Talk to your doctor about Mozart

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We have thousands of pieces of evidence that studying the humanities before and during medical school leads to better outcomes for both healthcare workers and their patients. It also forms the basis of life-long interest in literature, art, music, communication, culture studies, history, and more, which, again, lead to better health care interactions. Among the most important characteristics of good doctors are compassion, critical thinking skills, and communication skills, tools honed in the humanities. So why aren’t we trumpeting the study of humanities (and social sciences) to our current and future doctors and nurses?

The American Medical Association’s Journal of Ethics cites many instances in which teaching the humanities to medical students and physicians resulted in positive outcomes:

- That the humanities can be used to teach professionalism, listening skills, cultural sensitivity, ethics, and empathy.

- That literature encourages students to see the world from the perspective of another person and develop empathy for the characters.

- That music focuses attention on active listening which improves doctor-patient communication.

- That viewing art can enhance clinical practice by improving communication skills within teams and can inform the curiosity and questioning required when clinicians encounter patients.

- That anthropology and history can teach students about the diversity of human experience across space and time and encourage students to reflect seriously on their own values and perspectives.

- And that the history of medicine, by asking students to consider carefully the mechanisms of disease change over time, can open their minds to the complex interactions between individual and society necessary to truly to understand disease.

There are presently 141 accredited MD-granting institutions and 31 accredited DO-granting institutions in the United States, the vast majority of which have recognized the value of medical humanities in some small way. According to the American Association of Medical Colleges Curriculum Inventory and Reports, during the 2015–2016 year, 119 medical schools required humanities education, though it is often just one course or a 1-credit module. Undergraduate programs are popping up around the world as well, if a bit unevenly. It will be important to train humanities professors in medical history, sociology, and anthropology before we hand over entire classes of pre-meds to them. Or we can hire more medical humanists in our departments, rather than relegating them to their own small non-departmental units or groups.

Our doctors need to be trained in science and technology without a doubt, but aren’t we also looking for professionals well-versed in the importance and practice of the doctor-patient relationship; various ways that people across genders and age ranges and cultures view their own bodies; people’s experiences of illness and pain; how to help people cope with disability, dying, and death; the social process of aging; behavioral effects on illness and health; the economic role of pharmaceutical companies in the modern healthcare system; not to mention good communication skills and basic empathy? In 2011, Johns Hopkins researchers reported that medical knowledge and cognitive capacity are not sufficient for effective clinical care, calling for the addition of humanities training with clinical relevance in order to improve the emotional intelligence of medical staff, particularly those dealing with conceptual issues such as pain measurement and management. This is not stuff you learn in organic chemistry.

I have listened to physicians tell me stories about not being able to explain to patients from other cultures what it is that’s making them sick or why they need to take a certain medication. I often think back to the book The Spirit Catches You and You Fall Down, by Ann Fadiman, which was my first introduction to the frustrations of cross-cultural communication in medicine. It’s a book I recommend often to doctors and every one of them has come back to tell me they’ve learned something from it and wish it was mandatory reading for med students. When Breath Becomes Air, by the late Paul Kalanithi, was on the NYT bestseller list for dozens of weeks and nominated for a Pulitzer and comes up in nearly every conversation I have with physicians about their own mortality and mental health. The same for physician memoirs by Atul Gawande. A 2011 study of physicians working in VA hospitals showed that those who participated in a medical humanities reading group showed a great or medium increase in empathy for patients (82%), interpersonal skills (62%), communication skills (51%), job satisfaction (61%), cultural awareness (59%). But don’t get me wrong, we can’t rely on book clubs alone.

There have even been pleas from within the medical profession to teach students the value of empathy, altruism, and compassion toward patients, clinical communication and observational skills, imagination, self-reflection, and social and moral issues in medicine. While the effect of humanities training on medical care in our country is impossible to measure, there are hundreds of pieces of anecdotal and testimonial evidence linking the humanities to better quality of care and the improvement of members of the medical profession, and it’s not just about reading books:

- In a 2008 study in the Journal of General Internal Medicine, researchers from Harvard, UCLA, and Columbia reported that students’ ability to make accurate observations increased by 38% after taking a visual arts class.

- The study of comics in illustrating medical concepts to patients has been wildly successful.

- A new piece in the Journal of the American Medical Association showed that communication outcomes with urban youth improved when health care professionals used the language of hip-hop to reach their patients.

- While the well-known Mozart Effect is controversial (there’s no evidence that it will raise IQ, for example), we have seen some evidence that his music (or that with a similar tempo and structure) has been linked to positive behavioral changes, stress reduction, arthritis pain suppression, performance on eye-test charts, and has been studied for over 20 years as a potential tool in the treatment of epilepsy. Even understanding the history of this claim and the importance of music as a placebo is the territory of the humanities and social sciences.

While op-eds aren’t evidence, there are convincing arguments by life-long professionals that tout the role of studying musical performance for physicians (after all, there is a performative aspect to our medical encounters).

While interviews and GPA are still ranked at the top when med schools are asked what’s most important, we know that MCAT scores are still a major predictor of medical school admission success. The mean MCAT score in the US is 501.8. Biology is the most common pre-med major and students in those programs score a 501, on average. The MCAT was recently updated to include the social and behavioral sciences, and students who comes from those majors average a score of 502 on the MCAT. Interestingly, humanities students boast the highest scores, with majors averaging a 504 on the MCAT. Among matriculating (successful) students the national mean is 508.7 with the following averages:
Biology 508.3
Social Sciences 509.8
Humanities 510.5

So, kids, tell your parents you want to study the humanities, for the sake of your MCAT scores, if that’s what it takes. And for everyone else, you can find excellent resources on the importance of humanistic studies in medicine in NYU’s weekly Medical Humanities Newsletter and the Arnold Gold Foundation’s weekly Humanism in Healthcare Roundup.