Central PA Medicine - February 2017 - 27

daup h i n c m s .o rg

"Medicine is of all the Arts the most noble."
Hippocrates (460 BC - 370 BC)

that this conversation would remain confidential. She reached over
and placed her hand on his shoulder. "I assure you that nothing will
happen. I just need to know the truth so that I can provide you the best
and most appropriate care."

equally with your head." The medical humanities provide opportunities
for physicians-in-training to examine the values of medical care. Through
experience and self-reflection, student doctors are transformed into
compassionate and mindful healers.

With a heavy sigh, the patient admitted that he was "shooting
up" heroin. The doctor pulled her chair a little closer to the patient.
Rather than giving him pain medications and sending him off, she
took the time to develop rapport with the patient by creating a safe
environment and by inquiring about his past experiences, current
situation, and fears. She learned about the patient's struggles with
addiction, how it cost him his marriage, and how it put a large strain
on his relationship with his 17-year-old daughter. She then asked for
permission to talk about rehabilitation, using reflective listening to
normalize the situation. By simply listening to the patient and his
story, the physician was able to extract the underlying reason for the
patient's visit to the emergency department.

REFERENCES:
1. Hawkins, Anne Hunsaker and Marilyn Chandler McEntrye. Teaching
Literature and Medicine. New York: The Modern Language Society, 2000:
3-4. (includes history and resources).

Arguably, some may lament that the current healthcare system does not
support the integration of humanities. Modern-day physicians operate
under time constraints as they are required to see more patients within
a short period of time. Every encounter and telephone conversation
needs to be documented for medical-legal reasons. There is pressure
to generate as much relative value units (RVUs) as possible for billing
purposes. With less time and more work to do for each patient, it is
often quite difficult for the physician to connect with his or her patient
beyond a superficial level.
Even so, it is clear that medical humanities are vital to achieving
high quality of care. Humanism improves healthcare because patients
remember not only the medical outcome but also how they were
treated. A study by Rakel et al showed that in 700 individuals with the
common cold, patients who gave their physicians a higher empathy
score reported a shorter duration and decreased intensity of symptoms
as compared to patients of physicians with a lower empathy score2. Lab
studies also showed that these individuals with higher-rated physicians
had higher levels of immunoprotective cells in their bodies. Likewise,
a study by Del Canale et al showed that in over 20,000 patients with
diabetes, those of physicians with higher ranked empathetic scores had
lower rates of complications due to their diabetes3. Therefore, there is
substantial evidence that empathy forms the basis of healing.
Health is the integration of physical, emotional, mental, and spiritual
states. As physicians, we heal not only with medications but also through
active listening and providing emotional support. Physicians should strive
to create a safe environment which welcomes open conversations that
can inspire positive change. Sir William Osler, a well-known Canadian
physician, famously said, "The practice of medicine is an art, not a trade;
a calling, not a business; a calling in which your heart will be exercised

2. Rakel, D., B. Barrett, Z. Zhang, T. Hoeft, B. Chewning, L. Marchand
& J. Scheder (2011) Perception of empathy in the therapeutic encounter:
effects on the common cold. Patient Educ Couns, 85, 390-7.
3. Del Canale, S., D. Z. Louis, V. Maio, X. Wang, G. Rossi, M. Hojat &
J. S. Gonnella (2012) The relationship between physician empathy and
disease complications: an empirical study of primary care physicians and
their diabetic patients in Parma, Italy. Acad Med, 87, 1243-9.

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