9 Reflections, Refractions, and Prospectives (1972) Institute on Human Values in Medicine 134 10 Educating the Humanist Physician: An Ancient Ideal Reconsidered (1974) Edmund Pellegrino 148 11 Teaching in Literature and Medicine: An Overview and Commentary (1987) Suzanne Poirier 167 12 See Me, Hear Me: Using Film in Health-Care Classes (1995) Lester D. Friedman 178 13 Narrative, Literature, and the Clinical Exercise of Practical Reason (1996) Kathryn Montgomery Hunter 187 14 Narrative Medicine A Model for Empathy, Reflection, Profession, and Trust (2001) Rita Charon 207 15 The Physician as Storyteller (2001) Abraham Verghese 224 16 Today’s Professionalism: Engaging the Mind but not the Heart (2005) Jack Coulehan 236 17 Imagination Takes the Stage: Readers’ Theater in a Medical Context (2006) Gretchen A. Case and Guy Micco 256 18 Medical Humanities and their Discontents: Definitions, Critiques, and Implications (2009) Johanna Shapiro, Jack Coulehan, Delese Wear, Martha Montello 268 19 What Disability Studies Has to Offer Medical Education (2011) G. Thomas Couser 290 20 The Arts and Medicine: A Challenging Relationship (2011) Paul Ulhas Macneill 306 Index 334 Preface & Acknowledgments umanities-based instruction in medical training has a long history. HSpanning more than a hundred years of medical education in the United States, a science-driven and clinical-skills oriented curriculum has been integrated with subjects that draw on broader cultural and philosophical perspectives for critical reflection on medical practice. Concerns over the essentials of a well-rounded medical curriculum have yielded enormous amounts of published commentaries, critiques, and recommendations. Along the way, educators have developed new subjects and disciplines of use to future health professionals, have added strength to the concept of a “field” of medical humanities, and have diversified its curricular presence. The articles reproduced here, which span the period from the early 1900s to 2011, provide a one-stop introductory guide to the major developments in the history of this field. These selections, it is hoped, portray the historical depth and range of articulations, even to those familiar with the medical humanities who have followed recent debates about its uses and outcomes in professional education. From the purported gaps in prerequisite training in the years preceding the Flexner report, to the “moral challenges” of the 1950s and 1960s, to concern over professionalism and communication skills in the 1990s and 2000s, the evolving relationship between the humanities and medicine is a history of reflection on the philosophy of education and the conduct of medical practice. Overall, these articles reveal that humanities subjects in medical education respond not only to alleged problems or lacunae in medical training (whether that is being too technological or disease-centered), but to the changing social context that impacts the form and practice of medicine. Yet despite a history of strategies to bring holism to the education of healthcare professionals, there remain common and persistent challenges to the endeavor that go far back in time. An historical perspective is therefore useful to anyone teaching medical humanities or developing courses within this area. I started teaching the medical humanities in 2004, soon after it was created as an “Area of Concentration” for fourth-year medical student research projects at the University of California, San Francisco. Dividing my time between teaching graduate courses for PhD students in the history of x Humanitas: Readings in the Development of the Medical Humanities medicine program and teaching medical students, I struggled at the beginning to find the right balance in the level of scholarship assigned for discussion and measured my expectations of what could be accomplished over the course of one elective term. In the five years I directed that program before it was discontinued by a major curricular reform at the school, my colleagues and I felt that we had finally succeeded in engaging a multi-disciplinary humanities curriculum with medical knowledge and healthcare. The projects the students produced were informative, creative, and often extremely meaningful. Throughout that time, however, when I was educating myself about all the different approaches that encompass the medical humanities – narrative medicine, literature in/and medicine, readers’ theater, and so on – I was tasked with answering regular questions from curricular organizers and committee members about why the medical humanities were important to medical educa- tion. These are questions that almost everyone teaching medical humanities in medical schools needs to answer, repeatedly. Perhaps I would have been better prepared with these answers, better equipped to develop courses using diverse approaches, had I known the history of others’ attempts and rationales for do- ing the same. As an historian of science and medicine by training, my instinct has been to comb the literature, looking further and further back, for insights as to how this all came about. Going back to the beginning of the twentieth century, the emphasis here is on historical, primary readings that address the philosophy of medical humanities and the challenge of integration into medi- cal education. It will be easy to criticize all that has been omitted from this volume – particularly among the selections of more recent decades, when the amount of literature expands exponentially. The limitations of copyright permissions and occasional denials of requests to reproduce meant that some important pieces do not appear here, though I refer to some of these in the thematic introduction to the volume. I would like to make special note of a few titles that should be acknowledged as important sources of information on the state of the art of medical humanities. The Journal of Medical Humanities is the first. The history of this journal itself provides interesting