Student Humanities Blog

Parisa Selseleh is a medical student in the Class of 2022 at the University of Manitoba

 

 

Dear you,

I must be honest, I was not looking forward to seeing you in the gloomy October day that coincided with my birthday. Despite my eagerness to learn about human illnesses, I was not ready to shatter my ignorance of human mortality and the hearts that give up. I slowly walked the long hallways leading to your current resting place, the Gross Anatomy Laboratory. Then, I saw you covered by an orange body bag, and in the blink of an eye, I became a medical student.

I had a vague understanding of what it meant to be in the business of mending bodies and minds, but I felt the gravity of my role the moment I saw how. I did not have much medical knowledge when I first met you but slowly, you taught me. How lucky I was. ...continue reading

 Austin Lam is a medical student at the University of Toronto.

 

 

 


 

In a session on narrative medicine in medical school, a clip from the film (2001) was shown in which Vivian Bearing (portrayed by Emma Thompson), an English literature professor, was told that she has Stage IV cancer by Dr. Harvey Kelekian (portrayed by Christopher Lloyd). In this scene, he was, to put it mildly, less than considerate of the gravity that the discussion had for Vivian. He was Efficient. Domineering. Self-interested.

As Dr. Kelekian lectured her on the experimental treatment regime, he emphasized how she would be contributing to “our knowledge." In response, she repeated the word knowledge in a state of disorientation, seemingly to both him and herself.

What struck me the most was a question that came to mind: even if he had communicated in a gentler and more compassionate manner, even if he had mastered the art of breaking bad news, why would I still be left with a visceral feeling of discomfort?

At first glance, a fulsome sense of niceness would seem to be the answer — the answer to the power imbalance between patient and physician, amongst other problems, demonstrated in this movie scene. In fact, has been emphasized as an integral factor in treating patients.

The problem is that even if Dr. Kelekian, or his non-fictional ilk, were nice — maybe even counting amongst the nicest people in one’s life — there remains an ostensibly irreconcilable gulf between his stance of epistemic objectivity (“our knowledge”), , and that of so-called subjectivity in Vivian’s phenomenological reality, grounded in her experiences. The divide is not a Manichean duality. It is not that there is an inherent ‘rightness’ or ‘wrongness’ in one or the other.

The trouble lies in how the manner of approaching the patient’s concern(s) is framed: to explore that which is objective, and to this, adding considerations of the subjective (or the reverse in some cases). The conceptual divide between objective and subjective is not and cannot be solved by niceness. A change in attitude hardly substitutes for what is needed, namely, conceptual/philosophical sensibility, and corresponding epistemic humility.

One can imagine a hypothetically transformed nice Dr. Kelekian who nevertheless works under the guiding principle that his set of meanings, those belonging to “our knowledge,” are the ones that are objectively correct — and that when his patient’s meanings align, then all is well; but when they do not, then something has to give. An area not only of mis-understanding, but of non-understanding emerges between the ostensibly nice physician and the patient.

The patient may have a differing position that is judged to be ultimately misguided. It may be seen as a tolerable position or maybe even one with which the physician sympathizes but nonetheless sees as wrong — possibly accompanied by perceptibly nice phrases such as “I hear you, this is what I think…”. The physician may ultimately be ‘right,’ but in what sense? And so, here lies my discomfort: the . Equally, however, this discomfort does not necessarily translate into an espousal of untethered subjectivity.

What follows is not the demand that medicine requires expertise in academic philosophy. Rather, there ought to be a recognition that meanings can have truth, and that this does not require the meanings to be processed, subsumed, or translated into one objective account, the one taken-up and assumed by medicine. This kind of singular account has been as the following position: “the condition of my understanding you as you think and act in your terms is that I construe you as making sense in my terms most of the time.”

The underlying stance is that of ‘observer to object’ — the medical gaze — a notion introduced by philosopher Michel Foucault in . The medical gaze has been “how doctors modify the patient’s story, fitting it into a biomedical paradigm, filtering out non-biomedical material.” Despite many criticisms of Foucault’s ideas, his notion of medical gaze galvanizes further refinement in conceptualizing the constitutive forces in the patient-physician relationship.

The objectifying medical gaze necessitates a correction. However, this cannot be one of plastering ‘subjective’ elements onto ‘objective’ elements nor one of unbridled relativism for fear of losing grasp with reality and ending up with an impoverished category of ‘inner appearances.’ An account of understanding that transcends objective and subjective is needed. Philosopher Hans-Georg Gadamer provided this in his book .

Summarized by , Gadamer’s argument is “ontologically based: human beings are in contact with the real … Gadamer makes central the paradigm of a ‘conversation,’ in his understanding of human science, rather than that of an inquiring subject studying an object. Success comes, not with an adequate theory of the object, but with the ‘fusion of horizons.’” In essence, he challenged the subject-object dichotomy with his ‘conversation’ paradigm.

Again, elegantly wrote:

“If understanding the other is to be construed as fusion of horizons and not as possessing a science of the object, then the slogan might be: no understanding the other without a changed understanding of self … Real understanding always has an identity cost.”

The necessary identity cost cannot be paid for by niceness per se, it demands something more: an authentic conversation, where authenticity involves heeding the call of in a Heideggerian sense.

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 is an Internal Medicine Resident (R1) at the University of Toronto. Check back the last Thursday of each month for a new featured piece as part of his series (Doc Talks: Reflections to Reality)!

 


We are challenged to embrace frailty and a disarray between mind and body when we encounter patients at the end of their life. As we seek to nurture a place of comfort and wholeness for them, we are tested to bear witness to their helplessness, to appreciate their intrinsic values not only as patients but also as people, and to preserve their dignity. Moreover, we are presented with an opportunity to appreciate the internal struggle of their loved ones as they are confronted with a disconnect between the person they have known and loved, and the patient we provide care for in times of declining health.

