Preface

You are so young, so much before all beginning, and I would like to beg you, dear Sir, as well as I can, to have patience with everything unresolved in your heart and to try to love the questions themselves as if they were locked rooms or books written in a very foreign language. . . . Live the questions now.--Rainer Maria Rilke, Letters to a Young Poet (translation by Stephen Mitchell) When Mike Whitcomb first suggested that Academic Medicine publish a special theme issue on the medical humanities, I was excited at the prospect. When he suggested that I oversee the issue, I admit I was less enthusiastic. Having put together an earlier (and smaller) theme issue on the humanities, as well as a supplement on the arts and aging, not to mention handling the Medicine and the Arts (MATA) column and its ten-year anniversary book, I felt a little (dare I admit it?) weary of working on issues related to the humanities in medicine. I had recently turned over the day-to-day work on MATA to staff editor Anne Farmakidis, initially with reluctance (it was my “baby” after all), then with increasing relief. Further, as managing editor I had many new duties, including negotiating a contract with a new publisher. I secretly hoped Mike would forget about this idea, but when the AAMC agreed to cosponsor a fall conference at New York University School of Medicine (The Healing Continuum: Medical Humanities and the Good Doctor, October 17-18) Mike only became more interested in publishing a theme issue--and we now had an issue month to aim for: October, the month the conference was scheduled to take place. I took the step of roping Anne into working with me on the theme issue, then proceeded to drag my feet. Finally, in January of this year I knew I had to get started soliciting manuscripts or we would never meet the October deadline. I already knew about many programs through my work on the MATA column, and, thanks to the Internet, learning more about others was a relatively easy task. As I began making lists and contacting schools, I came to realize that this issue had the potential to be very important, not only to those teaching in the humanities but also to other medical educators and administrators. As I noted the number and diversity of programs in the United States, Canada, and abroad, it seemed that the poor stepchild of medical education had come into its own, now occupying more space in the curriculum than it had when I first began working with scholars in this field over a decade ago. It seemed important to document this success and highlight the hard work and commitment of those who had created and sustained these programs. It quickly became clear that my biggest problem would be narrowing down to a manageable size the list of programs to include. Not surprising, I have only one regret about this issue, and that is that there wasn’t space to include more programs, and I know some readers will feel dismayed that their programs weren’t included. As Anne and I made our choices, we focused on curricula that were substantive and/or comprehensive (as opposed to single courses) and/or those that seemed particularly innovative. I wanted to be sure a range of types of programs--BS-MD, college-level, UMG, GME--were represented, as well as a range of geographic locales and private and public institutions. I made an effort to choose programs that might be less familiar to people while also including some well-established programs such as those at Penn, Galveston, and East Carolina. Finally, I wanted to incorporate as many international programs as possible. To ensure that there was enough space for a large representation, Anne and I decided to offer some authors the opportunity to write long articles and others the opportunity to write brief descriptions. However, readers should not infer that the programs covered in the brief articles section are somehow less important than those discussed at greater length. The selection process here was a little more arbitrary: while some curricula were given less space because they were less comprehensive, others found their way into this section because I invited their inclusion late in the process (I kept finding new programs I wanted to include, and kept nudging the deadline envelope a little farther for each one). If the short descriptions or even the longer ones leave you hungry for more information, I encourage you to contact the authors and/or visit the programs’ Web sites. I also recommend that readers who are interested in exploring other programs look at the New York University Medical Humanities site 〈http://endeavor.med.nyu.edu/lit-med/medhum.html〉 and the Web site of the American Society for Bioethics and Humanities 〈www.asbh.org〉, where you will find excellent listings of programs, many of which, unfortunately, could not be included here. The AAMC’s Web site 〈www.aamc.org〉 also has links to all U.S. and Canadian medical school Web sites, and a search for “humanities” at those sites may provide additional information. While, as I said earlier, I am impressed by the place and status the humanities have earned in the medical curriculum, I don’t want to diminish the ongoing struggle of many to hold on to that place and status. We all know the curriculum is jam-packed, with new topics continually vying for space. Bioethics study has often crowded out or subsumed education in such areas as literature, history, and art. And in many schools, humanities courses remain electives, which means, of course, that only those students who already are inclined to such study (or those who see the humanities as an “easy A”) tend to take them. As medical science continues to make enormous strides in its understanding of the workings of the human body, the origins of illness, and the prospect for heretofore unimaginable cures, those who devise curricula may be inclined to squeeze the humanities out again. After all, isn’t the study of genetics now more important than the study of dead novelists or the history of medicine? However, as many of the authors in this theme issue argue, advances in medicine make the study of the humanities even more relevant and necessary. As our understanding of the mechanisms of disease and the technology for diagnosing and healing become more complex, so too do the human questions that accompany them. Science still hasn’t found a way to break the human condition into neat parts, or to understand the nonphysical aspects of illness, wellness, mortality, values, or spirituality. The study of the humanities can illuminate human interactions and concerns in a way the genome map or nanomedicine cannot. Such study can also be humbling--something physicians and researchers, particularly in the United States, badly need. Stem-cell research, advances in organ transplantation, genetic markers, and other innovations and new knowledge, all raise fundamental questions that human beings have grappled with in one way or another through the ages. And the questions raised are not only ethical ones; they are questions about what makes us human, what defines us as individuals, how we reconcile the needs of individuals with the needs of the community, what gives meaning to our lives, how we define a “good life.” These are questions all human beings--including or perhaps especially health care workers and patients--ask. These questions are the humanities’ milieu, and while the humanities cannot provide answers any more than the sciences can, they are the best resources to turn to to help us “live the questions.” Lisa R. DittrichLisa R. Dittrich, MFA Managing Editor

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