Comfort Care.

Description Death does not thrill me anymore. I am a trauma surgeon extraordinaire! The patient had suffered a traumatic brain injury and has struggled for weeks. He is only 16. Today, the family decided to make him "comfort care." I was at the end of my call, exhausted, drained of all energy. I looked out of the ICU window and saw the fading rain and the city lights. It somehow reminded me of a precious life ebbing away, and I burst into a silent scream. I am still human.

"This will keep me happy for weeks": care objects, affect and graphic medicine.

Looking beyond anthropocentric care relationships reveals nuanced levels of interdependence among human and non-human entities. Attention to these heterogeneous inter-relationships illuminates the subtle and visceral affective intensities among diverse participants, including humans, objects and the environment, among others. The interdisciplinary field of graphic medicine foregrounds these entanglements through comic affordances, challenging the predominant notion that care belongs only at the scale of human beings. This article analyses selected sections from graphic medical narratives such as Brian Fies's Mom's Cancer, Sarah Leavitt's Tangles and Joyce Farmer's Special Exits to illustrate how objects become a source of care for humans during illness, thus becoming care objects. Furthermore, using the affordances of comics, this essay examines, how the selected sections of the abovementioned graphic narratives portray the often unnoticed/overlooked affective entanglement between the sufferers and objects. In doing so, this article underscores the inter-relatedness between humans and non-human entities within the context of caregiving.

Disruption, transformation and silos: medical humanities and the management gurus.

To disrupt, to transform and to break through silos are common sense aims for the medical humanities and other interdisciplinary endeavours. These keywords arise because of the influence upon the academy of management and business gurus, reputed experts who arose in response to the economic crises of the 1980s. Despite the noted analytic deficiencies in the concept of disruption, and its association with product innovation, the term has been extended to academic research, where it connotes radical novelty in research practice, typically accompanied by profound organisational and managerial change. 'Disruption' has become wedded to the word 'transformation' as national funders seek to support more radically innovative research that will maintain Western economic hegemony. A distorted version of Kuhn's model of scientific revolutions underpins the discourse of transformation, which fits humanities research to a template in which revolutionary, transformative shifts can be instrumentally favoured by funders, at the expense of inferior 'incremental' progress. Disruptive and transformative research are, according to funders, more readily produced in organisations that have broken through silos between disciplines. The silo metaphor misleadingly models academic disciplines as if they were essentially unitary entities, akin to the functionally specialised units of a business organisation. The discourse of silos arises from the guru doctrine of the learning organisation. This theory supposes that the organisation-including the university-is literally a living organism, and thereby susceptible to corporate sickness, mortality, infection and disability. Medical humanity researchers should be aware of, and reject, this vitalist metaphysic in which the optimal organisation is a culturally homogeneous supra-personal organism whose immense capacities are harnessed by visionary leaders. Moreover, a new vocabulary should be developed for research evaluation, superseding the supposed hierarchical opposition between transformative and incremental research.

Federal field nurses and Indigenous births.

Beginning in 1924, the US Office of Indian Affairs sent public health or 'field' nurses to Native nations to provide preventative healthcare and education. The field nurse programme began under the US policy of assimilating Native Americans. To that end, field nurses championed 'modern' institutionalised medicine and opposed Indigenous health traditions. They taught an ethnocentric form of health education to Native mothers, and their work was complicit in the genocidal policy of removing Native children to federal boarding schools. However, Indigenous women resisted many of the interventions of the field nurse programme. They also exercised medical pluralism and sought other field nurse services relating to childbirth, prenatal and postpartum health, sometimes in defiance of the nursing programme's professional boundaries. The history of the field nurse programme reveals the ways in which professionalised public health nursing served settler colonial policy, yet it also showcases Native women's self-determination as pregnant patients and as nurses themselves.

'You come as a human being ': exploring sense of equality in arts interventions through an ethnographic study of Shared Reading.

