Rediscovering the Heart, Soul, and Art of Practicing Medicine

“In other words, a doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist; he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist. “The doctor, like a politician, who loves other men only in the abstract or regards them simply as a source of income can, however clever, do nothing but harm.” —W.H. Auden (1907-1973), British-American poet, Pulitzer Prize winner, and physician's son; from “A Certain World: A Commonplace Book” (1970), under his entry for Medicine (asamonitor.pub/3YvKhMR). ∗∗∗ This month's issue of our Monitor has a new column called “My Medical Muse” (see page 30). This column uses various forms of creative writing and visual art to explore and to experience medicine, health, and illness from the point of view of the patient, the clinician, or both.Image created by Microsoft Copilot®. Prompt used: “Create a watercolor image of a doctor rediscovering the heart, soul, and art of practicing medicine.”In recognition of Dr. Audrey Shafer's formative and sustaining contributions to the medical humanities – and in gratitude for her being a wise and trusted compatriot – we launch this new column with a poem by Dr. Shafer. ∗∗∗ Fresh out of fellowship, I joined a pediatric anesthesia private practice in my hometown of Akron, Ohio, once known as the “Rubber Capital of the World.” One day, a sharp-tongued pediatric nephrologist said, “You anesthesiologists are the blue-collar workers of medicine!” I responded, “Maybe, but we've got a great union contract and a tough union steward – and you're just jealous because I make twice as much money as you do!” Back then, I was brash and full of chutzpah. Seriously though, I doubt any of us went into medicine or chose anesthesiology simply to make a lot of money. For me, it was my idolized childhood pediatrician, along with my hunger for some socioeconomic stability after my disrupted upbringing in the Midwest Rust Belt of the 1970s. Call me a “master of the obvious,” but health care in the United States is a big business. In 2023, the U.S. health care industry amounted to $4.9 trillion and represented 17.6% of the nation's gross domestic product (GDP), with large spending across sectors like hospitals, physician and clinical services, and prescription drugs. Employing over 17 million people, or 10.8% of its total labor force, health care is the largest employer in the U.S. (asamonitor.pub/44Xqk5m; asamonitor.pub/49C0zZU). I am apt to say, “Health care is first and foremost a business, and if you lose track of that fact, you will quickly be out of business; but the practice of medicine is still based on human relationships, with your patients, their families, and your colleagues.” So, how can each of us rediscover and sustain the heart, soul, and art of practicing medicine? Unlike in the then-mind-bending “Walt Disney's Wonderful World of Color” television series of the 1960s, there is no fantastical Tinker Bell who can wave her magic wand and sprinkle us with pixie dust. I believe the medical humanities are an antidote for us to reclaim our lost essence as doctors and healers. The medical humanities use literature, visual arts, music, theater, and dance to understand illness and to promote health and well-being among both patients and clinicians. The medical humanities can break down the multicultural barriers in clinical practice, promote interdisciplinary teaching and research, and foster patient-centered care (asamonitor.pub/4qdLkgN). When considering the medical humanities, a frequent picture paints two opposing sides – the biomedical versus the humanistic. This conflict too easily turns into stereotypes: biomedicine being rigorous and more valid but cold and unfeeling versus the humanities being warm-hearted and well-intentioned but unscientific and less credible (Med J Aust 2005;182:5-8). If both sides are instead united into a common approach, it can deepen our understanding of human illness, health, and well-being by considering various perspectives: biomedical, literary, artistic, ethical, philosophical, historical, anthropological, and sociological (J Med Educ Curric Dev 2023;27:23821205231203487). This holistic approach results in a more comprehensive view of the patient, the clinician, and health care, as well as an enhanced capacity “to cure sometimes, to relieve often, to comfort always” (Med J Aust 2005;182:5-8). But the medical humanities are more than an academic pursuit and fodder for intellectual discourse – the magic potion of the medical humanities is meant to be experienced firsthand, up close and personal. Write. Photograph. Draw. Paint. Sculpt. Sing. Play. Dance. Act. Whatever comes naturally to you! Danielle Ofri, MD, PhD, is a primary care internist at Bellevue Hospital and a clinical professor of medicine (with a PhD in pharmacology) at the New York University Grossman School of Medicine. She is also an accomplished nonfiction writer (asamonitor.pub/4aQWXFy). Dr. Ofri speaks to me when she observes about an early inflection point in her career journey: “Somehow, I would have to shape my medical life so that it would encompass the arts and the humanities. This was a radical departure not only from my colleagues, but also from my academic career thus far. I'd been on the straight and narrow scientific path ever since I'd wanted to be [a doctor] in elementary school. I could never have imagined that the squishy arts might occupy a front row seat next [to] the hard sciences. But then again, I didn't plan this path; it just unfurled itself this way” (asamonitor.pub/4aQWZxa). This same “radical departure” occurred in my life – for me, better late than never. Maybe you choose instead to pivot slightly? ∗∗∗ Returning to W.H. Auden's quotes in the previous epigraph... What is a commonplace book? (asamonitor.pub/4pwe0Aj). According to Google AI Overviews: “A commonplace book is a personal notebook used to compile and organize information like quotes, anecdotes, observations, and facts for future reference and inspiration. Unlike a diary that records daily events, a commonplace book is a repository for useful wisdom and insights gathered from various sources, such as books, conversations, or media, and is used to reflect on and synthesize ideas. Keeping one can help focus thoughts, spark creativity, and develop a deeper understanding of a subject over time.”Image created by Microsoft Copilot®. Prompt used: “Create a playful, vintage image of A COMMONPLACE BOOK with doodles, quotes and notes.”Keeping your own commonplace book may be a good way for you to sample and savor the medical humanities – and to revive the heart and soul and art of medicine still within you (asamonitor.pub/4q9TvdL).Thomas R. Vetter, MD, MPH, MFA, ASA Monitor Editor-in-Chief, Professor, and Division Chief of Anesthesia and Perioperative Medicine, Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, Texas.