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"Davidson's Medical Humanities Program promotes an interdisciplinary understanding of medicine and health care. It enables students to appreciate the strengths and limits of the natural sciences, social sciences, and humanities as they seek to explain and to achieve a measure of control over disease, illness, and suffering. It helps students to grasp the institutional character of health care delivery, especially how legal and political institutions influence the production, distribution, and delivery of services."
-Davidson College Catalog
There is a certain poetic justice to be found within the walls of the old Preyer Infirmary on Concord Road, which opened in 1938 featuring "a waiting-room equipped with brown-upholstered chromium furniture in a distinctly modernistic note," as reported in The Davidsonian of the day.
For more than half a century until 1992, Davidson students looked to Preyer for caring and personal medical attention. In a different sense, they, and now many others, still do. Today, Preyer Building is home to the Medical Humanities Program offices, as well as home to the Pre-Med Program offices.
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The Medical Humanities Program--or "Med Humes," as it is fondly known--is a relatively new program in the context of Davidson's 165-year history, tracing its roots to the mid-1980s, when a changing healthcare marketplace, shifting academic currents, strong donor support, and active alumni involvement converged in curricular evolution.
It was a tall order, but one that stood then--and stands now--on solid ground: Med Humes complements one of the bedrock traditions for which the college is known nationwide: turning out well rounded physicians-to-be. But Medical Humanities is not just for doctors. That, in fact, is the point. Viewed more broadly, the Med Humes program addresses the rapidly increasing need across many career paths--as well as in patients' own decision-making--for learning and understanding healthcare issues.
In a nation that now spends fifteen percent of its gross national product on health care, more and more professionals are being drawn into careers that support (or, in some cases, fight against) an increasingly complex, political, and litigious healthcare delivery system. Even for the rest of us, understanding medical and bioethical perspectives is crucial. After all, just about everybody will be a patient, or consumer, of health care at some point.
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"A humanist education helps you understand that your point of view is not the only point of view," says Dana Professor of Philosophy and Medical Humanities Program Director Lance Stell. "Managing uncertainty is a major part of medicine. You have to make decisions and delay can be costly. The preparation for making wise judgments is one of the goals of a humanist education anyway: good values and imperfect information brought together in good judgment."
Stell is also medical ethicist for the Department of Internal Medicine at Carolinas Medical Center in Charlotte, a large teaching hospital that consistently ranks in the top tiers of its peer institutions. Since 1990, the Medical Humanities Program has enjoyed a partnership with CMC that puts Davidson students in the thick of medical action, whether garnering post-op wisdom in the physicians' lounge at the hospital's Level I trauma center, pondering the implications of a malpractice lawsuit, attending a lecture on the latest in space-shuttle medicine, or standing three feet from the operating table during a neurosurgery.
"To my knowledge, there is no other undergraduate institution with formal ties to a teaching hospital," says Stell.
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The depth and breadth of Davidson's Medical Humanities Program is indeed the exception rather than the rule at four-year liberal arts colleges, says Rosemarie Tong, the program's first director. In 1988, when President John Kuykendall designated the Samuel E. and Mary West Thatcher Professorship to the position and named Tong to fill it, she found many building blocks in place: Professor Don Kimmel's cutting-edge biology course in a growing academic current called "bioethics"; generous donor support from R. Dixon Speas in memory of his brother Frederick Womble Speas '43, from The Duke Endowment, and from other donors; a strong Pre-Med Program already geared to providing its students a comprehensive liberal arts background in addition to preparing them for admission to medical school; ready interdisciplinary participation from an enthusiastic faculty; and active involvement by alumni in the medical fields and others.
"There were a lot of things already in play and in motion that would just require enhancing and building upon and recombining. It is still something that distinguishes us, and we're not just one of the pack, saying, oh, yes, we have that, too. I think Davidson has a major card to play with its Med Humes and its interactive Pre-Med program," says Tong, fondly lapsing into the Davidson "we," though she is now Distinguished Professor Of Health Care Ethics at UNC-Charlotte.
