Central Line
Episode Number: 88
Episode Title: Medical Humanities & the
Arts
Recorded: February 2023
(SOUNDBITE OF MUSIC)
VOICE OVER:
Welcome to ASA’s Central
Line, the official podcast series of the American Society of Anesthesiologists,
edited by Dr. Adam Striker.
DR. ADAM STRIKER:
Welcome back to Center
Line. I'm your host, Dr. Adam Striker. Today we're going to talk about medical
humanities and anesthesiology with Dr. Audrey Schafer. Dr. Schafer is the guest
editor of the March Monitor, which shines a spotlight on the discipline of
medical humanities and the many ways humanities and anesthesiology intersect
and interact. Dr. Schafer, welcome to the show.
DR. AUDREY SHAFER:
Thank you. My pleasure
to be here.
DR. STRIKER:
If you don't mind
telling our listeners a little bit about yourself, your early training, and how
you got into medical humanities. And just give us a little bit of background.
DR. SHAFER:
Okay. Sure. So I went to
Stanford Medical School and then went to University of Pennsylvania for my
anesthesia training. I'm originally from Philadelphia, and it was kind of a
coming back home experience and then returned to Stanford for a research
fellowship year in pharmacology of anesthetics. And really, one of the major
goals at Stanford School of Medicine is to develop and encourage the physician
scientist. And that is how I had viewed my career. However, my childhood was
very immersed in the arts. My mother was a costume designer. My sister and I
pretty much grew up backstage at the theater she worked at in Philadelphia. And
I think sometimes your childhood comes back and informs the rest of your life.
And as I was starting in on an academic anesthesiology career, I began to feel
that perhaps I had more to offer in a field outside of pharmacology. So I
decided to explore an area that is at the intersection of the arts, humanities
and medicine. An area I had not realized was a true academic discipline. So
once I discovered that, started meeting people, joined the professional society
for that, began publishing, I was so excited by this field that I decided to
devote all of my scholarly work to this area.
DR. STRIKER:
Well, some of our
listeners might not be familiar with the term medical humanities. Do you mind
just explaining a little bit about what that is, how it relates to
anesthesiology?
DR. SHAFER:
Absolutely. I do think
that when I first started with this area in the early 1990s, extremely few
people had heard of medical humanities, including myself. But now it is a
growing field and it's an academic field that's interdisciplinary and explores
the context of medicine by placing all that it is that contributes to us being
human beings, our experiences of health, of health care, of illness, of
mortality, of caregiving in a much larger context, in a social context. And by
doing so, these tools that we gain from the arts and humanities enable us to
really think critically about what it is we do in medicine and vice versa. The
world of medicine is complex. It engages so many people, it engages everyone at
some point in their life. And to enable artists and people who are scholars in
the humanities and qualitative social sciences to enter into the world of
medicine and to explore it using the refined tools of their disciplines, I
think helps both those in medicine and those outside of medicine to better
understand what it is that we do in medicine and what what
it means to be a human being.
DR. STRIKER:
This episode of The
Monitor is is rather unique. Articles include
painting inspired by pediatric anesthesiology, reflections of an
anesthesiologists and photographer, even a poem about mouth-to-mouth
resuscitation. So for clinicians who create art, does the artistic process lead
to enhanced mindfulness in their clinical practices? And can you talk a little
bit about the value of the creative process for clinicians?
DR. SHAFER:
Sure. Thank you for that
question. I do think there are a number of clinicians who create art or who
care deeply about art and feel immersed in the arts in some way, whether it's
attending theatre, loving film or going to art museums. But there are many who
actually view themselves as as creators.
