Defunding liberal arts is dangerous for health care

January 25, 2024 4:47 AM

While liberal arts have been declining on college campuses, medical education is moving in the opposite direction, using the arts and humanities as teaching modalities within the traditional basic and applied sciences coursework that dominates medical school curricula. Through literature, poetry, theater, and visual arts, students acquire important professional capacities, such as tolerance of ambiguity, skillful clinical communication, and sensitivity in listening to and learning from patient stories.
posted by cupcakeninja (31 comments total)

"The communication, argumentation, and writing skills I acquired in that [freshman composition] course have served me well throughout my career[.]"

- Very technical roles require effective communication.
- We ought to value education for reasons in addition to employability.
- Marshalling human language is a technical skill.
- Without art, poetry, sport, camaraderie, respect, empathy, compassion, emotion, arguments, diplomacy, culture, panache, diversion, silliness, reflection, religion, respect, rhetoric, persuasion, and love (inter alia), what's the point of all these robots?
posted by GPF at 5:16 AM on January 25 [36 favorites]

I'm a software developer, and I remember in the 90s and 2000s being of the narrow mindset of "Go away before I replace you with a very small Perl script" and "Get a real major" that the EE students wore. But you don't need to be young and have good test-taking skills to mistake immaturity for cleverness. One of the biggest feeders of my engineering arrogance: the Dilbert comic strip.

It's pretty clear in hindsight to see what this attitude leads to.
posted by AlSweigart at 6:32 AM on January 25 [19 favorites]

As a stereotypical shy nerd I went the STEM route at 16 for A-levels, studied Electrical Engineering at University and then into a career in IT.

As an IT manager now, some 25 years later, I would have desperately benefited from improving my so-called 'soft skills' and EQ as part of my later education. The closest we came was one class on how to manage Union workers, on the assumption we would be on the other side of the table.

I use very little of the science or maths I studiously learned (though knowing how to write and deliver a good report, definitely) day to day; but working with people, understanding people, communicating sometimes complex topics with people, helping fix people's problems, leading people; that I do all day, every day. I might have a knack for wrangling computers, networks, and software to all work together - but in the end of the day the most important part of IT is that it's a 'helping people' job, which is something it took me far too long to realise.
posted by Absolutely No You-Know-What at 6:48 AM on January 25 [11 favorites]

I'm not in medicine, but I did get a non-science BA from a liberal arts college, and it has turned out to be particularly useful over the years in my quite-technical job. We have plenty of people on staff with PEs and PGs and a variety of -ology degrees for when capital-S science needs to be done, but almost none of them are able to communicate both technical and emotional information nearly as well as those of us with less straightforward educational backgrounds. I'm guessing big Tech is similar, where you can end up on a somewhat different career track by virtue of having some level of above average people or communicative skills, I wonder if the people they highlight in the article will turn out to head into leadership roles of one kind or another at higher rates with time, especially because the same skills you use on patients can be used on your coworkers.
posted by Dip Flash at 6:51 AM on January 25

I studied theater. I know a hell of a lot of people who are using what they learned in their theater degree to do totally different things. I've personally spun my degree and my ten years of stage manager experience into careers as an executive assistant who sometimes serves as ad hoc project manager.

Skill sets can be used multiple places, y'all.
posted by EmpressCallipygos at 7:15 AM on January 25 [12 favorites]

I worked in hospital administration for 30 years and was involved in several efforts to integrate the humanities with medical education and the lives of practicing physicians and surgeons. None of these efforts came to much. Doctors who are into literature are already reading and writing. Same with medical students. Book discussion groups fall apart after a few meetings. There is a kind of oil and water effect: You can see where medicine and the humanities seem to have similar properties, but however hard you try, they still don't comfortably mix.

I can't see someone becoming a more compassionate caregiver after reading "Death of Ivan Ilytch" unless they were already a compassionate caregiver. It takes a certain amount of sympathy and emotional flexibility to appreciate the arts in the first place. At the same time, anyone who's worked in direct patient care for any considerable time knows more about death, suffering and human strength and weakness than can be learned from books or movies.

