Tools of the Trade

Dr John C M Gillies, formerly Chair, RCGP Scotland

Education for compassion in healthcare: poetry for new doctors

‘Our great task is to succeed in becoming more human.’
 Jose Saramago. 1922-2010. Nobel laureate for literature 1998.
 
If you believe, as I do, that we are human beings first and doctors second, then the Portuguese novelist Saramago’s aphorism has something to tell us about how we should educate doctors. There is plenty of evidence that over the course of undergraduate medical education, students become more focused on the knowledge base of medicine—vital for the safety of patients in the future—but less focused on patients as human beings. To borrow from a definition of generalism[i], they learn to privilege biotechnical information over a biographical knowledge and understanding of the patient before them.
 
We are now more aware of this as an issue. Gawande[ii] states that medicine encompasses a relationship between two human beings, one of whom wants to help the other.  It is in the interstices of these relationships that the roots of compassion lie and are nourished.
 
How can the humanities help us as doctors, to become more human, to retain and develop our compassion in the face of constant exposure to human pain and suffering? The idea of a book of poems for new doctors was that of Dr Lesley Morrison, GP in Hawick, Scottish Borders. Her colleague Dr Pat Manson MRCGP, a distinguished, creative and compassionate GP and medical educator in the Scottish Borders encouraged the idea but sadly died before it came to fruition. Dr Morrison has been instrumental in completing the task, which has been supported by his family, colleagues and many of his patients. Scottish Poetry Library through Lilias Fraser provided their considerable professional expertise, as did Rev Ali Newell, chaplain at University of Edinburgh. As Chair of Royal College of General Practitioners (Scotland), I suggested poems and provided some publicity. The Scottish Deans Medical Educators Group have been positive and enthusiastic about the project.  We feel that the resulting book, Tools of the Trade, is both a fitting tribute to Dr Manson and a helpful resource for new doctors.
 
Tools of the Trade [iii], a slim volume of 50 poems, was given free to over 850 new graduates from the four Scottish medical schools—Aberdeen, Dundee, Edinburgh and Glasgow in 2015.  All 2016 graduates will also receive a copy.  We have also been heartened by the demand for copies from both established doctors and others, and encouraged by very positive reviews[iv].
 
The size of the book was selected as that which would fit into a pocket and could be looked at easily by doctors while at work. The title poem, by GP Dr Martin MacIntyre, and many other poems are available on the Scottish Poetry Library website[v] . Some poems (but by no means all) were written by doctors, by patients experiencing illness, and by relatives and friends of patients. They speak to the experiences of being human and dealing with the joys and sorrows of life, including pregnancy and birth, ageing, grief, death and bereavement. There are also a few poems  which take a metaphysical overview; perhaps this may give a useful context for the reality of human suffering witnessed every day by doctors.
 
Compassion is a common theme in many of the poems. This is the last stanza of Michael Rosen’s poem ‘These are the hands’, written for the 60th anniversary of the NHS:
 
And these are the hands
That stop the leaks
Empty the pan
Wipe the pipes
Carry the can
Clamp the veins
Make the cast
Log the dose
And touch us last.
 
Using hands as the parts of the body which make human contact and perform the hard and often difficult work of physical caring can enable us to see the patient as an individual person deserving and in need of our compassion as doctors. Martin MacIntyre’s title poem concludes:
 
To take a full history, examine closely and reach a
Working diagnosis: ‘You are a human being.
The stars sing as whitely as the mountains.’
 
To investigate with prudence
To reconsider the prognosis in the light of better quality
Information.
To appreciate; pass on; ponder
challenge, relinquish,
allow, accept
Be accosted by dignity.
To forgive and free.
 
To be able to do all of this as a young doctor requires a full set of tools of the trade, in working order and frequently honed and sharpened. We hope that our volume will help with this.
 
However, can such a book help with educating compassion? And how would you measure any effect in an era dominated by reductionist, left hemispheric approaches[vi]? The world becomes our measure of it.  There is a possibility of psychologists in Glasgow University evaluating the effect of the book on new doctors.  However, we are to date pleased by the reviews and by informal feedback from some of the new doctor recipients.  We hope that the book will encourage them to consider the patient as well as the illness, to become aware that ‘writing prescriptions is easy; coming to an understanding with people is difficult[vii]’. Gaining that understanding is both necessary and worthwhile for the practice of medicine, and for embracing and developing the compassion that is central to the medical gaze.
 
In the epigraph to this piece, Saramago challenges us to ’succeed in becoming more human’. Douglas Dunn in his poem ‘Disenchantments’ shows us how. All of us—doctors, patients and poets—need to ‘look to the living, love them, and hold on’.
 
John C M Gillies MA(Med Ethics & law), FRCGP, FRCPE
 
References

[i] Reeve J. Protecting generalism: moving on from evidence based medicine. BJGP 2010;60: 521-523.

[ii] Gawande, A. Being Mortal: Illness, medicine and what matters in the end. Profile Books, New York  2014.

[iii] Tools of the Trade: poems for new doctors. Eds. Dr Lesley Morrison, Dr John Gillies, Rev Ali Newell, Lilias Fraser. Scottish Poetry Library, Edinburgh 2014.

[iv] http://blogs.bmj.com/bmj/2014/06/23/richard-smith-a-book-of-poems-for-me...

[v] http://www.scottishpoetrylibrary.org.uk/poetry/poems/tools-trade

[vi] McGilchrist, I. The Master and his Emissary. Yale UP, Boston 2012.

[vii] Kafka, F. from “A Country Doctor’. Trans. Dr Iain Bamforth.  Br. J. General Practice 1999: 49; 1036-9.