BIOL 3715 - (Play)writing and Medicine 

Instructor: Deborah Salem Smith

By bringing together two communities––Alpert Medical School students and Brown/Trinity MFA Acting students––this course will explore how the tools of theater can make better doctors and how the skills and perspectives of medicine can make better artists.  Creating theater and practicing medicine are both deeply human endeavors.  Both fields confront real bodies in a specific space and time; both fields transform partial narratives into new, crafted narratives that inform, empower, and heal others. This course will be structured as a creative writing workshop.  All students will create short, theatrical works.  The goal is not to write a play.  Our goals are to learn how to craft brief, dialogue-based scenes, and to play with peers from another discipline. 

RISD ENGL E654/BROWN BIOL 3710M(RISD0730Y) - No Innocent Eye: Knowledge and Interpretation in Art and Medicine 

Instructors: Jay Baruch, MD and Kelli Auerbach, MFA

Practicing medicine and creating art are both informed by observation and perception, yet how artists and doctors view the world and their place in it might be quite different. By bringing two populations together – RISD students and Alpert Medical School students – this highly interdisciplinary course will examine the ways art and medicine have overlapped and entwined historically, and still do today. Through selected readings, discussion and creative assignments, we will discover the many ways creative and imaginative skills are essential to the ‘art’ of medicine.

Team-taught by Kelli Auerbach (RISD English) and Dr. Jay Baruch (The Alpert Medical School), and with the help of guest speakers from both Brown and RISD, the course will examine a range of topics that will inform the work of both doctors and artists. Examples include: how both fields figure the body; the ethics and challenges of understanding and treating pain; the role of enhancement technologies on identity and authenticity; shifting conceptions of normalcy; madness; mistakes; medical photography and illustration; medicine and eroticism; contemporary artists’ explorations of health and illness, as well as fiction and poetry by doctors.

Students should expect significant writing, readings of creative and critical texts, lively discussion, and both individual and collaborative projects (written, visual, and/or performance).

This course will allow both art and medical students to consider topics and foster skills not necessarily covered in art and medical school curricula, but which will be invaluable in the actual practice of doctoring, the professional and personal growth of physicians, and the deepening of more finely nuanced knowledge and practice for artists.

HMAN 1970V - Pragmatic Medical Humanities

Instructor: Jay Baruch, MD

The question, “What is medical humanities?” has flummoxed the very experts who ardently argue for its importance to medical education and the professional and personal growth of health care providers. Rafael Campo, esteemed poet and physician, wrote in a JAMA essay that “no concept of the ‘medical humanities’  compels, caught somewhere between manifesto, mushiness, and marketing lingo.”

Individuals harbor different meanings for the term and invest it with different values and goals. I believe humanities is elemental to the act of caring for patients. To fully respond to the sick and injured, one must not only attend to disease and physical damage, but appreciate the impact and meanings of illness and impairment. Through stories we tell ourselves and share with others, knowledge is constructed, experience is interpreted and we work towards shaping what we consider “right” and “good.”

Caring for the sick and injured is becoming an increasingly complex endeavor requiring more than clinical and technical expertise in a disorganized and unruly health care system. It requires creativity, sensitivity and imagination. The sciences don’t address the big, human questions that arise when patients face suffering and death, or prepare physicians to examine their own values, frailties, and capacity for compassion and tolerance. The medical humanities provides tools for fostering critical thinking skills, encourages respect for different and differing opinions, nurtures passion and curiosity, and fosters cross disciplinary discourse.

Medical humanities, regardless of definition, should be pragmatic. It should prove useful at the bedside as well as serve as a method of inquiry, a lens through which one’s moral imagination is given the necessary breadth and focus to successfully wrestle with complex and messy issues and ultimately respond in a thoughtful manner. Why is this important? The writer/physician William Carlos Williams once said, “...it is your response to the ethical questions that will make you what you are.” In fact, the word “ethics” shares roots with the greek word for character, ethos. The medical humanities scholar Kathryn Montgomery wrote: “Ethics is practical knowledge, forged experientially and honed on circumstance...in narrative, inquiry is inseparable from explanation, narrators and audiences must test the sources of our stories, compare versions, and sustain a healthy skepticism about answers. Thus, narrative represents the conditions of moral discourse, even as it is the principal medium of that discourse.”