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Kimmel recalls the snowballing academic interest in philosophy and bioethics from the mid-seventies.
"You had determinist ethics, situational ethics, cocktail-party ethics, cool-guy ethics, all of that ... and then in the mid-seventies, bioethics," says Kimmel, now professor emeritus. "All of a sudden, biologists were doing philosophy."
Interest and Principle:
The Medical Humanities Program's curricular home is as a "concentration." As such, it is a very flexible tool for rounding out a given student's college education, whether in a specific direction or on philosophical principle. Three students this year have declared Med Humes their major through the Center for Interdisciplinary Studies. Ten are working on a concentration. Students in the Pre-Med Program (which changed from a separate major to a pre-professional program in the late eighties) are particularly encouraged to take at least a few Med Humes classes (see box). And even for students in arts-and-letters disciplines, many Med Humes courses are just plain popular.
"Fluidity is the whole point," says Michelle Lim '02, who is majoring in Medical Humanities through the Center for Interdisciplinary Studies. Lim arrived at Davidson considering a medical career, but has decided to pursue a legal career centering on bioethical issues.
"Ideally, you should be a doctor and a lawyer," she says, only half-jokingly.
"Even pure scientists should take some Medical Humanities classes," says Professor of Biology Jeremiah Putnam, also director of the Pre-Med Program. He encourages all Pre-Med students to take at least two Med Humes classes, and sometimes pushes for a full concentration.
"Medical schools look at many aspects of student records now," says Putnam. "Community service, solid test scores, medical volunteering, interview presentation--no one thing gets them into medical school."
Sometimes, Med Humes leads a student away from the med school trajectory entirely, and into some other area. And that can be a good thing, says Stell.
"That's one of the great tragedies," says Stell, "the people who are smart enough to be doctors, but it's not suited to them. They are miserable, tortured souls."
Stell's own greatest motivation and pleasure is clearly his students, whatever their planned path. He recalls with unbridled glee the "applied bioethics" story that Beth McNally Zajicek '94 brought back from CMC after her first day shadowing doctors there.
"Beth is petite, and 'just as sweet as she can be,' and she came across this one surgeon who was pretty arrogant, who told her that medical ethics was b.s.," Stell recalls. "She backed him into a corner, expressing dismay that a highly-respected member of the profession would discount the underpinnings of his own calling. I had good reason to credit Beth's story, because the version recounted by the surgeon matched hers."
Beth is now Dr. Zajicek, and nearing the end of a radiology residency at Baylor University Medical Center.
Shadowing physicians in their natural habitat at CMC is one of the major pluses of Med Humes, says Bill Williams, M.D. '69, particularly in today's fast-paced medical world.
"A lot of important medical information turns over every five years," says Williams.
For example, just think of all the choices engendered by increasing medical technology, information access and security, targeted labwork, virtual humans, reproductive medicine, and genetic engineering and profiling--not to mention the potential for profiling in insurance company databases.
"It doesn't take a lot of imagination to recognize the dangers," says Williams.
In addition to the medical knowledge and procedural expertise necessary for all of the above, Williams insists that improving professionalism and communication with patients must be top priorities for good doctors.
"Communication? Where's that taught? You think that's taught in medical school? That's the territory of the undergraduate," Williams says with the conviction of experience. Williams received his M.D. from Baylor College of Medicine in 1973, did a residency in internal medicine and another in pediatrics, opened the Davidson Clinic in 1978, later became senior vice president and director of medical education and research at CMC's parent company, Carolinas HealthCare System, then became chief medical officer there. For the past two years, he has been working full-time on upgrading health systems in the United Arab Emirates.