I think you'll find in
some of the artists statements that accompany these creative works in this
March issue of ASA Monitor that these anesthesiologists find multiple benefits
to to doing their art, and in some ways it enhances
their abilities as clinicians. There's some mention about the flow, the feeling
of flow that can happen both in creating art and also in what we do as
anesthesiologists as we enter into that dynamic that happens in the operating
room. It also leads to skills of listening, of observing, and additionally
leads to communication in ways that strengthen our human-human contacts,
whether it's with a patient, or with a colleague, or even, as you'll read in
one of the articles between two colleagues who had never physically met but
bonded over their shared love of music. So I do think that there are a number
of listeners out there who have this interest, and I'm hoping this issue
highlights that that can really be part of our lives as anesthesiologists as
well. It doesn't have to be a completely separate compartment in our lives.
So for me, personally,
as a poet, I have found that my efforts to write poetry have encouraged me to
continue to deeply listen to my patients. As we all know, we have this very
tiny window to get to know a patient. And likewise the patient has a very small
window to get to know their anesthesiologists in general. And for me, as a
poet, I know that pauses, things unsaid, can be extremely important. So I
believe it helps me pay attention to my patient as he or she is speaking, and
to observe all the nonverbal aspects of communication as well.
DR. STRIKER:
Talk a little bit more
about that. How long have you been writing poetry and how long have you been
writing poetry regarding the specialty of anesthesiology?
DR. SHAFER:
I took my first poetry
writing workshop when I was a medical student, and I very much enjoyed it. The
flexibility at Stanford School of Medicine in terms of their curriculum and
also the physical location of the medical school on the campus of a major
university facilitates that kind of experience. But to be honest, I really was
so immersed in my clinical work as a clinical student and then as a trainee
that I wrote very little. And it wasn't until after my return to Stanford and
we had a year that we called attend a fellow back then, which was like a
transition year from your fellowship to your faculty appointment, that enabled
you to have some protected time to work on writing up all the work that you had
done as a as a research fellow. And it was in that year that I took my second
writing workshop that was with a poet, Denise Levertoff.
And I would say at that moment that I realized that how I am processing the
world around me is through poetry, that I think metaphorically, I wonder about
words that are said, I--and this got reflected later on when I was young
faculty member. For some reason, the phrase “under anesthesia” really sort of
struck a chord with me. It's a phrase that I use in communicating with a
patient about what they will undergo, saying you'll be under anesthesia or
under general anesthesia, thinking that that phrase is fairly benign and
neutral. But in reading more and more about metaphor and about words, phrases, metanims, then I became more familiar with sort of the
embedded history within the words that we use and how those can trigger some
reactions in others that we hadn't necessarily predicted. And this sense of
being down and under is frequently associated in our language with things that
are worse, things that are scary, being unhealthy, being ill, laying down and
even dying. And so I really just became fascinated by the words that we use.
And there are obviously some phrases that I think are more pronounced than
that. You know when somebody says you're going under the knife or some other
phrase that can be used in jest but really can have a sting to it. And I also
became fascinated about how we use metaphors for sleep in terms of describing
anesthesia when we as anesthesiologists know that the anesthetized state is not
sleep. But there is something for adults that is reassuring about sleep. You
wake up and you get through it. And so how we use our language in the operating
room with the patient or with our colleagues I think is just a fascinating
aspect of communication and anesthesiology.
DR. STRIKER:
No, absolutely. And you
know, you highlight such an important facet of what we do, which is trying to
take advantage of the very limited time many of us have with our patients to
establish a significant relationship and a bond of trust and figuring out how
best to do that, which is, of course, patient dependent, but is certainly a
challenging part of our practice that I think is underappreciated when it comes
to anesthesiology. Let's talk about storytelling a little bit. It's another
discipline from the humanities that clinicians can use in the day-to-day work
to improve communication. Can you talk a little bit about how that might be
useful?