Penned based on the reflections of numerous families I met on the wards, this piece strives to give a voice to the struggles many encounter alongside their loved ones in the end of life.

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Our voices echoing ...continue reading

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Austin Lam is a medical student at the University of Toronto.

 

 


The importance of mental health has rightly been emphasized in recent times. The stigma surrounding mental illness ought to be dispelled. However, I wish to take a closer examination at the conceptual elephant in the room: the mind-body problem — a philosophical issue that strikes to the core of continuing disparities between how the healthcare apparatus as a whole addresses “mental” versus “physical” health conditions.

As medical historian Roy Porter pointed out in his book (1997): “psychiatry lacks unity and remains hostage to the mind-body problem, buffeted back and forth between psychological and physical definitions of its object and its techniques.” This was a prescient remark. In 2018, the editor-in-chief of Dialogues in Clinical Neuroscience, Florence Thibaut : “recent advances in neuroscience make it more and more difficult to draw a precise line between neurological disorders (considered to be ‘structural brain disorders’) and psychiatric disorders (considered to be ‘functional brain disorders’).”

To begin, let’s analyze the statement — Mental health is health.  ...continue reading

 is an Internal Medicine Resident (R1) at the University of Toronto. Check back the last Thursday of each month for a new featured piece as part of his series (Doc Talks: Reflections to Reality)!

...continue reading

Noémie La Haye-Caty is a medical student in the Class of 2019 at McGill University

 

Katy is sleeping on the exam table. She came in looking tired, talking with a weak voice, and walking with small steps. I tried to ask a few questions, but her lack of sleep was evidently preventing her from answering.

She is here today for a follow-up appointment. She was admitted two weeks ago because she wanted to end her life.

I try to gently wake her up. “How are you doing, Katy?”

“Better.”

“Great! What’s better?”

“I was confused, before.”

“Why were you confused?”

Katy is 24 years old and has three young children. She is now a few weeks pregnant. Two of her children were recently taken by the , while the youngest lives with Katy and Katy’s own mother. Katy tells me that the father of her kids used to be violent with her and has been in prison for the past week. ...continue reading

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 is a medical student in the Class of 2021 at McMaster University

 

“Doctors are jerks.” It was a statement that I had always steadfastly believed to be true; a matter-of-fact statement, just like saying the sky is blue. Though I had no shortage of concrete personal examples to justify my belief, the irony was not lost on me as I stared out from behind the glass of the nursing station, ready to begin my first clinical experience as a new medical student.

I was in the child and adolescent psychiatric ward. From the nursing station, I could see the ward’s common area: the bolted-down tables and chairs, the colourful pictures adorning the walls, the patients scattered about the room—some in groups, some alone. It was a scene that was familiar, yet different. This was far from my first time in a psych ward, but it was my first time being on this side of the glass. ...continue reading

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 is a medical student in the Class of 2019 at the University of Toronto

 

It is well-known that workplaces strive for diversity and inclusion. Studies have shown that diversity improves productivity and contributes to creativity and new ideas. In medicine, this diversity is just as important. Having physicians from under-represented and marginalized communities provides unique views on what may be best for the patient. As medical schools continue to support new initiatives, such as specialized admission pathways for African American and Indigenous students, it is clear diversity is on the agenda. However, for those who are not of the majority ethnicity, diversity may not be enough. There also needs to be representation.

This idea was at the forefront of my mind during an elective rotation. After I had mentioned my interest in Indigenous health a number of times, I was asked by my attending whether I was of Indigenous background. I understood the hesitation, of course; sometimes it can make people feel uncomfortable to ask about your background or where you are from. Nonetheless, I was happy they had asked and I responded with a firm “yes.” ...continue reading

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 is a medical student in the Class of 2020 at Western University

 

It was my first week on service for internal medicine as a third-year clerk. I had finally begun to figure out the labyrinth of charts, forms, and computer apps that went into my interactions with patients. I still had four of the eight pens I’d started with and had managed to misplace my sacred “pocket guide” only twice — so, all in all, I was off to a good start.

I was told by my senior to go see a patient who was in ICU step-down and had recently been transferred to our care. I hurriedly went to the computers and started reading up on the patient’s history.

Mr. C had a long and complicated history. He had initially presented to the hospital with signs of cholecystitis but later developed multiple complications landing him in the ICU. After a flurry of resuscitative measures and close monitoring, Mr. C was finally deemed stable enough to be transferred to the ward. ...continue reading

Shaun Mehta is an Emergency Medicine Resident (R4) at the University of Toronto

 

In elementary school, I always dreaded bringing my report card home. My grades were good, but the teachers’ comments that followed could go either way — and were unfortunately of much more interest to my parents. I was often described as “disruptive,” and it seemed that relinquishing this quality was the key to making something of myself.

Two decades later, I’m finding out that being disruptive is one of my most valuable assets.

To clarify, we probably shouldn’t praise students for being disruptive in the classroom. But outside of the classroom... now, that’s an entirely different story. The health care industry is ripe for disruption; strapped for cash and bursting at the seams, we need better ways to manage today’s volume and complexity of patients. Forward-looking individuals and organizations have heeded the call and are making huge strides in health care innovation, yet patients continue to suffer as a result of systems-level issues.

By shifting our paradigm of innovation, creating an environment to foster disruption, and educating future leaders to drive change, we stand a chance at driving maleficent creatures (like hallway medicine and eternal wait times) to extinction. ...continue reading