HEALTH CARE * LES SOINS

lalhousi,e conference focuses on nonscientific side of medicine

Deborah Jones

It was a brutally moving poetry reading. Tears streamed down the faces of physicians and medical students as poet Susan Kerslake read poem after poem about dead and dying children, offering observations about "dead kids" in uncompromisingly plain language. A poetry reading may seem an unusual highlight for a medical meeting, but the focus of this Halifax conference, sponsored by Dalhousie University's Faculty of Medicine, was medicine and the humanities. A running theme was that physicians had to consider life as something more than individual medical problems, and this may have accounted for the audience's response to the poetry. When Kerslake, a gentle, softspoken woman, stood behind the podium, the 300 listeners were openly receptive to her powerful descriptions of the way children die at a Halifax hospital. Dr. Jock Murray, dean of medicine at Dalhousie, was delighted by Kerslake's presentation, tears and all. "You get a different understanding of patients and their suffering and what they are Deborah Jones is a freelance writer living in Halifax, NS. 1046

CAN MED ASSOC J 1991; 144 (8)

"The humanities give us a view of humanity that is important in the understanding of what medicine is and what medicine should be."

Dr. Jock Murray

feeling," he explained. "If we don't see that, how are we to care for them best? We may say the wrong thing because we have no idea of what's really going on in their minds." Murray, who has a earned a reputation as a Renaissance man because of his personal interest in the humanities and for engineering sweeping changes at his school, would like to turn physicians' traditional attitudes upside down. He thinks they have isolat-

ed themselves from the society serve and this has affected their ability to express emotions and provide care. The conference, which included presentations about writing, ethics, history and music, was a major success, attracting twice the audience organizers had predicted. Murray said it was designed to broaden physicians' and students' views about what medicine entails. "The humanities give us a

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view of humanity that is important in the understanding of what medicine is and what medicine should be," he said. ". . . The view of medicine cannot be the traditional one of our basic science departments and our hospitals where we teach on the wards. Our view of medicine must [take us] into the community. The community can be as wide as the planet, or it can be the (immediate] community. Out there are abused women, there are homeless, there are problems of pollution, there are problems of illiteracy. They are all health issues. "It is not the doctors who will treat all of that. But we have to look at [health care] in a broader context of the community's needs as well as the patient's needs and then we'd better determine how our role fits in that." Sister Nuala Kenny, MD, thinks it is more difficult being a physician today than in the past. "We're everything for a modem people - the grandmothers, the priests, the rabbis of another time," she said during the keynote address that opened the 2-day conference. "People want you to be a Nobel Prize winner and Marcus Welby, all at the same time." An animated speaker, she drew nervous laughs when she mentioned the practice of bloodletting. Today's physicians should not feel smug about such ancient practices, she warned. "Can you imagine how they're going to be laughing at us in 20 years?" said Kenny, Dalhousie's head of pediatrics. "It keeps you humble." Despite the demands of their profession, she said, physicians must reflect on their role and they must not let the marvels of technology obscure another important medical tool - their compassion. Dr. Eric Cassell also reflected on technology and how it has changed since he graduated from medical school in 1954. "I thought there wouldn't be anything left to do," he said wryly. APRIL 15, 1991

He thinks future generations will see the 20th century as an "interesting byway" in which people accepted the idea that technology could solve the world's ills. Cassell, an American physician recognized for his work in the medical-ethics field, thinks Dalhousie's commitment to melding the humanities with medicine is unusual for a North American medical school and he applauded organizers for holding a conference dedicated to the subject. Although they were told repeatedly about medicine's failings, medical students who attended the conference seemed pleased with the content. Brian Davidson, a second-year student, said he is pleased with Dalhousie's emphasis on the humanities. "I had heard horror stories about going into medical school intending to do good, and coming out the other end as a brain-dead robot," hesaid. Murray has no doubts that medicine has to allow the humanities to play a larger role in training new doctors. "They were always a part of medicine in the past but at one point medicine became a science," he said. He thinks the major change occurred late in the 19th century "when the concept of science gave the promise that the 4000 years of medicine as a caring profession could be replaced by medicine of the sciences. Science would cure now. We didn't need the shamans, the caregivers. What we needed were the scientists who would find the vaccines, the drugs, the new surgeries. And that would replace the care-giving aspects of medicine." Fortunately or unfortunately, physicians are beginning to realize that science, despite all the advances it is responsible for, also has drawbacks. Murray, for instance, specializes in treating neurologic disorders that are, at least for now, incurable. "If my view of medicine is that it is to cure, this is a pretty depressing [area for me

