Commentary

The old humanities and the new science at 100: Osler’s enduring message

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“Twin berries on one stem, grievous damage has been done to both in regarding the Humanities and Science in any other light than complemental.”
—Sir William Osler1

The year 2019 marks the 100th anniversary of Sir William Osler’s last public speech. Still reeling from the death of his only son in World War I, he had been asked to give the presidential inaugural address of the Classical Association at Oxford. It was the first time a physician had received the honor, and Osler took the assignment very seriously. He chose to speak about “The old humanities and the new science,” and to call for a reunification of the two fields. “Humanists have not enough Science” he warned, “and Science sadly lacks the Humanities…this unhappy divorce…should never have taken place.”1 Later, he said that it was the speech to which he had given the greatest thought and preparation. It was in fact Osler’s personal legacy: 2 months later he turned 70, and 7 months later he was dead.

Revisiting the address today, what can Osler teach the high-tech physician of today, when doctors have become “providers” and patients “consumers”? Is Osler’s message still relevant to our craft, or has he simply become an icon of professional nostalgia with little value for our times?

THE NEED FOR THE HUMANITIES IN MEDICINE

Medicine has certainly grown both powerful and successful. Yet it is also confronting hurdles that would have been unimaginable in Osler’s time. Physicians are now the professionals with the highest suicide rate,2 a burnout rate as high as 70%,3,4 rampant depression,5 dwindling empathy,6 a predominantly negative perception by the public,7,8 and a disturbing propensity to quit.9 These, of course, may just be symptoms of an increasingly meaningless environment wherein doctors have become small cogs in a medical-industrial complex they can’t control or even understand. Still, is it possible that something more personal may have been lost in the way we now select and educate physicians? Could this, in turn, make us less resilient?

In this regard, Osler’s last public speech serves as an enduring reminder of the need for the humanities in medicine. Osler not only believed it, but throughout his life never missed a chance to express in words, writings, and deeds that the humanities are indeed “the hormones” of the profession. In 1919 he warned against the risk of separating our humanistic tradition from the sciences, and urged us “to infect [anyone] with the spirit of the Humanities,” since to him that was “the greatest single gift in education.”1

Unfortunately, the humanities are slippery, not easily quantifiable, hard to define, and seemingly incompatible with an evidence-based approach. Quite understandably, today’s data-obsessed medicine views them with suspicion. But besides reminding us that in medicine not all that counts can be counted, and not all that can be counted counts, the humanities are in fact a fundamental component of the physician’s skill set.

In a multicenter survey of 5 medical schools,10 there was indeed a correlation between students’ exposure to the humanities and many of the personal qualities whose absence we lament in today’s medicine: empathy, tolerance for ambiguity, emotional intelligence, and prevention of burnout. Most significant was a strong correlation with wisdom, as measured by the 21-item Brief Wisdom Screening Scale.11 That all these traits may correlate with humanities exposure is intuitive, since the humanities not only teach tolerance and compassion, but also capture the collective experience of those who came before us. Hence, they teach us wisdom. Wisdom is not an ACGME competency, but it’s undoubtedly a prerequisite for the art of healing.12 In fact, wisdom may very well be the fundamental trait that characterizes a well-rounded physician, since it encompasses empathy, resilience, comfort with ambiguity, and the capacity to learn from the past. Not surprisingly, wisdom in the world was Osler’s closing wish in 1919.

The humanities can also nurture the very personal qualities we desire in physicians. For example, observing drama fosters empathy,13 as does taking an elective in medical humanities.14 Drawing enhances the reading of faces,15 and observing art improves the art of clinical observation.16 Reading good literature prompts better detection of emotions,17 and reflective writing improves students’ well-being.18 Playing a musical instrument reduces burnout.19 And an undergraduate major in the humanities correlates with greater tolerance for ambiguity,20 a highly desirable trait in physicians, since it means openness to new ideas and the capacity to better cope with difficult situations.21

In fact, some of the qualities fostered by the humanities even translate into better patient care. For instance, tolerance for ambiguity correlates with more positive attitudes towards patients who have frustrating complaints,22 with lower use of resources,23 and with a career choice in direct patient care.24 Hence, it has been suggested that it should be a prerequisite for medical school admission.25 Physicians’ empathy is also beneficial, since it correlates with a lower rate of complications and better outcomes in the care of diabetic patients.26 This should not come as a surprise. As Hippocrates put it 2,500 years ago, “some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.”27

Lastly, studying the humanities may provide crucial antibodies against the pain and suffering that are unavoidable staples of the human condition. To paraphrase Osler, the humanities might vaccinate us against the difficulties of our profession. Hippocrates himself had suggested that “it is well to superintend the sick to make them well, to care for the healthy to keep them well, but also to care for one’s self…”27 That is why many institutions now require medical students to take humanities courses.28

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Telemedicine: Past, present, and future

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