Ellen Melamed’s medical humanities courses at the University of Arizona are encouraging medical students to develop empathetic relationships with their future patients.
Melamed, the child of Holocaust survivors, draws on her family’s history of trauma and illness, as well as her own experiences in the arts, to inform her teaching.
On Tuesday, April 30, first-year medical students sit in a roundtable forum for two hours in the UA Poetry Center to discuss some of the ethical questions that can overwhelm physicians and medical students.
Each student is given an article or blog to read and analyze. The first few articles speak to the rise in physician suicide and mental health stigmas within the medical community.
One student says her author highlights the overwhelming stigma attached to mental health deterioration in the medical community. She describes the domino effect of physicians being unable to talk about their mental health to their colleagues, thereby affecting the relationships they have with their patients.
When mental health is stigmatized in the medical community, it stigmatizes patients, she says, thereby dehumanizing the practice of medicine.
“It’s important that we are able to speak to people in need,” she says.
Another student’s presentation includes some thoughtful reflections on the topic of physician suicide.
“We suffer the knowledge that our mistakes cause people’s deaths,” she says.
Melamed adds that physicians are pressured to rush through grief for their patients because of busy schedules and mental health stigma. They are not allowed the luxury of expressing grief.
“Asking doctors how they’re doing is not a common practice,” Melamed says.
Melamed’s medical humanities classes are part of a movement that has started at medical schools across the country, but she is pioneering its implementation at the UA College of Medicine.
She allows the students to reflect on their articles before bringing in her own experiences to enlighten their interpretation of the texts.
Melamed was versed in the medical community’s problems from a young age, having a variety of hospital experiences with her family members.
She matured quickly, being the primary caregiver for her parents, who were frequently ill.
“My father died of a brain tumor when he was 52 and my sister had serious mental breakdowns; she was born in a displaced-persons camp in Germany with a serious heart problem,” she explains. “I’ve been around the medical world since I was 6 or 7.”
Melamed was surprised by how doctors treated her and her family. They recognized and diagnosed the physical ailments her family experienced but never inquired about the mental traumas they carried.
Her encounters with medical practitioners led her to feel dehumanized, she says, as they disregarded the deeply emotional aspects of being a patient or a
caregiver.
Her sister’s illness at birth and her parent’s survival of the Holocaust were never discussed by her physicians as a cause of their subsequent illnesses.
The work she does in her medical humanities courses illustrates the experiences she had growing up and continues to have, she says.
For example, Melamed uses her experience as a breast cancer patient to build on an article given to one of the students that focused on breast cancer awareness and the corporatization of the disease.
Melamed chimes in after this student’s reflection to provide a relevant example, recalling one of the support groups she attended after being diagnosed, where she was given a gift bag that contained feminine products laced with harmful carcinogens and parabens.
“We have sexualized this cancer and did something disproportionate,” she says, “and with all the propaganda, we forget about the person’s individual experiences.”
In February, the first-year medical students met with Melamed for a different two-hour session that involved interpreting visual art created by physicians, patients, and caregivers.
Utilizing art, she says, helps enhance the students’ observation skills, which are incredibly important for making diagnoses in the future.
Melamed, a former playwright, is a current artist-in-residence of the Alexander Technique at the UA College of Fine Arts. The Alexander Technique retrains students to move their bodies in a way that reduces chronic pain and prevents repetitive injuries.
Melamed structured her medical humanities courses on a model of narrative medicine developed at Columbia University.
Columbia offers a master’s degree in narrative medicine, an aspect of medical humanities that “seeks to strengthen the overarching goals of medicine, public health, and social justice, as well as the intimate, interpersonal experiences of the clinical encounter,” according to the Columbia website.
“I knew the arts were a successful way of enabling people to understand empathy because many people think empathy cannot be learned, but it can,” she says.
Melamed teaches a semester-long class at the UA Honors College for pre-health sciences students who want to dive deeply into the study of medical humanities, while the two two-hour discussion segments are required for first-year medical students at the UA College of Medicine.
Melamed says she is fortunate to be able to teach these courses as a requirement.
“It eliminates the idea that medical humanities are extra-curricular as opposed to integral to a medical curriculum,” she says.
Melamed hopes that her required courses will continue to grow; in the meantime, she recently got approval to teach a semester-long enrichment elective course in medical humanities at the college.
Students actively supported this course and were integral in creating the syllabus with her.
“Two of the students who wrote some of the curricula will not even benefit from it because they will be in their clinicals already, so they can’t take the elective, but they see the value,” she says.
Melamed engages students in class discussions on future curriculum that they would like to see at the college, giving them a voice within their heavily structured coursework.
By incorporating humanities into the study of medicine, Melamed is developing a new way of interpreting patient care at the college that will change how physicians build relationships and diagnose their patients, she says.
“It cannot be stressed enough how important it is to incorporate arts and humanities into the medical curriculum, and I think people see it as primarily beneficial to patients. But I would like to emphasize that physicians and caregivers benefit a great deal because their jobs become more fulfilling,” she says.
