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Tuesday, November 27, 2018

The Medical Humanities' Contribution to Medicine

At the Singapore Writers Festival, I went to a talk on the Medical Humanities (Singapore Writers Festival - What Does Literature Teach Us About Medicine?).

I was skeptical at first, but the talk was actually quite interesting (though on reflection, the panel had almost nothing to do with literature; this year they shoehorned a lot of non-writing related material in - at the Minimalism event one speaker actually admitted there was nothing to do with writing).

Here are some aspects the medical humanities cover/some insights from the field from 2 of the speakers - one on end of life and another on linguistics (the third speaker talked about charms in Medieval English medicine but that wasn't quite as interesting, so).

End of life:

Some doctors are scared of telling their patients that they're dying, so they recommend treatments of limited use.

Some patients ask for chemotherapy and debilitating treatments. They don't know the tradeoffs - qualitative vs quantitative time (e.g. you may live 3 months longer but suffer a lot more). Stories about dying can help us - we won't just look at prolonging life (in terms of lifespan).

End of life conversations make people feel like they're giving up - but they're important (more for your family rather than you, since you'll be gone). Some ways to approach the conversations: the tell ask tell model. The patient says what's most important to him, for example being pain free, eating spicy food or retaining lucidity for as long as possible. Patients will ask what treatment options match these goals. Patients will then consider the trade offs and decides what to do.


Linguists analyse patient-doctor conversation. The speaker takes video recordings of actual patient doctor consultations and studies their interactions. He showed us one example:

A video of a doctor talking about putting a scope up the patient's penis. It is routine to the doctor but the patient is worried about pain. The doctor needs to struggle between proving information and empathy.

"we'll give you some local anesthetic only" - this de-emphasises the power of the anesthetic

Patient: "Will I be falling asleep throughout"
Doctor: "No you won't be asleep. You'll be awake"
Patient: "Wah" - The patient continues to be fearful

Doctors need to diagnose. So the language used is very transactional. Do you have this? Yes/no. The patient is lost in this. The doctor looks at the patient as an object to be fixed. So they should be more aware of the patient and not just objectify him - put on the human hat, not just the doctor hat. At the same time, during medical training doctors become less human. They become detached so they don't burn out. This is a coping mechanism.

At NTU, medical students get training in communicating with actors to help with all this.

Also, bad things happen when doctors don't talk to each other. The chance of being harmed in a plane - 1 in a million. But chances of the healthcare system harming you - 1 in 300. Up to half of these are preventable. Errors in diagnosis are 1 in 10 to 1 in 20 - more common than errors in treatment.

In Singapore patients are subservient to doctors so it's hard for them to be patient centred.

Some soldiers lose a limb but laugh because of adrenaline.
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