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A Moral Enterprise

Dr. James Marcum, professor of philosophy in Baylor’s College of Arts and Sciences, believes strongly that competent and comprehensive healing requires thorough knowledge of the science behind the human body’s function, as well as a respect for the personhood of the patient.

While some dismiss these emotional tools as unnecessary for doctors who rely on evidence-based scientific knowledge, Marcum, who is also the director of Baylor’s Medical Humanities Program, sees the art of healing and the science of medicine as two sides of the same coin, with both competencies equally necessary to provide optimal patient care.

“Medicine is a moral enterprise, not a social or behavioral science,” he explains. “Patients want their doctors to see them as a person, not a diseased body part. Physicians need to connect with their patients as humans because that connection gives patients confidence that their doctor is doing what’s best for them.”

Marcum is no stranger to the hard science of medicine. He holds dual Ph.D. degrees in physiology and philosophy and was previously a faculty member in the Harvard Medical School’s department of pathology.

He came to Baylor in 2001 to teach philosophy of medicine, an area that he says is in many ways both a young field and an old one.

“All the way back to Hippocrates, medicine has existed on a continuum between art and science,” he explains. “Early physicians were more like priests – faith-based healers who performed rituals meant to draw on the healing power of the supernatural. Later, doctors became natural philosophers who sought to understand the world through an intellectual approach to studying its processes.”

Prior to the early 20th century, medical schools in the United States varied greatly in their curriculum and admission requirements. There was little uniformity in the scientific rigor of the coursework schools offered, and many had admission requirements that seem shockingly lax today. Some did not even require applicants to graduate from high school before enrolling.

The tide began to turn in 1910 when Abraham Flexner published a set of recommendations for medical education based on the standard model in use at The Johns Hopkins University School of Medicine. Flexner called for medical schools to emphasize more strongly rigorous scientific training as part of their admission and graduation requirements, leading to nationwide changes in curriculum at both the undergraduate and professional levels. While the desire to improve doctors’ technical and scientific expertise is laudable, it quickly became evident that placing greater emphasis on science caused many physicians to undervalue the art of healing – the human element of treating disease.

One early critique of this trade-off came from Dr. Francis W. Peabody, a Harvard Medical School professor. In a 1925 lecture, he praised the progress of science that had occurred in recent years, but argued that the art of treating patients should not be ignored. He challenged medical schools to turn students into physicians who could see the entire “clinical picture” of a patient, which he described as “not just a photograph…but an impressionistic painting” that takes into account a patient’s home life, occupation, culture, emotion and spirituality. “One of the essential qualities of the clinician is interest in humanity,” he concluded, “for the secret of the care of the patient is in caring for the patient.”

Now, nearly 90 years later, Marcum says ample evidence suggests Peabody’s criticism was correct.

“One of the most common complaints from hospital patients is that doctors don’t listen,” he says. “An important part of decision-making is intuition; doctors have to make their emotions work and get patients involved in treatment decisions. Managing relationships, demonstrating empathy and giving patients confidence require virtues on the part of the physician.”

Becoming an empathetic, virtuous person doesn’t happen overnight, nor does it happen in a one-semester course. That’s why Marcum believes education in the medical humanities is a lifelong process that should begin with developing skills as a student then remain a focus all the way through continuing medical education for practicing physicians.

“Studying medical humanities is important because it helps doctors develop a moral compass,” Marcum explains. “It needs to be appropriate to the student’s expertise and maturity level, but it is critical to helping students think about important issues in appropriate, socially acceptable ways.”

Marcum is not alone in his belief that humanities study is important for future doctors. He points to recent changes to the MCAT – the standardized test used as an admission tool by most medical schools – as evidence of a growing consensus regarding the need for more humanities training in medical education.

“The push to make medicine a science tended to exclude the humanities. But more and more medical schools are recognizing the importance of humanities training, and that is reflected in changes to the MCAT. It now includes behavioral medicine and medical ethics, which encourage pre-med students to take courses like bioethics, critical thinking and sociology of medicine.”

With medical schools placing such a strong emphasis on humanities education, Marcum says it’s critical that Baylor provide a strong foundation to its pre-med students. That’s also a big part of why he believes it is important for faculty to be active researchers.

“Baylor’s reputation has always been tied to healthcare,” he says. “Pre-med is our most popular undergraduate major, so we have to prepare those students to be leaders. If our professors’ ideas aren’t being tested by the larger academic community, then those professors aren’t giving their students the best education possible.”

But the importance of Marcum’s research stretches far beyond just preparing students for success. He sees the function of his work as advancing scholarly conversations about issues that matter to everyone.

“As professors, we have to profess to more than just our students. We’re professing to the academic community, too. Some of those conversations can be difficult or even painful, but that’s all a part of the process of generating knowledge. Human understanding is critical to being a compassionate, caring person. If we’re not doing research, we won’t have a very deep understanding of the human condition.”