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ART AND
or transformation, in other words, prompts that elicit our human
response to the privilege and challenges of caring for our fellows in
moments of great joy, pain, loss or distress. These are moments we
experience every day. Rarely do we process them. They accumulate
in ways that weigh us down. A six-word story costs so little effort to
write. And yet, it can lighten the existential load we bear when we
share the story with peers.
In the Project 6-55 workshop, participants are timed: they have
to write as many six word stories as they can come up with in exactly
five minutes. Next, participants select the most evocative set of six
words, and are given exactly 15 minutes to expand the story to 55
words. For the timid, those who regard a blank piece of paper with
as much dread as if it were a 14,000-foot peak to be conquered, a
digestible prescription is offered. Sig: take 10 words per line, times
5 lines on your paper, and 1 more line with just 5 words. Disp: #
55 words. Writers are coached to focus on clarity and simplicity of
expression. They learn to dispense with adjectives and hue to the
core of what they most desire to communicate.
As a workshop leader, I relish the intensity in the room as a chorus
of pencils fervently scratches sheets of paper, punctuated by frantic
erasing under pressure of the stopwatch. There is something magical
about the 15 minute time constraint. It relieves anxiety about a po-
tentially limitless amorphous task (after all, one can only bear to
probe the meaning of one’s existence by knowing the scrutiny will
end very soon), and it forces one to shed all frills, layers of ego and “Poverty, Health and Disease,” elicit student responses that suggest
self-indulgence in the interest of getting the gist across with a pow-
erful economy of words. What emerges is something crystallized and
pure. The writer often does not realize what is bubbling up from
their subconscious through their choice and juxtaposition of words.
Only by sharing the expression with peers does insight emerge
through discussion and feedback. Every 6-55 workshop I’ve at-
tended has elicited some form of wonder, frequently accompanied
by laughter or tears, as healers recognize and affirm one another for
the humanity in their responses to role of healer.
So, too, the other disciplines within medical humanities pull from
us expressions of our humane-ness, enhancing our cognitive empa-
thy, which is nothing more complicated than our capacity to imag-
ine the experience of the Other. At the Center for Medical
Humanities & Ethics, we offer elective courses in four areas: Com-
munity Service Learning, Global Health, Literature and Art, Ethics
and Professionalism. These four seemingly disparate areas are linked
together in their common purpose, offering a means through which
to teach ethics and professionalism while nurturing empathy and
humanitarian values. One cannot accompany a patient through a
fraught ethical dilemma without understanding the full context of
their illness as well as their prognosis and medical options.
The information you need to help make correct therapeutic de-
cisions must come from context, which is to say, the story the patient
MEDICINE
has to tell. But one can only get that context by eliciting the story
and listening in a way that leads to insight, and mutual trust. One
must understand how your physician perspective differs from that
of your patient. One must understand how patients perceive and
understand their disease in order to be credible enough to coach
them back to health. Patients perceive a lack of empathy in their
computer-screen fixated physicians and become dissatisfied with
care, more likely to sue and less likely to adhere to treatment regi-
mens. Hemoglobin A1cs and LDLs don’t reach their goal, and the
doctor lashes out with “medical non-compliance” in the problem
list. The literature is rife with studies proving that patients value a
doctor who cares about them. Medical humanities courses teach all
this in an experiential manner; all involve learning through reflection
and active doing of some kind; all are designed to nurture empathy
and to see reality through another’s perspective.
How, you may ask, do medical humanities courses relate to the
mission of medical education? Is there value and relevance to health
care for this kind of teaching? The answers to these questions are
tough to find and impossible to quantify, but I refer to narrative
evaluations of courses like our “Art Rounds” elective for medical and
nursing students at the McNay Art Museum, or “Patient Notes,”
exploring music and medicine, or “Medicine through Literature”
where students read physician-writers like Abraham Verghese, Anton
Chekov and Victoria Sweet, as well as works by blind poets and ex-
Marines. All our courses, from “Foundations in Global Health” to
transformation, the introduction of new ways of seeing the Other,
of understanding the role of the physician in the world, and the
value to the world of being a compassionate physician.
A decade of student narratives and letters from former graduates
consistently attest that experiential learning in the medical human-
ities is truly “preparing tomorrow’s healers to ACT, with compassion
and justice.” For physicians well into their careers and battling
burnout, student attestations remind us of the joy in connecting.
Connecting to humanity through the arts and to our core healing
purpose through the stories of our patients — this is the ultimate
answer to burnout.
Dr. Ruth Berggren directs the Center for Medical Hu-
manities & Ethics at UT Health San Antonio. In this role,
she teaches ethics and professionalism while nurturing em-
pathy and humanitarian values. Dr. Berggren is the Mar-
vin Forland, M.D., Distinguished Professor in Medical Ethics, and she
holds the James J. Young Chair for Excellence in Medical Education.
Dr. Berggren is board-certified in both internal medicine and infectious
diseases with significant experience and particular interest in clinical
AIDS and viral hepatitis research, as well as in implementing HIV care
in resource-poor settings.
visit us at www.bcms.org 33