In Reply: Dr. Koepke makes valuable points: that basic science faculty’s often uninterested and even unsympathetic attitudes toward the medical humanities further complicate the already challenging task of establishing “common ground” between clinicians and humanities scholars, and that, during the initial two years of medical school, basic scientists serve as students’ primary role models. In our experience, although medical students (rightfully) respect achievement in biological science and, in this sense, “look up to” basic science faculty, most first- and second-year students see the clinical faculty whom they encounter—more now, fortunately, than in the past—as their more substantial role models. That having been said, basic science lecturers do exert substantial influence on students in terms of the attitudes and behaviors demonstrated in the classroom. This influence is compounded at schools where the basic science faculty exercise virtual control over the first two years of the curriculum, creating the perception of prestigious “insider” status. Even in so-called integrated curricula, humanities scholars do not begin to approximate this level of legitimacy. Regarding the certitude with which many of our basic science colleagues rely on the logico-scientific perspective (what they might term Truth), we agree that this stance makes meaningful intellectual exchange difficult at times. Here, the fable of the blind men feeling the elephant comes to mind. The point of that classic tale is that the sum is necessarily greater than its parts. This would seem to be especially true about the complex art and science of doctoring. No one, not scientist, not humanist, not even clinician, possesses enough “truth” to fully encompass the intricacies involved when one person tries to heal another. As Koepke astutely notes, the most pressing concern is that, in the medical education hierarchy, certain voices are prioritized over others. In the first two years of medical education, these dominant voices often belong to basic scientists. In the last two years, the clinicians hold sway, especially those from high-status specialties. The humanists, alas, remain mostly on the sidelines. When ideas, perspectives, and values can fairly compete in the intellectual and affective marketplace, we have confidence that challenges from basic science colleagues can only enrich the dialogue about how to better teach future physicians. But when humanities scholars must engage in such conversations not only within the context of a shared blindness but with a piece of tape over their mouths, then the disadvantages confronting the humanities will never be overcome. Johanna Shapiro, PhD Professor, Department of Family Medicine, and director, Program in Medical Humanities, University of California Irvine School of Medicine, Irvine, California; ([email protected]). Jack Coulehan, MD, MPH Senior fellow, Center for Medical Humanities, Compassionate Care, and Bioethics, Stony Brook University Health Sciences Center School of Medicine, Stony Brook, New York. Delese Wear, PhD Professor of behavioral sciences, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio. Martha Montello, PhD Associate professor, History and Philosophy of Medicine, University of Kansas School of Medicine, Kansas City, Kansas.
Read more
4
