More to the story: how the medical humanities can learn from and enrich health communication studies

ABSTRACT

The fields of communication studies and the medical humanities intersect and inform each other in interesting and important ways; and yet, these connections are rarely made explicit. As such, this special collection of articles from scholars in diverse fields such as disability studies, communication studies, the medical humanities, philosophy, and medicine discuss the ways that these fields diverge and converge and what we can learn from one another when we dissolve disciplinary divisions. In this Guest Editor’s Introduction, I explore broadly how health communication studies informs the medical humanities and medical education, as well as how embracing the philosophical, pedagogical, and methodological approaches of the medical humanities can, in turn, expand and enrich health communication studies. I make my argument by drawing on the various ways the medical humanities can inform communication studies, as illustrated by the essays included in this special issue: by offering more expansive notions of forgiveness at the end of life and what it takes to authentically engage with “difficult” patients; by taking a more critical look at how clinical, social scientific, and communication research on disability, race, gender, or socioeconomic status might reify problematic stereotypes and generalizations; and by centering medical pedagogy on the question of who we want our future clinicians to be, rather than how we want them to behave.

KEYWORDS:

• Medical humanities
• communication studies
• health communication
• medical pedagogy
• medical professionalism

Notes

1. Johanna Shapiro et al., “Medical Humanities and Their Discontents: Definitions, Critiques, and Implications,” Academic Medicine 84, no. 2 (2009): 192.

2. Thomas R. Cole, Nathan S. Carlin, and Ronald A. Carson, Medical Humanities: An Introduction (Cambridge: Cambridge University Press, 2014), 1.

3. Mohammadreza Hojat et al., “The Devil Is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School,” Academic Medicine: Journal of the Association of American Medical Colleges 84, no. 9 (2009): 1182–91; Eric S. Williams and Asheley Cockrell Skinner, “Outcomes of Physician Job Satisfaction: A Narrative Review, Implications, and Directions for Future Research,” Health Care Management Review 28, no. 2 (2003): 119–39; See also Alexi A. Wright et al., “Associations between End-of-Life Discussions, Patient Mental Health, Medical Care near Death, and Caregiver Bereavement Adjustment,” JAMA 300, no. 14 (2008): 1665–73.

4. M. Kim Marvel et al., “Soliciting the Patient’s Agenda: Have We Improved?” JAMA 281, no. 3 (1999): 283–7; Ruth Patricia McNair, Kelsey Hegarty, and Angela Taft, “From Silence to Sensitivity: A New Identity Disclosure Model to Facilitate Disclosure for Same-Sex Attracted Women in General Practice Consultations,” Social Science and Medicine 75, no. 1 (2012): 208–16; Sharon M. Parker et al., “A Systematic Review of Prognostic/End-of-Life Communication with Adults in the Advanced Stages of a Life-Limiting Illness: Patient/Caregiver Preferences for the Content, Style, and Timing of Information,” Journal of Pain and Symptom Management 34, no. 1 (2007): 81–93.

5. For more on the use of narrative in social scientific research related to health and illness, see Lars-Christer Hyden, “Illness and Narrative,” Sociology of Health & Illness 19, no. 1 (1997): 48–69.

6. See Lynn M. Harter, Phyllis M. Japp, and Christina S. Beck, eds., Narratives, Health, and Healing: Communication Theory, Research, and Practice (Mahwah, NJ: Erlbaum, 2005); Carla L. Fisher, Coping Together, Side by Side: Enriching Mother–Daughter Communication Across the Breast Cancer Journey (New York: Hampton Press, 2014); Elaine Wittenberg-Lyles et al., Dying with Comfort: Family Illness Narratives and Early Palliative Care (New York: Hampton Press, 2010); Laura L. Ellingson, Engaging Crystallization in Qualitative Research: An Introduction (Thousand Oaks, CA: Sage, 2008); Elissa Foster, Communicating at the End of Life: Finding Magic in the Mundane (London: Routledge, 2006); Lynn M. Harter, Imagining New Normals: A Narrative Framework for Health Communication (Dubuque, IA: Kendall Hunt, 2012); Wayne Beach, The Cancer Play, https://www.facebook.com/The-Cancer-Play-433814780045649/info/?tab=page_info.

7. Elizabeth A. Suter, “Introduction: Critical Approaches to Family Communication Research: Representation, Critique, and Praxis,” Journal of Family Communication 16, no. 1 (2016): 1–8.

8. Walter F. Baile et al., “SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer,” The Oncologist 5, no. 4 (2000): 302–11.

9. See Xiaoquan Zhao, “Relationships Between Sources of Health Information and Diabetes Knowledge in the US Hispanic Population,” Health Communication 29, no. 6 (2014): 574–85.