The interdisciplinary nature of medical humanities, engaging in conversations with persons who possess different expertise, different knowledge and different approaches to knowing, provides opportunities for examination and insight unavailable elsewhere.

During this seminar, students will investigate alternative meanings, interpretations, and purposes embedded in the term “medical humanities.” They will develop their own personal relationship to this term, this field of study, and it’s utility as a tool for understanding and responding to the profound experiences of clinical medicine, illness, and health.

HMAN 2970E - Pain, Medicine, and Society

Instructors: Jay Baruch, MD; Christine Montross, MD, MFA; Michael Steinberg, PhD

Pain is a mystery, an elusive, dancing ghost unlike anything else a physician treats. The roots of pain can’t be dissected, located on a CT scan or quantified through lab work. Associated with, or a manifestation of, certain diseases and injuries, pain is ultimately modulated and given significance by the mind. Shaped by the patient’s experience, pain must be validated and given legitimacy by health care providers before it can be understood and effectively treated.

Defining pain has proven to be a challenging endeavor, one that seems to substantiate the mystery rather than adding clarification. It has been said that definition isn’t the way to begin learning about pain, but rather “to explore the ways in which it tends to get away from us.”

Pain has been described as a state of crisis. Modern medicine, with a Western, technocratic world-view, misrepresents pain as purely a medical problem, the creation of anatomy and physiology, and ignores the experience of pain as phenomena of the mind, shaped by historical, cultural, and psychosocial factors. 

Translating a pain story can prove problematic when pain’s profound voicelessness is ephemeral, subjective, and defies categorization. The medical model, with its focus on objectification and identification, seems a deficient process through which to address meaning, and it ignores the relationship between pain and suffering.

Pain is soul-destroying. Patients may be located in the doctor’s office or hospital room, but lost in their pain. Pain shadows their every move, disrupting lives at a basic level, affecting relationships, job performance, and the ability to think and reflect clearly. Pain eventually hijacks individuals from who they once were, taking away their self-identity, autonomy, and capacity to control their present and future. Pain can become their identity. Pain can be terribly isolating. Sometimes pain can only be identified indirectly, by attending to silences and metaphors, focusing on visual expressions and inconsistent stories.

Pain is embedded with moral implications. Are physicians even listening to the pain story, or are diagnostic and biological considerations trumping what the patient wants heard? What ought to be expected from physicians and caregivers when, as Arthur Frank said, “One of our most difficult duties as human beings is to listen to the voices of those who suffer?”

Ultimately, pain demands a response. Easing and relieving pain is an elemental human endeavor. Adults know they can often ease the pain of a child with a gentle rub, a kiss, a held hand, and yet, pain is universally undertreated in medicine. Studies over the past twenty years demonstrate little, if any, improvement in this endeavor. Regulatory bodies trumpeted the undertreatment of pain as a massive public health problem, a challenge that is complicated by the epidemic abuse patterns of prescription narcotic medications. Insensitive or inadequate attention to pain can devalue the patient’s experience, cause further isolation and push the person deeper into the dark shadows. For a profession that pledges to “do no harm,” the undertreatment of pain, or oligoanalgesia, borders on egregious ethical conduct. 

In this seminar, we take on the big question of pain as a truly interdisciplinary enterprise, drawing on the rich and varied faculty of Brown University and Alpert Medical School. We will examine acute and chronic pain, physical and psychic pain, individual and collective, social pain.  We will also consider the nature of suffering;  why certain people might find value, even solace, in pain and suffering; representations of pain in literature, art, and music; shifting conceptions of pain and suffering across cultural,  ethnic, and religious communities.  We’ll examine the actual and perceived barriers to effective treatment of pain. Most importantly, we aim to foster sensitivity and impart tools that will improve our understanding and treatment of individuals of pain.

