Medicine and humanities combine to improve the human condition

In the largely negative media coverage of a health system under strain, we can forget that not only are the majority of people treated well but also that there is constant progress in the development of services and technologies in Ireland.

An unheralded example is the Nimis system developed by the HSE whereby nearly all X-rays in the public hospital system are now digitised and can be seen online by doctors (with appropriate clearance) throughout the country.

For example, when we use clot-busting drugs with a patient with a stroke in Tallaght Hospital and are also considering clot retrieval in Beaumont Hospital, the brain scans can be seen simultaneously on both sites.

My own hospital in Tallaght has taken a particular interest in the use of technology to enhance access to and quality of care: our department of geriatric medicine had the first telemedicine service in stroke in the country in 2009.

The system linked the consultant geriatrician on duty at home to a mobile robot in the emergency department of Tallaght, Naas and Mullingar hospitals. This enabled round-the-clock access to clot-busting drugs across three hospitals. It was shown to be safe and effective, and paved the way for the ongoing roll-out of a national system.

Doctors and arts academics

A new, and to some surprising, use of technology pioneered at the hospital in recent months linked doctors in the hospital to arts and humanities academics in Trinity College Dublin for research seminars in the medical humanities.

The humanities have been a long-standing but variably articulated element of medicine since classical times. They came into sharper focus through the work of Ed Pellegrino (1920-2013), an American pioneer in promoting the medical humanities as a specific area of study.

His aphorism, that medicine was the most humane of the sciences and the most scientific of the humanities, reminds us that medicine is itself one of the humanities.

The contribution of the humanities is to provide a deeper and broader understanding of what it is to be human, of wellness, ill-health and our interaction with the health systems. Literature, history, philosophy, music, art, cinema and many other areas of scholarship provide the basis for studying this bigger picture.

A number of doctors and nurses across Ireland are engaged in research in the medical humanities: for example, in arts and health, ethics and history at Tallaght Hospital. An ongoing challenge is ensuring continuing linkage with the methodologies of the broader arts and humanities.

Physical distance and time pressures are potent barriers. For example, while TCD has taken a lead in hosting postgraduate seminars in medical humanities, a one-hour seminar would consume three hours if doctors were to travel to the humanities centre (the Long Room Hub) in the city centre campus, or for arts/humanities scholars to travel to the hospital.

In response we have developed interactive video links so that healthcare and humanities academics and students can meet virtually and debate the topic presented. We also match each speaker with a discussant from the other faculty to promote in-depth interdisciplinarity.

Fresh perspectives

This month’s seminar illustrated the benefits of this approach. A lecturer in French examined the writing of Louis Wolfson with a psychiatrist as discussant.

An American diagnosed with schizophrenia, Wolfson developed an intolerance of his native English language. His first book, Le Schizo et les langues, is written in what at first sight is French but hovers in a limbo between several languages, with phonetic borrowings for English phrases from a range of languages that he taught himself that would not be out of place in Myles na Gopaleen.

This exploration provided deep insights into the lived life of mental health above and beyond our usual categorisations and definitions.

The ensuing discussions in real time between hospital and humanities institutes unpicked a range of fresh perspectives, including the reliability of his diagnosis and reflections on a range of writers who wrote in other languages by choice, with French appearing to lead the way for the Russian, Andreï Makine, and the erstwhile Anglophone Canadian, Nancy Huston.

While these exchanges might seem esoteric to the lay public, they are no less important than molecular research in understanding and responding to the human condition. Just as technology supports technical aspects of healthcare, it is exciting to realise that it can also advance our understanding of meaning and narratives in health and illness.

A version of this column appeared as a BMJ Blog. Prof Des O’Neill is a consultant geriatrician at Tallaght Hospital and co-chair of the Medical and Health Humanities Initiative at Trinity College Dublin