10. Ichiro Kawachi, “Why the United States is Not Number One in Health,” in Healthy, Wealthy, & Fair: Health Care and the Good Society, ed. James A. Morone and Lawrence R. Jacobs (Oxford: Oxford University Press, 2005), 19–36.

11. Dominique G. Ruggieri et al., “Perceived Colonoscopy Barriers and Facilitators Among Urban African American Patients and Their Medical Residents,” Journal of Health Communication 18, no. 4 (2013): 372–90.

12. John F. Dovidio et al., “Disparities and Distrust: The Implications of Psychological Processes for Understanding Racial Disparities in Health and Health Care,” Social Science & Medicine 67, no. 3 (2008): 478–86.

13. For more, see Jonathan Metzel, Helena Hansen, and Sewit Bereket, “Structural Competency,” Structural Competency, http://structuralcompetency.org/.

14. Ronald A. Carson, “On Metaphorical Concentration: Language and Meaning in Patient–Physician Relations,” The Journal of Medicine and Philosophy 36, no. 4 (2011): 389.

15. Howard Brody, “My Story Is Broken: Can You Help Me Fix It? Medical Ethics and the Joint Construction of Narrative,” Literature and Medicine 13, no. 1 (1994): 80; Carl Edvard Rudebeck, “Grasping the Existential Anatomy: The Role of Bodily Empathy in Clinical Communication,” in Handbook of Phenomenology and Medicine, ed. S. Kay Toombs (Dordrecht, Netherlands: Kluwer, 2001), 297–316.

16. Rudebeck, “Grasping the Existential Anatomy,” 297.

17. Brody, “My Story Is Broken.” For a similar perspective that emphasizes the phenomenology of illness, see S. Kay Toombs, The Meaning of Illness: A Phenomenological Account of the Different Perspectives of Physician and Patients (Boston: Kluwer Academic, 1993).

18. Fredrik Svenaeus, “Hermeneutics of Medicine in the Wake of Gadamer: The Issue of Phronesis,” Theoretical Medicine and Bioethics 24, no. 5 (2003): 408, 415.

19. Ibid., 416.

20. For example, those informed by George L. Engel’s biopsychosocial model; advocates of the patient-centered clinical method as put forth by Michael Balint in the 1950s; and those who emphasize the importance of narrative approaches to medicine. See Ian R. McWhinney, “Focusing on Lived Experience: The Evolution of Clinical Method in Western Medicine,” in Handbook of Phenomenology and Medicine, ed. S. Kay Toombs (Dordrecht, Netherlands: Kluwer, 2001), 331–50; Katherine Montgomery, “Medical Ethics: Literature, Literary Studies, and the Question of Interdisciplinarity,” in The Nature and Prospect of Bioethics, ed. Franklin G. Miller, John C. Fletcher, and James M. Humber (Totowa, NJ: Humana Press, 2003), 141–78; Anne Hudson Jones, “Literature and Medicine: Traditions and Innovations,” in The Body and the Text: Comparative Essays in Literature and Medicine, ed. Bruce Clarke and Wendell Aycock (Lubbock: Texas Tech University Press, 1990), 11–24; Joanne Trautmann, “The Wonders of Literature in Medical Education,” Mobius 2, no. 3 (1982): 22–31; Rita Charon, “Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust,” JAMA 286, no. 15 (2001): 1897–902.

21. Ronald Carson, “The Hyphenated Space: Liminality in the Doctor–Patient Relationship,” in Stories Matter: The Role of Narrative in Medical Ethics, ed. Rita Charon and Martha Montello (London: Routledge, 2002), 171–82.

22. Ibid., 180.

23. Arno K. Kumagai, “On the Way to Reflection: A Conversation on a Country Path,” Perspectives in Biology and Medicine 56, no. 3 (2013): 367.

24. A recent meta-analysis of randomized control trials shows that elements of the patient–clinician relationship—including trust, empathy, genuineness, and warmth—lead to better health outcomes, including pain relief and control of blood pressure. See John M. Kelley et al., “The Influence of the Patient–Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” PLOS ONE 9, no. 4 (2014): e94207. See also Suzanne Koven, “The Doctor’s New Dilemma,” New England Journal of Medicine 374, no. 7 (2016): 608–9.

25. See Andrew H. Brainard and Heather C. Brislen, “Viewpoint: Learning Professionalism: A View from the Trenches,” Academic Medicine 82, no. 11 (2007): 1010–4; Frederic William Hafferty, “Professionalism and the Socialization of Medical Students,” in Teaching Medical Professionalism, ed. Richard L. Cruess, Sylvia R. Cruess, and Yvonne Steinert (Cambridge: Cambridge University Press, 2009), 53–70; Thomas S. Inui, A Flag in the Wind: Educating for Medical Professionalism (Washington, DC: Association of American Medical Colleges, 2003).