My academic path was deeply marked by two people I would like to pay tribute to. The surgeon, Amadeu Pimenta, a “humanistic doctor”, who was one of my internship supervisors in the last year of my degree, and Isabel Azevedo, a doctor and my PhD supervisor. With the former I was able to closely observe a “humanistic doctor” interacting with his cancer patients. He combined knowledge and technical skills with serenity, kindness, respect, and compassion for his patients. I also accompanied him for two years in the outpatient clinics where he followed his patients after surgery. At that time, few patients were informed about their disease, the word “cancer” was avoided, but everyone put their lives and hope in the doctors’ hands.
The art with which he managed this information with each patient made me reflect on how complex, intimate, and delicate is this relationship that is established between a doctor and his patient.
Besides this contact with his clinical practice, under his guidance, I presented for the first time at a scientific congress (in 1994) results related to nutritional assessment of cancer patients.
Years later, my PhD supervisor was the inspiration I needed as a researcher, teacher, and team leader. An example of love for science and dedication to teaching and research. Professor Isabel Azevedo always promoted a healthy academic and scientific environment, and provided the necessary support and conditions for us to feel free to dedicate ourselves to our tasks. Both were highly respected by colleagues and students and in the case of Professor Amadeu Pimenta, he also beloved by his patients.
To both I owe the confidence to enter academia and the certainty that there are people destined to serve and inspire others.
Although I have been privileged, in my more or less recent career, there have been several episodes in which I have been the target of dishonest practices that contrast with the profile of the role models I have just described.
A few years ago, I applied for funding for a research project and invited some colleagues from another university to join as partners. On the evening of the last day of the application deadline I received an e-mail informing me that, in addition to their partnership with us, these colleagues would also be applying for the same competition. The jury of the competition was from the same university, and they won the competition with the idea that I had shared.
While still a PhD student, my name disappeared from the list of authors in one of the team’s articles.
A student doing her PhD under my supervision was persuaded to drop her proposed topic, and months later she was being guided by someone else in the same PhD program.
There have been many instances where my students have reported abuse of power, unprofessionalism, and dishonest practices in clinical settings and beyond, both in their relationship with their tutors and in their relationship with their patients.
There has long been widespread concern about the lack of humanity and professionalism in the medical profession, which has worsened in recent years due to factors such as individualism, work overload and lack of time, financial pressures, and the excessive use of technology, all of which cause a loss of closeness and connection to the patient.
Also, the ideals and expectations with which medical students enter medicine can become compromised over time, thus medical schools should strive to nurture humanism and professionalism.
Medical schools cannot assume that humanistic attitudes and professional values are innate characteristics that cannot be taught and modulated.
Therefore, they have to reflect on the best strategies to foster humanism and professionalism during medical training, refocusing on the patient and the human condition, and to promote good practice and search for truth in medical research.
We need to know more about how to improve and maintain safe professional and research environments, and also how the relationship between these attitudes and professionalism can in turn help the well-being and satisfaction of researchers, teachers, and clinicians (often brought together in the same person) and the raison d’être of these professions.
Role modelling in medicine has been described as influencing professional behavior, identity, and career choices of medical students. We have to explore and share more good examples, and reflect on our own conduct, since we are seen as role models every day. We have to share our own dilemmas and concerns and encourage our students to reflect on their own professional identity and future profession.
We have to challenge them to make ethical choices and then discuss them with different perspectives.
We have to expose them to various art forms and literature to identify common and unique experiences, to shed light on community concerns, to develop critical thinking and language, and perhaps to share their own experiences and art forms, through which they will learn more about human nature.
Clinical practice should be based on the best science and technology but only the mind, without the physician’s soul, compromises the quality of care. Through practicing in clinical settings with positive role models, students will develop their own humanity, acquire empathy for patients and better comprehend the human condition. By engaging in research, they will better understand the diseases they are fighting and ultimately the surrounding world.
Students come to medical school eager to embrace the high standards of their future profession.
Thus, rather than contributing to their loss of resolve, medical schools should support them in developing their reflective, ethics, and compassion skills to increase the quality of patient care.
In spite of the efforts that have been made, technical competence still appears to often displace caring and we are again realizing that a more humanistic approach is needed in training to nurture humanistic values and overcome the current medicine dehumanization.
In our school, this can be addressed as soon as students enter the course through the interwined of anatomy classes, in which they have to handle with a human cadaver, with the humanities in medicine course, that explore the human condition in its various features, and the link to the clinical years and contact with patients.
My wish as a medical educator is that our medical students achieve excellence in medicine and science in a safe environment focused on providing the best health care to their future patients.
About the Author:
Professor Laura Ribeiro is an Assistant Professor and Director of the Masters in Academic and Clinical Education. She is also involved in teaching Academic/Research Integrity and Humanities in Medicine at the Faculty of Medicine of the University of Porto (FMUP), Portugal.