Research shows that the arts hold a particular potential for promoting health, well-being and social inclusion for vulnerable people. However, the use and consumption of the arts tend to be socially skewed in favour of people with high cultural, social and economic capital. While extensive research has been conducted on how to create equal access to arts activities for vulnerable groups, little research has investigated how to ensure meaningful engagement with the arts by this group. Shared Reading (SR) has had considerable success in engaging vulnerable groups in collective literary practices, and research suggests that this may partly be due to the unique forms of social and literary engagement that the concept fosters. These forms of engagement, we suggest, lay the foundation for a sense of equality among participants that may promote social connectedness and well-being. On this basis, the present study aims to investigate whether and how a sense of equality may play a role in SR practices. The study found that SR promotes a sense of equality by creating a space where social interaction and relatedness does not hinge on social roles, but rather on lived experiences-and vulnerabilities inherent to these-conveyed through literary texts and shared among participants. However, to promote a sense of equality in SR, meaningful engagement for all participants must be ensured, making facilitation an essential element of SR practices and an important focus in arts interventions in general. We conclude that SR, and arts interventions more generally, may be a promising way to promote a sense of equality, but further research is needed on the specific qualities of and potential contexts for the promotion of a sense of equality.

Prognostication: A fading Hippocratic art?

Over the past 75 years modern medicine has advanced in its ability to diagnose and treat many diseases. However, the medical profession's ability to prognosticate the course and outcome of an illness has not satisfied the needs of many patients. Physicians must not lose the ability, or desire, to consider the whole person in relation to a patient's disease. We need to ask ourselves what person has the disease, not what disease the person has. Here I endeavor to demonstrate why Hippocrates valued prognostication highly, how its importance may have faded from the consciousness of current medical practice, and how modern technology is attempting to reinvent or revise it.

The Heart of Residency.

Description As part of wellness activities in 2023, our family medicine residents produced individual paintings. Samantha coalesced these 4 × 4 canvases to create this heart. The following quote is also poignant for those of us in family medicine.

Increasing the Efficiency of Lifestyle Medicine Counseling: A Visual Approach.

Description Too much to counsel on, too little time? We would like to present a unique and innovative perspective on lifestyle medicine counseling through the lens of a homemade flyer, designed to bridge the gap between conventional health care practices and personalized, holistic well-being. In the promising field of health care humanities, the homemade lifestyle medicine flyer serves as a tangible manifestation of individual agency in promoting health and vitality. The flyer encapsulates a diverse range of self-care practices, dietary insights, and mindfulness techniques, emphasizing the inherent connection between mind, body, and spirit in one's health journey. This double-sided document highlights the significance of empowering individuals to take an active role in their own health journey. Included are a broad range of tips for building a solid health and well-being foundation, as well as a QR code with resources to make those changes happen. Patients may understand that they need to eat healthy foods and spend time outdoors but may not know how best to implement those changes in their area. Although there is limited time for the average office visit, something as simple as a visual aid can go quite far in creating ripples of change beyond the clinic. As a take-home document, it can become an opportunity to share and empower others in the patient's own sphere of influence as well. The flyer acts as a tangible artifact, becoming a conduit for fostering a sense of community engagement, encouraging dialogue, and promoting shared experiences in the pursuit of well-being.

Turmoil.

Description I painted this picture after tearing up over the phone with her parents. "I think she's passing away," I had told them, "You'd better come up to the hospital." Inexperienced as a brand new physician, I felt like I was drowning in my responsibility over the care of my patients. Real people, with real lives, with real consequences to my decisions. It has gotten easier to feel okay while helping other humans pass away. And it sounds a little dramatic, but I've found ways to help myself cope without being stranded by the waves.

Max Bill's concrete art, as an instrument against irrational thinking and arguments in medicine.

