Internal and Emergency Medicine | 2019
Why include the humanities in medical studies? Comment
Abstract
We read with surprise and great interest the article by Boniolo et al. [1]. We are deeply in agreement with the indispensable need to include the humanities in medical studies and we applaud with admiration the Ferrara Model. In 2007, the European Consensus Document of Internal Medicine identified the essential competences of the Internist’s core curriculum. Communication skills, ethical and legal competence, organizational and educational ability were mentioned in addition to the classic medical knowledge and patient care [2]. During university education it is mandatory that the future doctors must acquire knowledge and know-how. Unfortunately, poor attention is sometimes payed, during medical studies, to the acquisition of knowing how to be, i.e. the emotional, cognitive and ethical foundations of the human relationship, the other constitutive column of the medical profession. The philosopher and sociologist Edgar Morin affirms that school teaches some knowledge, but not the nature of knowledge that carries within itself the risks of error and illusion in which we can incur continuously. Scholastic education should also teach to live and face the fundamental and global problems of the individual, of the citizen, of the human being”. This includes how to interact with the world, with other people and with yourself, how to face uncertainties, to use knowledge in a pertinent way, to understand human complexities and to recognize errors and illusions of knowledge. Morin as well underlines the importance of the humanities, and in particular of philosophy, for personal growth and error avoidance and mitigation [3]. Young doctors do not suffer from lack of notions, but rather from the inability to adequately place themselves in a new working environment, to analyze and solve problems, to effectively communicate with colleagues and patients, to manage stress and emotions. The lack of soft skills (or life skills) constitutes the gap between the educational and the professional world [4]. In the past, a wide baggage of cultural notions and logical abilities was necessary for a complete diagnostic reasoning and clinical problem-solving. Unfortunately, nowadays it is an almost out-of-business commodity. The Italian poet and philosopher Giacomo Leopardi wrote in the Zibaldone, one of his most famous literary works, that “Nature is great, reason is small”. Classical culture teaches not only the method but also skepticism; the doubt is in fact essential in an age of scientific theories too often prematurely advertised or believed in an apodictic way. We are experiencing a historical period characterized by a profoundly changing medicine. We have to daily deal with the ever-increasing complexity of our patients, both from a clinical and management point of view. The exponential rise of patients with different languages and cultures, psychiatric illnesses, pathological addiction to drugs and alcohol, challenges even more the already difficult doctor–patient relationship. Moreover, the unstoppable technological progress that keeps pushing the limit of what is possible poses every day new and unmatched ethical and deontological dilemmas. This is why we need to incorporate in our professional baggage a system of thought that can act as an ethical and philosophical guide to help us make right clinical, relational and human choices. This will be more and more important in the near future, when an holistic approach to the patient in his complexity will be essential. A model based exclusively on the disease becomes soon a model wrongly focused on the doctor. The patient desires and needs a medicine that really puts him in the spotlight, investigating his concerns and satisfying his need for information, a medicine practiced not only to cure, but also to care. Furthermore, we think that the concept of hidden curriculum is not of minor importance in the formation of a * Marco Badinella Martini [email protected]