Perspectives in Biology and Medicine

FINDING HUMANISM IN MEDICINE KIM A. EAGLE* Under the broad title of humanism in medicine, there are five areas that I would like to consider with you. These are: the "medical" club, death and dying, humor, the elderly, and "technolatry." The "medical club" is a term that I use for the settings when people involved in medicine enter the special language, procedures, and facilities of the profession. Of necessity these are instances in which heart attacks become myocardial infarctions, strokes become cerebral thrombi, and blood tests of kidney function become urea nitrogens and creatinines. These are times where quick, efficient communication and action are necessary to provide patients with quality health care. The medical club is indeed people like you and me involved with people; but the club can be destructive if we're not careful. In the midst of our medicaljargon and sophisticated tests and treatment, we can lose touch with the very patients we strive to help. Patients can become "cases," old and afraid men can become "gomers," and sometimes we ponder transition to death as just another "code 5." I have felt these feelings, and I know how easy it is to lose that caring, sensitive attitude in the midst of a busy, pressure-packed schedule. We of the profession enter the medical club to shield ourselves from the day-to-day suffering that we can see. To an extent this is essential if we are to continue to provide clear, rational decisions in patient management. But it is clear that the club separates us from the patient. He or she is unable to understand our medical terms, and often the procedures are both mystifying and frightening . If we speak in medical terms and if we always think in terms of disease pathology, we can lose touch with our patients. It is a very special gift to be able to bridge that natural gap between patient and profession. It is a gift that I urge you to strive for—one that allows you to share thoughtfully, in lay terms, your reason for ordering certain tests or This paper is based on the commencement address to the class of 1984 of the Physician Associate Program of Yale Medical School. *Cardiac Unit, Massachusetts General Hospital, Fruit Street, Boston, Massachusetts 02114.© 1985 by The University of Chicago. All rights reserved. 0031-5982/86/2901-0458$01.00 Perspectives in Biology and Medicine, 29, 1 ¦ Autumn 1985 \ 109 treatment, one that helps you carefully prepare patients for surgery, one that enables you to seekjust the appropriate level at which to deal with a dying patient. This gift allows you to work within the medical club but with that frame of mind that allows you to move from the technical and complicated aspects of care to the human aspects, thereby providing insight and alleviating fears in your patients. * * • Thanks to the human heart by which we live; Thanks to its tenderness, its joys, and fears; To me the meanest flower that blows can give Thoughts that do often lie too deep for tears. [Wordsworth, Intimations ofImmortality] If Wordsworth had finished that introduction, it surely would have concluded with "thoughts of death." Of death and dying—surely this part of our professional life is the most painful, yet it offers opportunities that can bring great consolation and meaning to our patients, their families, and ultimately to ourselves. I'm sure that one could spend several hours discussing this area and not really do itjustice, so I will try only to briefly highlight this more important topic. Charles Aring wrote, Students of medicine receive little specific instruction in the care of the dying. This likely reflects the conflicted feelings of physicians (and society) about it. Studies confirm that physicians are afraid of death in greater proportion than patients. The physician's role in caring for the dying has been defined by Feder: "I don't have any idea how to help a person to die, but I am sure we can do much to help a person live until the time of death." This living, as any life, should entail dignity, respect, and humanity. The immediate threat of dying is isolation, a condition that...