Medicine is currently confronted with an increase in irrationality, and non-scientific thinking manifesting in semingly more holistic and natural treatment options, especially in cancer therapy. The Covid-19 pandemic has demonstrated that irrational beliefs are widely spread even among physicians. Max Bill (1908-94) was a Swiss architect, designer, and artist representing an art style called concrete art that focuses on geometrical abstraction and mathematical thinking. December 9, 2024, will be the 30th death anniversary of Max Bill. The following manuscript describes Max Bill's life and art and tries to offer some suggestions on how his concept of art together with the philosophy of critical rationalism may be excellent instruments to teach medical students and young doctors scientific thinking, and may even be an antidote for irrationality in medicine.

An Empathy and Arts Curriculum During a Pediatrics Clerkship: Impact on Student Empathy and Behavior.

Introduction: Empathy is critical within medicine and improves patient outcomes and satisfaction. Empathy declines during the clerkship years due to the hidden curriculum, where students observe emotional distancing and desensitization by providers. Studies show arts curricula can preserve empathy but are limited by sample bias and preclerkship occurrence. We implemented and evaluated a brief pediatric clerkship arts curriculum to improve empathic behaviors. Methods: We created two 1-hour required small-group sessions for pediatric clerkship medical students. The first session paired arts observation techniques with various paintings. The students then applied these techniques to video-based simulated patient interactions in the second session. We used the Toronto Empathy Questionnaire (TEQ) and an empathy behavior checklist (EBC) as pre/post assessments to gauge self-reported empathy and empathetic behaviors. We compared responses of learners who attended the sessions (curriculum group) to learners unable to attend (control group). Results: Thirty-four students participated in the curriculum; 19 were in the control group. Neither the control nor the curriculum group had a significant change in pre/post TEQ scores. Students with pre-TEQ scores less than 45 who participated in the curriculum had significant improvement in post-TEQ scores compared to their control group counterparts (p = .02). On the EBC, there was a significant difference between the curriculum and control groups for those who explored more about the child/family's experience (p < .05). Discussion: Our work suggests that a brief clerkship arts curriculum is useful for improving self-reported empathy ratings and empathetic skills, particularly for students identified as having below-average empathy.

Nature in Seclusion. The Monastic Republic of Letters in Southern Germany.

Monasteries were famous for their extensive libraries and richly decorated churches. Less well known are their observatories and their mathematical-physical collections with telescopes, air pumps, and friction machines. But how did the way of life in the monastery and scientific practices influence each other? This paper examines the interaction of scientific practices and religious way of life using the example of southern German monasteries in the second half of the eighteenth century. It shows how the monks pragmatically linked monastic life and research practice, thereby forming their own specific scientific culture. This closes an important gap in the understanding of scholarship in the eighteenth century by foregrounding the monasteries as places of knowledge production, which have so far received little attention alongside universities and academies.

Towards a transformative health humanities approach in teaching the Sustainable Development Goals (SDGs).

The adoption of the United Nations' Sustainable Development Goals (SDGs) marks a significant shift in global political agendas, emphasising sustainability in various fields, including health. To engage meaningfully with sustainability, a transformative educational approach is essential. Lange's concept of transformative learning encompasses three levels: personal and cognitive change (micro level), changes in our interactions with others and the environment (meso level) and societal changes (macro level). This paper posits that applying health humanities approaches, particularly narrative medicine, can enhance transformative education at these three levels, leading to a powerful, transformative health humanities framework for teaching sustainability and the SDGs. This interdisciplinary method, which includes reflective self-assessment, exploration of different relational perspectives and social reality comprehension, facilitates transformative learning. However, implementing this transformative strategy requires a critical reassessment of some core principles and methods within the existing health humanities paradigm.

By Medical Students, for Medical Students: A Narrative Medicine Antiracism Program.

