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11/06/2018

Docsplaining: Health Humanities Are Not the Canary in the Dangerous Coal Mine

by Craig Klugman, Ph.D.

Doc• splain (/’däk splān) verb. Informal. (of an MD) explaining (something) to someone, typically a PhD, in a manner regarded as condescending or patronizing

At the 2018 Meeting of the American Society for Bioethics & Humanities, we were treated to two excellent plenary sessions: Jonathan Metzl on gun violence and Despina Kakoudaki on Frankenstein. The third plenary was a bit of an aggravating mystery to those of us in the audience who work in the health humanities and have built careers around that field.

David Sklaris a professor emeritus of emergency medicine at the University of New Mexico and is the editor-in-chief-of Academic Medicine, the major journal about medical education. He was receptive to a host of health humanities leaders who met with him at the 2017 AAMC meeting. In the December 2017 issue of his journal, Dr. Sklar wrote about the importance of the health humanitiesin the practice of medicine and that it has a necessary place in medical education. He discussed the importance of storytelling to understand the human context in which patients live, for talking about the quality of health care delivery (cost, serving the underserved, quality improvement), addressing the physical and psychological needs of the health care provider (combatting burnout, depression, and ennui in the profession), and fostering activism.

Art by Craig Klugman

In his plenary, Using Health Humanities to Reanimate Medicine,” Dr. Sklar spoke about the “Health humanities and particularly stories—both the stories of our patients and our own stories—can provide the antidote to this malaise.” His talk covered familiar territory and then suggested that the health humanities can take care of medical error, health equity, and even reduce the cost of providing health care. The reality is that in 60 years since the term medical humanities was coined by George Sarton and in the 40 years since the first Department of Humanities was founded in a medical school, none of that has happened. The humanities are not the panacea for a broken medical system nor is it the cure for health care practitioners who have been disempowered.

Reaction to his talk was swift in the Q&A. One prominent health humanist echoed that the humanities won’t cure medicine: “The humanities are not the canary in the coal mine and can’t help when the mine is damaged.” Another humanities scholar said, “Don’t start with medicine and try to shove the humanities into it.” The message is clear: the humanities do not exist to service the MD.

Although many of us appreciate that Dr. Sklar used the term “health humanities,” he really discussed “medical humanities”—the humanities as a handmaiden to medicine. Dr. Sklar spoke as if he was Columbus discovering an “empty” land and not seeing (or ignoring) the thousands of people already living there. For the native inhabitants of this land, Dr. Sklar’s docsplainingsuggested that only when an MD talks about the humanities does it matter. When an MD talks about the value of the humanities, the world takes notice (consider Dr. Rita Charon’s recent NEH Jefferson lecture; or that only MDs have a “Dr.” prefix in the New York Timeswhile Ph.Ds. are M.). Those of us who have “just a Ph.D.” seem to not exist.

Part of the problem may be the Dunning-Kurger effect. This is a psychological phenomenon where people with little information or ability assume that they superior skills in many areas. “This overestimation occurs as a result of the fact that they don’t have enough knowledge to know they don’t have enough knowledge.” In the world of medicine and health, MDs are thought to be superior in what they know about our bodies and our lives, thus we assume they must be experts on all things. Despite efforts to teach humility to medical students, and to instill the knowledge of “when you need a consult”, this idea persists in society and is embodied in medical practitioners. Thus, we tend to believe something more when a doctor says it and we assume that doctors know a lot, even when something is outside of their area of expertise.

And that is part of the concern that the health humanities community has with ASBH and medical education. The ASBH feels like a space that became about serving MDs and ignoring the inherent value of the humanities themselves. Medical humanities seems like it has become a subspecialty of medicine. The new credentialing exam has furthered this sense of a system that looks a lot like medical credentialing and is not affordable for many. The pricing of these meetings and the certification test are closer to what one expects for medically-oriented activates instead of the humanities, where scholars make lower salaries and there are fewer activities resources. Thus, the rise of health humanities in undergraduate(“baccalaureate” to PHDsplain that term) settings and the focus on patients., families, nurses, allied health professionals,  culture, and sociopolitical systems, rather than physicians. Hopefully there will be strong connections made in the new ASBH Task Force on Health Humanities (on which I serve as a member).

At the end of his talk, Dr. Sklar pitched his book, Atlas of Men, which is a thinly veiled account of research done on boys in prep schools that required the boys to have naked pictures taken. Dr. Sklar offered free copies to anyone who would write a positive Amazon review (all four reviews on the site are 5 out of 5 stars, with one even saying she got the book at a conference and another receiving a reviewer’s copy). The book seems to be a vanity project as this is only book in the publishers’ catalog.

I invite Dr. Sklar and others who wish to learn about the real health humanities to engage with scholars in this field. There is great value in studying the humanities for learning about the human condition, for connecting to each other, and for self-fulfillment. But the humanities are not a handmaiden to medicine and they are not an easy magic bullet pill to solving the entrenched structural problems of affordability, accessibility, and availability that plague the modern practice of medicine. Reading a poem will not suddenly save docs from depression and suicide. Listening to a concerto will not reinstate meaning and conquer professional ennui. I am not saying that the humanities should not be accountable or should not be assessed like other parts of the curriculum. What I am saying is to echo the health humanist in the audience, the premise of starting with medicine and “shoving in” the humanities will not work. Both have to be seen as equal partners in the task of healing. We are waiting to talk, but please do not docsplain the value of what we do to us.

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