Diversities and Complexities
The increasingly diverse cultural complexion of patient populations, coupled with the convolutions and mutations of the healthcare delivery system, make it imperative that doctors learn how to be advocates for their patients, says Williams. That's where the leadership skills and broad knowledge base of Davidson students in general and Medical Humanities students in particular come in handy.
"Very few health needs are confined to the specifics of a virus or a particular malady," sums up Williams. "There are two sides to the doctor-patient relationship, and we want both sides covered."
Matt McKillop '99 is acutely aware of the advantages Medical Humanities has given him in that regard. A Davidson English major and Med Humes concentrator who is now in his third year at the University of Florida College of Medicine, McKillop says, "Learning the human side of medicine, patients' stories, how illness affects their lives, that's not something you get a lot of in medical school.
"I was surprised at the paucity of knowledge that people had of medical ethics, the groundbreaking landmark cases that led to what is considered modern medical ethics. I haven't met someone with an equivalent background (as Medical Humanities). Unfortunately, the discussion doesn't come up that often, but I can tell some of my colleagues are impressed with the background knowledge I'm coming in with, and these are extremely intelligent people coming in. The Medical Humanities Program is a distinct advantage that Davidson has, and just the overall education from Davidson in general has done me a great service."
That kind of gratitude motivates many alumni supporters. K.D. Weeks, M.D. '69, for example, lives in the Lake Norman area and mentors Davidson students through the Physician Mentor Program of the Pre-Medical Program, when he's not busy running Mid-Carolina Cardiology in Huntersville and Mooresville. Mentoring and shadowing opportunities in local facilities have long been a hallmark of Pre-Med, just as mentoring and shadowing are integral, too, in Medical Humanities' relationship with CMC.
"I have a particular bias toward Davidson students who are candidates for medicine," says Weeks. "I've seen lots of them. I was director of intern training at Walter Reed Army Medical Center. You always knew what you were going to get with a Davidson student. It's very rare that they're not prepared, or that they don't know what they're getting into. You know you'll get a conscientious person, an intellectually honest person, and a highly durable person. Most of them have personality and all of them have character."
There's another angle to gratitude that's important to remember here, too, says Michael Thomason, M.D. '74, associate chairman of the department of general surgery at CMC, who coordinates much of the surgical shadowing that Med Humes students do at the hospital. Thomason says he's especially glad for the fresh presence of students on the inevitable days when things like a high operating-room mortality rate or exhausting red tape with insurance companies make him feel down or jaded.
"Having these undergraduates there refreshes my perspective on why I do what I do," says Thomason.
Having an undergraduate shadow, full of all kinds of questions, is definitely a plus for the doctors, both intellectually and ethically, agrees Wes Hofferbert, M.D. '88, an attending physician at CMC.
"As a clinician, often, I'm not always thinking about the why's, I'm just thinking of what comes next," says Hofferbert. "It's good to be pushed now and then."
For students, these on-site contacts as well as on-campus classes prove invaluable in understanding medical and bioethical issues in their larger contexts.
"It's not like a math problem when you can get the right answer," says Kristin LeBlanc '02, co-editor of the Medical Humanities student newsletter, The Ethical View. She is planning a career in clinical bioethics. "You can grapple with these issues for years and still not have your own foundation."
From the Pre-Med perspective, says Putnam, Med Humes is good for Davidson's next generation of doctors, and so it's good for their patients, too.
"The Medical Humanities Program has extended the definition of 'what it takes' to be a good doctor from the sciences to include the medical humanities," says Putnam.
The same can be said in a broader sense for many professional careers, agrees Stell, whether healthcare-related or not.
"The Medical Humanities Program is simply a more intentional and formalized effort in Davidson's tradition of producing professionals well-rounded in the humanities," says Stell.
Kimmel looks back over three decades of biology, ethics and medical humanities at Davidson.
"What Med Humes has done, among other things," says Kimmel, "is to open up a beautiful way to go through a rigorous education."
And that's a solid foundation for keeping "whole" and "health" together.
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