Does an appreciation of the arts make for a better doctor, or should prospective medical students stick to science? Nigel Glass reports.
Awaiting minor heart surgery, Ann became so "fragile emotionally" that her doctor, Clive, unable to find what was wrong, considered cancelling the operation. Then he recalled that Ann always wore low-cut dresses and the penny dropped - she believed, mistakenly, that the operation would leave her cleavage scarred for life. "The term is emotional intelligence, and I don't know how much I possess, but I want more," Clive says.
Many modern medical educators say Clive and his colleagues can best achieve this by studying the humanities. "It will help them to empathise and deal sensitively with patients and their families when they are often at their most vulnerable and in need of understanding," says Sir George Alberti, president of the Royal College of Physicians. The college recently published Medical Humanities , from which the story of Ann and Clive is taken.
Three years ago, a conference sponsored by the Nuffield Trust called for medical students to be recruited from more liberal educational backgrounds and for the medical curriculum to incorporate the humanities. There is support from some powerful figures in the medical establishment and the first chair in medicine and the arts in the United Kingdom is about to be established at King's College, London, with a grant from the D'Oyly Carte charity. But the idea remains misunderstood.
Typical of this is a comment from general practitioner John Bignall, a past senior editor of The Lancet. In an April issue, he wrote: "Literature's relevance to coping with people in the Monday morning surgery queue is nil - unless they happen to be very old Russians."
"He is telling us: 'I have not got a clue about what you (the humanities) do'," says fellow GP Deborah Kirklin, co-editor of Medical Humanities. She argues that studying the humanities is about giving doctors different ways of identifying people's needs. She cites two main misunderstandings: the naive belief that reading poetry makes a doctor more humane and that a cultured doctor is a better doctor.
The new educators are producing lucid and persuasive practical examples of arts-informed medical education.
Studying Captain Corelli's Mandolin on the humanities course at London's Royal Free and University College (RFUC) medical school, a team of paediatric gastroenterologists found echoes of their own problems. A child asks the novel's Dr Iannis to rescue and cure a pine marten caught on barbed wire. The students recognised the doctor's confusion and irritation in their own response to their young patients' differing viewpoints.
Marshall Marinker used to tell his medical students at Guy's, King's and St Thomas's: "You're welcome to bunk off my lectures if you can show me that it was to see a good play or film that enlarges on what we've been discussing." He, along with the Royal National Theatre and the Y Touring theatre group, went on to inspire the sort of theatre worth bunking off for - the Theatre of Debate.
This spawned a series of short experimental plays written by sixth-formers, medical students and arts and science teachers, aided by professional playwrights and directors, based on stories recounted by medical specialists. One, about a young Muslim boy who chooses to die rather than offend his father by accepting a liver transplant from a pig, reduced Marinker to tears.
"What is great is that we can raise questions in a way that they will stick in people's minds rather than having some dry intellectual and sterile debate," says John Stewart Cameron, a semi-retired professor of renal medicine at Guy's, after one workshop. He wishes he had had drama available to augment his lectures.
Kirklin says doctors in the post-genomic era can explore modern dilemmas by reflecting on the science fiction film Gattaca : the film's hero, with only natural genes, struggles in a genetically modified society.
Painting is also being used in training. "This is the frustration, fear, the overwhelming feeling I would have if I had to face cancer," says medical student Jez, holding up a blank sheet of paper. He is among a group at RFUC asked to interpret their reactions to being diagnosed with cancer through art.
But while such approaches seem persuasive, most medical schools do not have humanities departments. "They are not putting their money where their mouths are," says Jane MacNaughton, lecturer in general practice at Newcastle and contributor to the Nuffield initiative. Later this year, MacNaughton will join groups from the more enlightened medical schools to see how much they are doing to implement Nuffield's ideas.
The efforts being made to recruit more liberally educated undergraduates have disappointed many. "Our biggest problem is persuading the secondary schools that you don't have to do just science to be a doctor," says Sir Cyril Chantler, former vice-principal and dean of Guy's, King's and St Thomas's. But the medical schools are not leading the way with specific endorsements of, say, English literature or history A levels.
Some 60 per cent of the places in medical schools are on courses that mention only sciences as mandatory or preferred subjects, and no school suggests subjects other than science, according to figures in the Careers Research and Advisory Centre Guide 2000-01 . "There is an unshakeable belief among deans that those with the top science A levels make the best students," MacNaughton says.
Allen Vincent, general secretary of the National Association of Careers and Guidance Teachers, suspects that medical schools make passing reference to flexible admission systems only to give themselves room to "pick up outstanding applicants", who might not offer three sciences.
His views are echoed by Rob Edwards, head of sixth form at London's Barking Abbey Comprehensive School. He says: "When it comes to the nitty-gritty, from my point of view, medical schools want the sciences and it is safer to give students that advice." He is wary of recommending the expensive changes necessary to give more liberal mixtures on the timetable, lest it is just "another whim" of the medical schools.
But Lynne Bolton, careers adviser at Denbigh High in Wales, says that the timetabling demands of the AS-level curriculum has reduced individual choice, but she believes the medical schools are genuine in seeking breadth of education. "I would definitely advise prospective doctors to go with humanities," she says.
James Burnett, author of Getting into Medical School , highlights two important practical pros and cons. In the light of changes in the styles of entrance interviews, which make them less focused and more transparent, "those who have studied humanities often perform better". But in terms of getting the grades, "for those who are good at science, a third science is less risky because it is more fact-based."
Market forces might soon become a deciding factor. Applications to medical schools are dwindling despite an expansion in places available, according to Andrew Gray, professor of public health at Durham. "By 2004 the number of medical school places will equal the number of applications," he says, adding that this shows the need for wider access to be made available to courses.
The most radical supporters of the humanities say that knowledge of the humanities does more than augment the practice of medical science. "There is a feeling in some academic circles that the humanities should be a core subject, not just to gain an understanding of the human condition, but as something to offer in the appreciation of science itself - in the interpretation, deduction and aesthetics of science," MacNaughton says.
It is early days, but there is evidence that those with some arts background make good doctors. An Australian study showed medical students with arts degrees did slightly better than other graduate entrants. Further proof comes from the performance of the many eminent British doctors whose secondary education was largely devoted to the humanities. In 1950, Marinker went to medical school after studying English, French, German and history. "I didn't know what science was until I went to medical school," he says.