Robert Marshall

Teaching and learning pathology: a critical review of the English literature

Aim  There are few publications summarising the main issues concerning pathology teaching and learning within undergraduate medical degrees. This article examines the themes that have emerged from the literature over the last 2 decades.

Making sense of clinical reasoning: judgement and the evidence of the senses

Background  Close noticing, as keen discrimination and judgement between qualities, is a key capability for work in visual domains in medicine. This generic capability is normally assumed, and its specifics are left to develop through experience, as traditional apprenticeship in a specialty. Discrimination is an outcome of learning in the affective domain, and introduces a vital aesthetic dimension to clinical work that aligns with the interests of the medical humanities. An aesthetic approach to clinical reasoning, however, remains largely unexplored as an explicit focus for medical education.

Can the science of communication inform the art of the medical humanities

CONTEXT  There is increasing interest in establishing the medical humanities as core integrated provision in undergraduate medicine curricula, but sceptics point to the lack of evidence for their impact upon patient care. Further, the medical humanities culture has often failed to provide a convincing theoretical rationale for the inclusion of the arts and humanities in medical education.

Learning how to see: doctors making judgements in the visual domain

Initial results are presented from an ongoing, work‐based collaborative inquiry between three medical consultants (a pathologist, a radiologist and a dermatologist) and three experienced visual artists into processes of clinical and aesthetic judgements in the visual domain. The doctors’ habitual conventions are challenged through the interventions of the artists, leading to a re‐education of the senses through a revitalised clinical imagination. Outcomes include self‐assessed improvement of clinical acumen through systematic review of the clinical reasoning process looking specifically at the aesthetic dimension. A central research interest is how forms and styles of judgement construct identities of the expert practitioner in work settings. The papers describes a change in practice from “looking” to “seeing” as the development of a “connoisseurship” of informational images informed by tolerance of ambiguity, creating a practice identity against the grain of the normative technical‐rational discourse of clinical reasoning.

The death of Hector: pity in Homer, empathy in medical education

Empathy is thought a desirable quality in doctors as a key component of communication skills and professionalism. It is therefore thought desirable to teach it to medical students. Yet empathy is a quality whose essence is difficult to capture but easy to enact. We problematise empathy in an era where empathy has been literalised and instrumentalised, including its measurement. Even if we could agree a universally acceptable definition of empathy, engendering it in the student requires a more subtle approach than seems the case currently. We therefore examine this modern concept and compare it with others such as pity and compassion, using the medium of Homer’s Iliad. Two famous scenes from the Iliad elicit pity in the characters and the audience. Pity and compassion are, however, given a complexity within the narrative that often seems lacking in modern ways of conceptualising and teaching empathy.

Lost in translation. Homer in English; the patient's story in medicine

In a series of previous articles, we have considered how we might reconceptualise central themes in medicine and medical education through ‘thinking with Homer’. This has involved using textual approaches, scenes and characters from the Iliad and Odyssey for rethinking what is a ‘communication skill’, and what do we mean by ‘empathy’ in medical practice; in what sense is medical practice formulaic, like a Homeric ‘song’; and what is lyrical about medical practice. Our approach is not to historicise medicine and medical education, but to use thinking with Homer as a medium and metaphor for questioning the habitual and the taken-for-granted in contemporary practice. In this article, we tackle the complex theme of ‘translation’. We use the lens of translation studies to examine the process of turning the patients story into medical language. We address the questions: what makes a ‘good’ translation? What are the consequences of mistranslation and poor translation? And, while things are inevitably lost in translation, does this matter?

Putting it bluntly: communication skills in the Iliad.

In current undergraduate medical curricula, much emphasis is placed on learning the skills of communication. This paper looks at Homer’s Iliad and argues that from it we may learn that our skills can be mechanistic, shallow and simplistic. Homer was regarded in the Greek and Roman world as the father of rhetoric. This reputation rested greatly on book 9 of the Iliad, the embassy from the Greek leaders to the bitter, wrathful Achilles. The mission of the three emissaries is to persuade him to return to the ranks of the Greeks, who are being routed since his refusal to fight. We learn how the outcome of a conversation may be predetermined by the previous relationship of the speakers, and how a man beyond reason responds to reason; we should reflect that Homer’s audience heard the piece knowing the outcome, giving it a tragic inevitability. We, the audience, cannot analyse the discourse rationally, because in this, as in all communication, reason is disturbed by emotion.

Sing, Muse: songs in Homer and in hospital

This paper progresses the original argument of Richard Ratzan that formal presentation of the medical case history follows a Homeric oral-formulaic tradition. The everyday work routines of doctors involve a ritual poetics, where the language of recounting the patients ‘history’ offers an explicitly aesthetic enactment or performance that can be appreciated and given meaning within the historical tradition of Homeric oral poetry and the modernist aesthetic of Minimalism. This ritual poetics shows a reliance on traditional word usages that crucially act as tools for memorisation and performance and can be linked to forms of clinical reasoning; both contain a tension between the oral and the written record, questioning the priority of the latter; and the performance of both helps to create the Janus-faced identity of the doctor as a ‘performance artist’ or ‘medical bard’ in identifying with medical culture and maintaining a positive difference from the patient as audience, offering a valid form of patient-centredness.