A Case for the Humanities
by Faryal Irfan
Manipulative. Dependent. Self-destructive. Those are some of the words used to describe pain patients. Today’s providers may find treating chronic pain patients an uncomfortable experience due to the subjective nature of pain. Despite its universality, science has only come so far in understanding the intricacies of pain. Medical therapies, injections, and spinal stimulators have varying degrees of success in treating chronic pain patients. There is also a not-so-small subset of physicians who deny the non-physiological origins of pain. I argue that a humanitarian education would make physicians more adaptable to the multiple dimensions of pain.
Studies such as philosophy, literature, and history are consistently devalued because they are not objective and economic powerhouses like the STEM fields. Why are pre-medical students required to take these courses as graduation requirements? Removing undergraduate studies would produce more youthful physicians better able to tackle the physical demands of medical training. Less time would also be spent relearning concepts forgotten between undergrad and medical school. However, as I reflect on my anthropological training during undergrad, I believe physicians would be under-equipped if we follow this model.
Through my education, I became comfortable with the conflicting nature of the human experience. During my anthropological training, I was forced to challenge what I thought were obvious truths. Take, for example, the comparison between philosophical and religious views of pain. Stoic and Epicureanism philosophers believed pain was a negative driver of morality as it interfered with our judgments. But in religious texts, such as the Bible, it is the threat of pain that drives good behavior. And if pain is used as divine punishment, why do the religious engage in prayer when undergoing painful experiences?
No single perspective is a complete truth. There is no p-value or meta-analysis I can use to reject the above theories. While a humanitarian education cannot provide absolute answers, it can provide perspective and comfort in the unknown. In my indigenous perspectives class, I was challenged to see other species through human habits. This was one of the more difficult classes I took as an undergraduate. One of our readings suggested jaguars see blood as how humans see beer. “This is nonsense”, I thought. I was pushed to the limits of my intellectual flexibility and wanted to write the class off entirely. Years later in medical school, I’m glad that course challenged my views so I could practice thinking with relativism.
In my third year of medical school, I encountered a “difficult” pain patient. She had chronic musculoskeletal and neuropathic pain. She had lost her son a few years back. She was anxious that her pain was a sign of “something bad”. During my interview, I learned about her pain. Pain was punishment for her son’s death. Pain became a social function through doctor’s appointments. Pain was the fixation of her thoughts, and it had become her identity. It was perhaps because of these reasons she had missed her EMG appointment and medication refills. She was quickly discharged with a lecture on medication adherence. “It’s those types of patients that annoy me”, the physician huffed later. Like my experience with the beer-drinking jaguars, it was easier to see her from our trained perspective of a problematic, rather than a misjudged, patient.
While I was not thrilled to relearn the Krebs cycle for the 3rd time (maybe more) entering medical school, I have found my undergraduate education invaluable during rotations. I was given the framework to understand the complexity of my patients through analysis of religious writing, historical events, and cultural studies in college. A purely medical background would not have only handicapped my ability to contextualize patients with chronic pain but would have accelerated my burnout.
The malingering, the non-compliant, and the dependent are all adjectives that demoralize both patients and providers. If we see patients as incompetent or irresponsible, we spend more time gatekeeping medicine than practicing it. Many patients are unable to communicate their pain effectively, and it is up to physicians to tease out their lived experiences. These are not skills quickly picked up through an accelerated medical program but are instead refined through a liberal education and then integrated into medical practice.
Faryal Irfan is a fourth-year medical student at the UTCOMLS.