DR. SHAFER:
Sure. I think that
storytelling is a helpful term for describing what it is that we do as
anesthesiologists when we're talking with our patients, when we're describing a
case we're about to do and want some feedback from a colleague or some advice,
when we are talking with our surgical colleagues and then more formally, when
we are writing things up for publication or writing a grant proposal. All of
this is storytelling in a way. And the more one can practice in it, whether
it's written or oral or both, I think the better. And acknowledging that
storytelling is part of who we are as humans. It is something that is key. And
that stories can be passed down through generations, can be very differently
interpreted in different cultures, and sort of an acknowledgement of the
diversity of storytelling and storytellers, I think is part of an appreciation
of how deeply storytelling plays into the practice of medicine. And there are a
number of academic books in medical humanities that speak to the importance of
story. Although the science of medicine requires data and requires numbers and
statistical significance and things like that, there is still a story behind
it. There's still a reason why we're interested in that particular area and why
we want to study it. And communicating that interest, why it's important, is
part of storytelling. So it really infuses all that we do in anesthesiology, in
research and in the practices that we have in all the parts of the of the
hospital and clinic.
DR. STRIKER:
You've mentioned a
historical perspective a couple of times. Let's just talk about history for a
minute. We've done several episodes on history of anesthesiology coming from
different angles, and they've always been some of the more popular episodes. I
wanted to get your take on why you think many of us are drawn to history, why
you think it's so popular, and from your perspective, what does history tell us
regarding our specialty and what is the significance of it all?
DR. SHAFER:
Yeah, well, history of
medicine is an extremely well-developed academic discipline that gives advanced
degrees at different universities and is an area in and of itself. But it's
also part of this large Venn diagram of overlapping disciplines with the
practice of medicine that is medical humanities.
I think people are
interested in the history of of medicine and of
anesthesiology because we know we are not coming de novo into an operating room
with no historical background to it, that there is a long line of patients, of
physicians, of nurses, of researchers, educators who are enabling us to be in
the moment that we are in. So I think an acknowledgement of that is important
and I think also leads to this interest.
So we have had some
residents in our anesthesiology department who have submitted essays to history
of anesthesiology contests. And I would encourage anyone, including our our trainees, to look into this as a way to think about
what it is that they are embarking on as an anesthesiologist. Or, if you're
practicing for a while, to reflect back on what it is that you have been doing.
So all the history of of anesthesiology is packed
with stories and characters and plot twists. And I think that that has also
contributed to an interest in in the history of anesthesiology.
DR. STRIKER:
Earlier, you mentioned flow,
and I want to elaborate a little bit on that concept. The concept was described
by the author of the 1990 book, Flow, as, “the state in which people are so
involved in an activity that nothing else seems to matter. The experience is so
enjoyable that people will do it even at great cost for the sheer sake of doing
it.” I know whether you're an artist humanitarian, pretty much anybody probably
experience this to some degree. But how do you think anesthesiologists do
specifically?
DR. SHAFER:
I do think that there
are moments in the delivery of anesthesia care that are associated with
experiencing flow, whether it's doing something physically, a procedure,
getting ready for a case in the operating room, that you do enter into this
sense of flow, this sense of timelessness, of being there in the moment and
experiencing it and being sort of aware of yourself in that moment. And some
other things can drop away. But we all know as anesthesiologists that we cannot
stay in that moment. We have to be able to dually pay attention to very focused
things and also to anything that might be happening in the room that could
affect our patient and our anesthetic care. So unlike a surgeon who I do feel
has more opportunity for extended periods of flow in the operating room as they
are focused in on one area of the patient's body, the anesthesiologist has to
develop this sense of being in the moment, but also being aware of what has
just happened, anticipating what is to come, and have an understanding of all
the things that might be happening in an operating room that could impact what
you need to do for your patient as their anesthesiologist, as their guide, as
their protector.
So I, I think it's a bit
different than my experiences as a writer in terms of experiencing flow where
you don't have somebody's life at stake. And I think where these sort of
differences become apparent can be extremely interesting, just as like where a
metaphor might break down that those moments and sort of the edges of things can
be extremely interesting, particularly as someone who's been involved in the
education of anesthesia residents for a long time. I think that is one of the
things that simulation is so good at in terms of being part of trainee
education and continuing education. Is that examining how people approach an
issue that develops and whether that focus on one thing prevents them from
being aware of other things going on. Or vice versa, being too distracted and
unable to see what's really important that's happening. So I think there's some
overlap in terms of those experiences of flow, but also important differences.