The seminar will attempt to engage questions associated with both medical and humanistic education, including:

1. Why pain can be so difficult to understand and treat
2. Multiple meanings  of pain,  the consequences of uncontrolled pain, and the importance of pain in our lives
3. Barriers to pain assessment and management 
4. Benefits of interdisciplinary investigation into complex problems

BIOL 3710A - Humanities as Medical Instruments

Instructors: Kevin Liou, MD'14; Jay Baruch, MD

"Much medical training is about information and knowledge and less about traveling the more difficult path of feeling…it’s crucial for doctors to stay with the feeling, listen feelingly, and not turn away from the pain and suffering in patients and themselves. There is one shining difference between knowledge and understanding: We doctors may forget knowledge, but we never forget what we understand. We understand through feeling."

- Samuel Shem, “Fiction as Resistance”

The work of medicine is a complex endeavor that requires more than simple scientific knowledge and technical expertise. The sciences can give us tools to examine the anatomy and physiology of patients and the biochemical mechanisms of diseases but they cannot help us feel the pain of others, or give us insight into human suffering.  Scientific knowledge alone cannot teach us how to interpret the stories of patients, how to respond to their experiences, or how to make sense of their illnesses.  To care for sick, we must turn to the humanities to gain a deeper, more nuanced understanding of how we live and suffer.  In this interdisciplinary elective, students will have the opportunity to explore the pragmatic value of the humanities in medical practice and education.  

Through the diverse lens of art, poetry, literature, graphic novels, comics, music, film, and performing arts, second-year medical students will acquire the clinical skills to translate their scientific knowledge into effective, compassionate care.  They will also serve as teaching fellows for Integrated Clinical Arts, a series of interactive, humanities-based workshops designed to strengthen the clinical skills of first-year medical students, deepen their capacity for empathy, imagination, and creativity in medical practice, and foster new ways of thinking about medical issues. 

Goals:

• Examine how the humanities provide essential, pragmatic tools for the work of medicine
• Formulate and apply an interdisciplinary approach to medical education that strengthens the clinical skills of medical students and deepens their capacity for empathy, imagination, and creativity in medical practice
• Promote new, diverse ways of thinking about medicine through collaboration with the humanities, arts, and sciences
• Discover and develop one’s “voice” by teaching and mentoring fellow students

Medical-Legal Narrative Seminar Series

Instructor: Liz Tobin Tyler, JD, MA

Seminar 1: The Patient Narrative - Understanding the Patient’s Narrative in Social Context

This seminar will explore the multilayered nature of patient narrative and the relationship between the “health narrative” and the patient’s social context. What do patients’ stories tell us about the social context of their lives? How does social environment (the patient’s socio-economic status, social supports, family, employment status, etc.) impact health and a patient’s understanding of health? What is the role of law and social policy in constructing that social context? What is the role of personal responsibility, knowledge, efficacy in shaping social context? How should physicians elicit a patient’s story to better understand social context and to effectively respond in order to improve health?

Seminar 2: The Doctor/Lawyer Narrative - Stories of Conflict and Stories of Collaboration

Lawyers and doctors have always had a complex, if not antagonistic relationship. How is the doctor-lawyer relationship narrative constructed by the media, by our educational institutions, by the healthcare system? Does the narrative have to be adversarial (i.e., lawyers suing doctors for medical negligence)? Is there room for a narrative that exemplifies mutual respect, collaboration and support to find the most effective avenue to improved patient health? This seminar will explore various narratives of the doctor/patient relationship, including newer models of collaboration such as the medical-legal partnership, in which doctors and lawyers educate one another about their respective professions and work side-by-side to serve vulnerable patients and clients.

Seminar 3: The Societal Narrative - How Advocates Tell Stories about Health and Justice

Doctors and lawyers can both serve as critical advocates for improving patient and population health and the health care system. They may be critical players in focusing the attention of the media and policymakers on the links between law, social policy and health outcomes. But what is the most effective way to tell the “story” of patient and population health to effect change? What narratives are compelling in the policy arena? For the media? This seminar will explore health, health care and health policy narratives and the ways in which those narratives are interpreted and used by the media and/or policymakers.