In the past five years, the landscape of medicine has changed drastically for patients and providers, from the rising use of informatics to the widening gap among the iron triangle of access, quality, and cost of care laid bare by the COVID-19 pandemic. This is coupled with the challenges of caring for an aging population, rendering the practice of medicine, and anesthesiology in particular, more complex, necessitating creative solutions. Moreover, the post-pandemic era of medicine has highlighted the impact of burnout among health care professionals and the need to infuse empathy into medical settings for both patients and providers. Challenges like these require creative problem-solving, a practice that is best achieved through a diverse workforce that brings multiple perspectives, life experiences, and varied insights to bear on issues at hand. The burgeoning field of medical humanities, built upon a foundation of creative practice, comfort with ambiguity, and unique approaches to challenging topics and subjects, can be used as a springboard for diversity, equity, and inclusion (DEI) as well as a tool to tackle some of health care's most pressing challenges, particularly within anesthesiology.
Anesthesiologists as artists
At the crux of the anesthesiologist's practice is the nexus of high-stakes communication and real-time decision making. We narrate complex data to surgeons, to one another, and to patients in ways that each require a distinct voice. In doing so, anesthesiologists adeptly combine evidence-based medicine with storytelling. In the few minutes an anesthesiologist has to gain rapport with a patient or discern a diagnosis, it is the skill of persuasive, effective communication that can help bridge the gap between patients and providers or even provider to provider. These conversations must be compelling, clear, and moving. During the early stages of the COVID-19 pandemic, the chasm of information and misinformation between the public and health care professionals became especially salient. Conveying health information to the public requires communicating in ways that others can understand and also use as motivation to change or modify behavior. It is this ability to simultaneously distill complex data into a digestible story as well as communicate health information that can be strengthened through the practices of the medical humanities. At Stanford, this practice takes myriad forms and has been effective from the level of trainee to senior faculty. Whether through writing workshops and courses, live storytelling training, or discussions of captivating literature, the effects of these experiences mirror those published by institutions offering similar programming: positive impacts on patient-centered care (Patient Educ Couns 2013;91:280-6).
The role of medical humanities in DEI efforts
The medical humanities have also been effective in conveying intangible and hard-to-teach subjects of medical training, including the relational, reflective, and interpretive care necessary for professional development and appropriate patient outcomes among diverse patient populations and on diverse teams. It is the ability to genuinely understand another's plight that facilitates DEI efforts and positive patient outcomes more generally. Health care professionals cannot truly advocate for a group with whom they bear no emotional understanding. Given the breadth of disparities anesthesiologists have the opportunity to impact – pediatric racial mortality, maternal racial mortality, and even the use of certain anesthetic techniques – we must understand the immense impact our roles can have in bringing justice to medicine each day (Pediatrics 2020;146:e20194113; Anesth Analg 2016;122:472-9). Yet, most DEI instruction is built on informational lectures that lack the self-reflection, transparency, and introspective discussion necessary to spark change. In one pilot using narrative medicine to educate medical school faculty on DEI, participants wrote, “During the workshop I realized how much I bought into and accepted blatantly racist systems without critical thinking. I thought I was doing good, but really I was doing harm. I knew antiracism work was work and required conscious thought and analysis. But I guess I'm still realizing the scope” (Teach Learn Med 2022;24:1-10). Thus, the marriage of literature, art, writing, and conversation can become a powerful tool for advocacy within medicine and beyond. We foster this approach through a complementary curriculum to the Stanford medical students' clerkship curricula by delivering seminars, workshops, and discussions on topics ranging from medical sustainability and psychological trauma to health care of the incarcerated and LGBTQ health.
How the medical humanities foster healing
The process of writing and storytelling can also be an effective tool in building resilience among health care communities and systems struggling with dissatisfaction, depersonalization, frustration, and attrition. The rise of burnout among health care professionals has made attempts at promoting employee wellness increasingly challenging. This is due to many factors, including the fact that well-intended efforts offered by institutions often do not strike the core of physician burnout. Namely, the misalignment of one's daily work with one's purpose or value system can lead to resentment that too much time is spent on activities that aren't meaningful rather than those that bolster long-term patient and provider well-being. Creative practices, such as reflective writing sessions, live storytelling opportunities, and communication workshops, encourage participants to share both positive and negative experiences, help elucidate one's professional passions, remind individuals of their purpose, and offer space to work through the emotional challenges of anesthesiology, where the time to process our high-acuity practice is both a luxury and often unavailable. The efficacy in this approach is that it shifts the onus of wellness from the individual to the collective. Furthermore, many storytelling and writing opportunities inherently require an audience, and it is audiences who facilitate change and hold institutions accountable.
Beyond potential improvements on individual and collective well-being, medical humanities training, especially creative writing and speaking opportunities, supports a more informed population in matters of public health. Physicians and other dispensers of public health information who are able to share information in clear, accessible, and moving ways make for a lay public that is less vulnerable to medical misinformation. Physicians and other clinicians must learn to be engaging, agile, authentic communicators because what is at stake is humanity's understanding of, and interest in, public health and medicine.
Where do we grow from here?
The power of stories is part of the human spirit and inextricable from the practice of medicine. Nearly every encounter with a patient – every preoperative consult and postoperative follow-up – is an opportunity to engage one's humanity and communicate authentically, persuasively, and vulnerably in support of a good outcome. The medical humanities are merely another way of referring to a practice that excellent healers have done for millennia, that is connecting powerfully in high-stakes situations in which the pathway forward isn't always clear. We believe the incorporation of medical humanities tenets into medical training, department team-building, and faculty professional development can serve as a powerful tool to equip anesthesiologists to tackle the greatest challenge of our times: equity in all its forms.