DR. STRIKER:
Well, it brings up kind
of this age-old question about medicine and specifically in our context,
anesthesiology being an art or a science, I would imagine most would answer
that it's both. Most would probably feel that it's both. How do you perceive
the specialty when it comes to that question?
DR. SHAFER:
Yeah, I absolutely think
it's both. I think it's like improv. It's it's and
you know, you're always going for the inclusion. There just are some things
about anesthesiology, about the practice of it, that are not predictable.
There's some ambiguity. Even though we as anesthesiologists like precision and
like, say, to have our patient's blood pressure within a very limited band,
which we feel is best compatible with their health at that moment, it doesn't
always happen that way. And why we're not able to control things so precisely,
how to deal with that particular patient's physiology and anatomy, I think, is
part of this range of skills that the anesthesiologist brings to the table. So,
yeah, we we just do have to accept that there is an
art to the practice of anesthesiology. Every patient that we meet is different,
has different background connections, experiences. And if we rely on one way to
approach every patient that's going to fail us and fail our patients. On the
other hand, we can't be reinventing the wheel every single time. We know what
certain drugs are useful for. We know what we need to accomplish in terms of
placing a patient into the anesthetized state such that they can have surgery
performed on them. So the science of anesthesiology is extremely important. And
learning the science of anesthesiology, and keeping abreast of all the changes
and updates to that, is extremely important. I think it's is definitely an and.
And one complements the other. And there is also some overlap because in
science there's ambiguity as well. And the arts can help us deal with our
discomfort with ambiguity can enable us to, to see it and enable us to deal
with it in a way that doesn't lead to pure frustration.
DR. STRIKER:
Can one exist without
the other?
DR. SHAFER:
You know, I don't think
so. Maybe we can't all be the Renaissance man like Da Vinci. But I do think
within each of us, there is an interest in both the arts and the sciences.
That's part of how we live in this world, how we're social beings, how we are
intellectual beings, and growing in our emotional lives as well. I feel it's a
bit artificial to separate them out. There is, as we've said before, there is
storytelling in science and there's just incredible works of art that are based
on science itself. As we look at microscopic images of our tissues and things,
it's just stunning. So I think there's there's many
ways they overlap.
DR. STRIKER:
Well, want to continue
talking about this. But before we go any further, let's take a quick patient
safety break and we'll be right back.
(SOUNDBITE OF MUSIC)
DR. DEBORAH SCHWENGEL:
Hi. This is Dr. Deborah
Swingle, chair of the ASA Patient Safety Editorial Board.
Perioperative
hypothermia continues to be a common occurrence despite extensive knowledge of
its ill effects and the common practice of warming patients during surgery. The
amount of time a patient experiences hypothermia matters. Work to prevent heat
loss, reducing the percentage of time patients experience hypothermia and
ensure the patient is normal thermic upon arrival to the PACU. It's essential that
all team members understand the importance of pre warming patients prior to
entering the operating room and then actively warming during surgery. A team-based
approach with the anesthesiologist who is responsible for ensuring patients
remain normal. Thermic as the team leader improves perioperative temperature
management.
VOICE OVER: For more
information on patient safety, visit asahq.org/patientsafet22.
DR. STRIKER:
Welcome back. Well, Dr.
Shafer, do you think that as a medical field, that not in training, but in
looking for people that are interested in medicine, that we place too little
emphasis on the arts, too much emphasis on the arts in terms of what people study,
what people's aptitudes are--arts versus like the
natural sciences, if you will, when we are looking for students of medicine.
