What is the most important characteristic a medical student should have?
Intelligence? Empathy? Time management?
I recently came across an article by Dr. Faith T. Fitzgerald, former dean of students at the University of California, Davis, School of Medicine, that pitches a different idea:
Dr. Fitzgerald wrote her insightful piece in response to a request from politicians that more humanities coursework be added to the medical school curriculum. The idea was to help medical students became more humane.
But the dean was skeptical. “I wondered what evidence supported the idea that being well versed in the humanities made one more humane,” she wrote.
So she did a study. She and her colleagues read reviews of third and fourth year medical students in their clinical clerkships, written by supervising physicians. They noted words that suggested humane behavior, such as “caring” and “warm.” They then looked to see if there was any connection between positive descriptors and coursework taken prior to medical school.
Surprisingly, there was. Medical students viewed as more humane took on more coursework in college – but not just in the humanities. The more classes students took, period – in the humanities or in the sciences – the nicer they were described.
But why? What does taking a lot of classes have to do with being compassionate?
According to Dr. Fitzgerald, there is a single trait underlying both the desire to learn in the classroom and to be empathetic on the wards. She writes:
“What is kindness, as perceived by patients? Perhaps it is curiosity: ‘How are you? Who are you? How can I help you? Tell me more. Isn’t that interesting?’ And patients say, ‘He asked me a lot of questions’; ‘She really seemed to care about what was going on with me.’”
That is, the same inquisitiveness that fuels students to seek knowledge in the classroom also propels them to find out more about their patients. And seeking to find out more comes across as a display of compassion.
There are many gems in Dr. Fitzgerald’s argument. One is that it calls into question the unfair yet enduring stereotype of the cold, distant doctor (or medical student), who objectifies patients as intriguing problems to be solved instead of fellow human beings to be empathized with.
This stereotype is not unique to doctors. Scientists not in the medical profession may be even easier targets. I’ve always found odd the idea that an interest in science somehow suggests a person is emotionally detached. That it is impossible to harbor, in the same body, the ability to think through scientific problems and to care deeply about others. That students who choose to study the humanities do so with a moral advantage.
It does not make much sense to me that engaging with Nabokov instead of glycolysis makes a person more likely to donate to charity.
Speak with students passionate about the sciences and those passionate about the humanities, and you’ll find they are often motivated by similar desires. They summon similar concepts to explain their interest. Both want – that is, are curious – to understand some aspect of the world around them. To do so, they learn a language specific to their field and immerse themselves in it until they begin to discern patterns. The only difference is whether these patterns are in physical phenomena, or in the human experience.
A second gem from Dr. Fitzgerald’s article is the message of how to actually go about exhibiting curiosity. Watching talks given by Nobel Prize winning scientists for inspiration, she noticed similarities in their ways of thinking. They all seemed to toss around ideas with no pretense of linear thought, no semblance of structure, and, perhaps most importantly – no pretense of competence.
“The scientists seemed oblivious to intellectual constraints and unconcerned about being seen as naive or unknowledgeable.”
Dr. Fitzgerald hits upon something here that I have found particularly relevant in medical school. It is much more difficult to obtain knowledge, much less to propose something innovative, if you are preoccupied with proving yourself. In order to discover a good idea, you need the luxury to experiment with bad ones. To put forward incorrect hypotheses, explore false leads, and work through ideas without any particular end goal – or any guarantee you will uncover something at all.
The pass/fail system during the first two years of many medical schools is a good first step in cultivating a non-pressured, curious environment. Especially at this early stage of training, we should be more concerned with gaining knowledge than with showing off that we’ve got it. Don’t understand something? Ask questions. I try not to let a fear of sounding “dumb” overwhelm an opportunity to learn.
“Rather than stating that the study of humanities makes one humane, I propose that humane people are curious and therefore choose to explore the humanities as well as the sciences."
I am a bit late (now twelve years since her article was published) in lauding Dr. Fitzgerald for so elegantly pointing out a quality essential to many aspects of medicine. It is time we recognize that the sciences and humanities are complementary, not conflicting, and that it is counterproductive to construct arbitrary walls between them. Lopsided intelligence is not in vogue. Scientists can write compelling arguments, and humanists can solve puzzles. Viewing the world from diverse angles should be encouraged as a way of understanding it in a more complex, more meaningful way.
“Truly curious people go beyond science into art, history, literature, and language as part of the practice of medicine. Both the science and the art of medicine are advanced by curiosity.”
I am inspired by the idea that we can point to a single underlying trait that makes one more likely to keep up to date in the medical literature; to understand the biochemistry of a patient’s reaction to a drug; to propose improvements in health care systems; and to simply ask a patient: “how are you feeling today?”
(From the archives: this post was originally published on December 5, 2011, on Unofficial Prognosis’ former website.)