Objectives: Medical schools have sought to incorporate concepts of race and racism in their curricula to facilitate students' abilities to grapple with healthcare disparities in the United States; however, these efforts frequently fail to address implicit bias or equip students with cultural humility, reflective capacity, and interpersonal skills required to navigate racialized systems in healthcare. The purpose of this study was to develop and evaluate an antiracism narrative medicine (NM) program designed by and for preclinical medical students. Method: Preclinical medical students at a single center were eligible to participate from June-July 2021. Program evaluation included a postprogram qualitative interview and electronic survey. The semistructured interview included questions about program experience, lessons learned, and perspectives on antiracism curricula in medical education. Interviews were qualitatively analyzed using open and axial coding. Survey data were analyzed with descriptive statistics. Results: A total of 30 students registered. All (100%) respondents reported "somewhat true" or "very true" in the postprogram survey when asked about their ability to reflect on their own racial identity, racial identity of others, and influence of their racial identity on their future role as a healthcare worker through the program. Qualitative analysis revealed 3 themes: (1) curricular engagement; (2) racism and antiracism in medicine; and (3) group experience. Subthemes included: meaningful theoretical content; multimodal works and unique perspectives; race, identity, and intersectionality; deeper diversity, equity, and inclusion engagement; reconstructive visions; future oriented work; close reading and writing build confidence in discomfort; community and support system; and authentic space among peer learners. Conclusion: This virtual, peer-facilitated antiracism NM program provided an engaging and challenging experience for participants. Postprogram interviews revealed the program deepened students' understanding of racism, promoted self-reflection and community building, and propagated reconstructive visions for continuing antiracism work.

It's "Classical Advice!" Why Medical Education Should Go Beyond Science.

This article is a reflection on a new (but ancient) definition of medicine, which considers doctors and patients alike from their complex human experiences. It explores the doctor-patient relationship as well as the practice of medicine itself through an historical lens, by examining some of the scholarship of Galen of Pergamum, the ancient Greek doctor and philosopher of the second century CE. The intention is not to give a new, definite answer, but to use an example from the past to look at the matter from a different, perhaps unusual, perspective.

Epistemological Flexibility in Person-Centered Care: The Cynefin Framework for (Re)Integrating Indigenous Body Representations in Manual Therapy.

BACKGROUND: Chiropractic, osteopathy, and physiotherapy (COP) professionals regulated outside the United States traditionally incorporate hands-on procedures aligned with their historical principles to guide patient care. However, some authors in COP research advocate a pan-professional, evidence-informed, patient-centered approach to musculoskeletal care, emphasizing hands-off management of patients through education and exercise therapy. The extent to which non-Western sociocultural beliefs about body representations in health and disease, including Indigenous beliefs, could influence the patient-practitioner dyad and affect the interpretation of pillars of evidence-informed practice, such as patient-centered care and patient expectations, remains unknown. METHODS: our perspective paper combines the best available evidence with expert insights and unique viewpoints to address gaps in the scientific literature and inform an interdisciplinary readership. RESULTS: A COP pan-professional approach tends to marginalize approaches, such as prevention-oriented clinical scenarios traditionally advocated by osteopathic practitioners for patients with non-Western sociocultural health assumptions. The Cynefin framework was introduced as a decision-making tool to aid clinicians in managing complex clinical scenarios and promoting evidence-informed, patient-centered, and culturally sensitive care. CONCLUSION: Epistemological flexibility is historically rooted in osteopathic care, due to his Indigenous roots. It is imperative to reintroduce conceptual and operative clinical frameworks that better address contemporary health needs, promote inclusion and equality in healthcare, and enhance the quality of manual therapy services beyond COP's Western-centered perspective.

Between medicine, humanities and the law: compiling a living archive of assisted dying.

Stories about personal experiences of assisted dying, a term comprising both instances when a lethal substance is administered by a physician or by the patient themselves, are frequently cited in law-making processes. These experiences of healthcare systems and the laws governing end-of-life procedures thereby interactively influence the future of medicine at the deathbed. With more countries legalising some form of assisted dying or opening political debate about the issue, addressing how these personal stories shape public opinions and social institutions is timely. In this current controversy, we question how medical humanities researchers are to make sense of the role of these stories in law-making, and critically reflect on a digital archive that seeks to make these interconnections visible. At the methodological level, the reciprocal interactions in assisted dying between medicine, law and the arts urges us to reconsider the conceptual foundations of interdisciplinary research in the medical humanities.