DR. SHAFER:
Mm hmm. Yeah, that's a
really complicated question. And I do think that there, you know, there are
certain courses that are expected for a student who's going to be entering
medical school, and there are certain tests that are required. And even though
there may be writing components or components about the context of medicine,
such as ethics questions or anthropology related questions, the bulk really, I
believe, is still in the domain of the sciences. Having said that, I think that
medical schools are interested in a diverse student body, and diversity comes
in all kinds of ways, including having students who have had different
educational journeys to get to medical school, and that I believe medical
schools feel that this enhances the life of the medical school. I do think that,
in this age where there is so much bashing of science by some members of the
lay public, it is critically important to note that science is foundational to
medicine and that we really do need people who are able to move that needle
further in terms of our our scientific understanding
of how the body works and how medicines work and how illness affects us. But we
also, having said that, need to have a very human understanding of the
experience of all of those things. And that comes from having educations which
include not only basic sciences, but also include a much broader range of
courses in the arts, humanities, and social sciences.
DR. STRIKER:
I know you know how much
physicians grapple with intense work schedules, increasing demands, whether
it's clinical, regulatory, administrative, what have you. And we've talked
about wellness and burnout. And I wonder if you might talk a little bit about
how the humanities can help in that regard and perhaps maybe keep us as
physicians from becoming too dehumanized from all the stressors or demands of
the job or the rote routine, if you will.
DR. SHAFER:
I mean, the issues of
wellness and burnout are critical to our specialty and to medicine at large.
The impact of the pandemic, I think, has echoing repercussions, and that will
continue for a long time.
I would say it's just a
really complex, complicated area, and I don't want to promote medical
humanities as some panacea or some slap on add on experience that can cure
these really deep and important aspects of our experience of being health care
workers and being anesthesiologists. But having said that, I will say that
including the arts and humanities in programs that are designed to help the
clinician appreciate what it is that they've gone through, to help them reflect
on who they are now, I think is extremely helpful.
So, for example, in our
department, we are fortunate to have a professional writer, Dr. Laurel
Brightman, who has given TED talks. So she's both an oral storyteller and a
writer, and she leads some of the groups in our department, because you don't
want to do it en masse, in intense writing workshops,
even people who feel they're not writers, this experience of writing together,
of sharing, of having permission to be vulnerable, of feeling protected in that
group, I think can really be beneficial.
So there are areas where
the arts and humanities can offer us ways of connecting. And I think connection
is critically important for our wellness as human beings and certainly for our
wellness as physicians. So I do think that it can be helpful. It's also the
fact that we just hsbr our own experience to learn
by. But if you if you share with others your own experience, your own
storytelling of that experience, or visual response to that experience, and by
drawing that those can also help us understand how others have experienced
their working life, their attempts to find balance in their lives, their
passions and their struggles. So I do think that there are places for the arts
and humanities in programs to promote wellness, but it shouldn't be like a
slapped on, added on extending the workday kind of experience. It needs to be
more integrated and supported by the program that you're that you're already
in.
DR. STRIKER:
Well, speaking of the
program and departments, we've talked a little bit about the individual, but
how can supporting the arts and humanities A. benefited department and or
organization? And then along with that, what, if anything, should departments
or organizations be doing if they're not in support of this?
DR. SHAFER:
Well, there is a
wonderful article in the March issue of the Monitor that I would direct people
to by Dr. Ron Perl, who was chair of the department at Stanford for 22 years
and was an incredible supporter for developing arts and humanities in our
department and hence also at the School of Medicine and the university. And I
think what he says is that this connection to the arts and humanities connects
our department to other departments, to the school as a whole, to the
university as a whole. And because anesthesiology can be a hidden profession,
even within a school of medicine. This, this, this different layer of
connection through building a program in the arts and humanities can then help
make our department of anesthesiology more visible. And indeed, because I love
being an anesthesiologist and through growing a program in arts and humanities
at the School of Medicine, I would meet many medical students. I always
encourage them to take the elective clerkship because you just never know until
you take that clerkship whether you're going to fall in love with the field of
anesthesiology and become an anesthesiologist yourself. So I think there's some
benefit in terms as he terms it being an ambassador for the department, and
that comes from the very interdisciplinary nature of medical humanities.