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Church service helps students deal with dissection A church service will be held in Halifax this spring to lay to rest 50 people who donated their bodies to the Dalhousie University medical school. The annual service, which will attract medical students, faculty members and donors' families, draws up to 300 mourners. Although it honours donors who have helped advance medical knowledge by donating their bodies, it was originally designed to help medical students cope with dissection. Professor June Penney said that the cadaver assigned during first-year anatomy classes will be the first confrontation with death for many students; she said studies have revealed that 80% of them have difficulty dealing with the experience. "They meet the cadaver the first week they arrive," she said during a recent conference at Dalhousie. "It's always the thing they're concerned about, especially so if somebody has had a death in the family. If they know someone who died in Nova Scotia and donated their body they're always worried that it might appear." Up to 10 years ago students were sent into the dissection laboratory without being prepared for this face-to-face encounter with death. Dalhousie began holding orientation sessions in order to allow students to see and touch a cadaver before working on one and then memorial services were added at the end of each academic year. to concentrate on] because I can't cure any of those people," he said. "So what do I do? I give them information, explanation, reassurance, support, be there when they get an attack. I talk to children 1048

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"It seems to have made a tremendous difference in the way they approach anatomy," Penney told CMAJ. "We have far less horsing around and joking around in the dissecting room now. Once we had done that, students came and said, 'Teach us more about death. We don't get anything about that to help us when we're dealing with dying patients.' " Dalhousie already had a committee dealing with palliative care issues, so it organized a conference dealing with teaching about death and dying, and eventually introduced courses on palliative care. When Dalhousie started these programs, it did not realize they would eventually open the door to student-support services that have put Dalhousie on the map for taking a new approach to the teaching of medicine. Most of the innovations were suggested by students and are driven by need and the university's philosophy that treating students in a humane way will produce well-rounded, humane physicians. Special support is needed because medical students lose many things others take for granted, Penney told the conference on medicine and the humanities. Leisure time disappears, friendships and social lives suffer, and students are subject to fatigue. Their selfconfidence is also threatened, as most find themselves, for the

about the issue of dealing with parents becoming disabled. I have to understand people, what they're about, what their house is like, whether the kids are in trouble, whether there's a problem

first time, beat out for top spot in the class. The ultimate results of the stressful training are well known - high rates of marriage breakdown and of addiction to alcohol or other drugs. These problems aren't new, but the approach Dalhousie and some other schools are taking is. At students' request the university began a counselling program for medical students that includes discussion of topics ranging from how to manage marriages and money to the recent Persian Gulf war. Oneon-one confidential counselling is available for students with any kind of problem or for those with failing grades. There is also a program for students with drug- or alcohol-related problems. The best example of Dalhousie's changing approach to its students and medicine in general are the services to honour donors. Penney thinks they have changed attitudes towards cadavers, both within the medical school and outside of it. "It is incredibly supportive for the relatives," she said. "Most of them have never held any kind of memorial service, they wait for this one. Not all relatives support the donation but they seem to derive a great deal of comfort from the service. It also allows students to participate in the grieving process. "These people have given a gift to medical science. So it's really a thanksgiving service for their gift." with their spouse drinking too much." In other words, said Murray, he does everything but isolate himself from his patients and their problems. D LE 15 AVRIL 1991

Dalhousie conference focuses on nonscientific side of medicine.

HEALTH CARE * LES SOINS lalhousi,e conference focuses on nonscientific side of medicine Deborah Jones It was a brutally moving poetry reading. Tear...
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