But I think there's
other aspects to it. And one of them that I feel passionate about is diversity.
And the way that arts and humanities improves diversity in a department is that
for those people who have an interest in the arts and humanities or social
sciences, it provides a way for them to flourish within the department as well.
And the arts and humanities, as I've mentioned before, opens our eyes, widens
our world, deepens our understanding of what it means to be in this world, in
this very diverse world. And our country is a country of diversity, and that
needs to be celebrated, welcomed and also examined as to what are the struggles
that have resulted from imbalance, from prejudice and bias. So the arts and
humanities enables us to critically think about what it is we do in medicine.
And I think that benefits a department. It strengthens the department by
encouraging diversity, by encouraging opinions to be expressed and and encouraging people to feel comfortable that they may
have different backgrounds and different views on things and that those will be
respected. So it provides for more of a sense of inclusion within the
department. So I think that's a really major aspect of how arts and humanities
can perhaps more indirectly but foundationally improve diversity in a
department. And it's something that I feel is extremely important.
I think the other thing
about an arts and humanities program within a department is that now that the
academic field of medical humanities has gained so much traction, there are a
couple hundred undergraduate colleges with majors in medical humanities,
similarly with minors in medical humanities. So more and more students are
being exposed to this area. And as those students go up through the system,
there should be, and there will be, a way for those intellectual passions to be
supported. And so in our department, for example, medical humanities is now
recognized as a potential pathway for success, for development as a faculty
member, for reappointment promotion and so forth. And there are a number of
faculty in our department who are pursuing medical humanities. So I think
you'll find some of them in this issue of the ASA Monitor. And I think that's
also true across the country as well, that it's it's
just an exciting area to explore. And I encourage other departments across the
country to consider really being supportive of this growing, exciting, dynamic
area.
DR. STRIKER:
Well, for our listeners
who want to learn more about medical humanities in general, do you mind pointing
them to a starting place or a resource that they might first engage?
DR. SHAFER:
Well, I think that our
medical journals are a good place, and for a long time, medical journals have
included what has become very popular columns such as JAMA, New England
Journal, British medical Journal, Lancet. All of these journals have areas in
them that focus on medical humanities, on reflections, on perspectives, on art.
And in our specialty, Mind to Mind in Anesthesiology is a great place to start.
It also includes poetry as well as prose. reflections on the experience of
being an anesthesiologist. There are multiple areas. The Human Experience in Anesthesia
and Analgesia is another major journal that has that promotes this concept that
we as anesthesiologists have something to say that is of importance and should
be out there in in a major publication about some aspect of being an
anesthesiologist.
DR. STRIKER:
Well, let's wrap up the
conversation. Circling back to the March ASA Monitor issue, as the guest editor
of this issue, what do you hope the readers will experience or take away from
reading it?
DR. SHAFER:
Thanks. Yes, I do hope
that readers will understand that there are many entryways into this area and
many moments in your career where you could start to become involved. For those
already involved, I'm hoping that this issue encourages you to share that
involvement with those around you and to support others who are exploring this
area. I have tried to include a range of contributors from people who have just
finished residency all the way through to established and senior
anesthesiologists. I hope that the issue sparks some interest. Is also fun to read
and provocative as well in terms of enabling our readers to think about aspects
of anesthesiology that touch all of our lives.
DR. STRIKER:
Well, Dr. Shafer, thank
you for joining us today to discuss this underappreciated topic and aspect of
our specialty, but more importantly, for sharing your insights. And I can't
wait to read the issue, and I certainly hope everybody else does as well.
DR. SHAFER:
Thank you so much, Dr.
Striker.
DR. STRIKER:
And to our listeners,
thank you so much for joining us on another episode of Central Line A please
check out the March ASA Monitor at asamonitor.org. Tell your friends about our
podcast. If you find it interesting, we review and tune in again next time.
Take care.
(SOUNDBITE OF MUSIC)
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