Despite my own passion for a dedication to literature and writing, I have to conclude that injecting the humanities into the professional environment of doctors, nurses and technicians does not improve empathy or patient care in any lasting way. Hospitals are hard places. Working in a hospital is like having a front row seat on the human condition -- it is incredibly fascinating and rewarding and I would recommend a career in healthcare to any curious and intelligent young person. A previously acquired knowledge of history, literature and art will help you appreciate. your own situation with greater breadth, but in the end, the best thing you can do for patients is pay attention to the science, follow best practices, and learn from direct experience.
posted by Modest House at 7:19 AM on January 25 [18 favorites]

An old classics professor of mine said something like this:

"If Western Civilization began with the Ancient Greeks, we have to consider that it did not start with metalworking or agriculture or animal husbandry or rudimentary medicine or mathematics or astronomy or navigation or finance or law. All of those things were already around. Civilization did not really get started until a blind man wrote some poems."
posted by gauche at 7:26 AM on January 25 [16 favorites]

My son is a sophomore in college at a liberal arts school, studying biology with hopes of a career in medicine.

I happily supported him doing the Honors Program, because it means an extra year of "Western Civilization" small-group seminars. Not that I am Harold Bloom, but because I want him to keep developing those humanist critical thinking skills as much as his lab skills & anatomy knowledge.

Doctors are hard to find these days. Good doctors are harder to find. And doctors who care about the whole person are rarer than hen's teeth!
posted by wenestvedt at 7:42 AM on January 25 [7 favorites]

Med schools have been trying to teach those characteristics for decades. But I'm with Modest Mouse. Some folks got 'em and some don't. I'm not sure how well they can truly be taught. Like anything else, people in the field are not of one kind.

Furthermore, doctorin' is a pretty diverse field of study. I know a whole lot of MD PhDs who went into research and MDs who went into fields with very little typical patient interaction. Possibly because they didn't want that kind of interaction.

Of course, if you're wanting to sell the angle that humanities teaches actual usable skills, you may be called to show results. Which I'm not sure is necessarily a step in the right direction for the humanities.
posted by 2N2222 at 7:49 AM on January 25 [1 favorite]

I went to film school and ended up a web developer. Project managers often prefer to work with me just because I can speak human.
posted by brundlefly at 7:50 AM on January 25 [8 favorites]

"Yeah, yeah, people skills and soft skills are important. We get it. But is learning about Shakespeare really going to solve this problem?"

Yes, quite literally. I was a comp sci major but a lot of this stuff is really cool, and if you don't study it you'll have the quite ignorant stance of "English Degree == Shakespeare" as if English majors sit around reading Romeo and Juliet and Dostoyevski for four years. You won't even be able to spell Dostoyevski.

This is not hypothetical. We see this now: Zuckerberg has thrown away billions (thousands of millions!) of dollars because he read Snow Crash when he was a teen and wanted to make the Metaverse.

He didn't even bother coming up with a new name.

Musk's ridiculous truck is straight out of the Cassette Futurism sci-fi style that was cool when he was a teen. (And his fans aren't much better: their iconography is limited to Tony Stark in Marvel movies.)

These are unimaginative middle-aged men wasting billions (thousands of millions!) of dollars because of their ignorance. Hell, they aren't even that technical. They're just white guys with rich parents and just enough privilege and tech skills to get away with stealing the things that made them rich (Winklevoss twins for one and Paypal/SpaceX/Tesla/Twitter for the other.)

Oh, and my use of Shakespeare is intentional. The ultimate form of this myopic tech-worship is, of course, bitcoin: the singular most destructive idea of the 21st century so far. And Sam Bankman-Fried has the infamous cringe, "What are the odds that the greatest writer would have been born in 1564? The Bayesian priors aren’t very favorable."

That's exactly the kind of horseshit you end up saying when you think of liberal arts as nice-to-haves instead of critically important. When you are profoundly ignorant of your own profound ignorance.
posted by AlSweigart at 7:52 AM on January 25 [30 favorites]

p.s. Answering a contrived question that you yourself wrote in the third-person is a literary device that allows you control the framing of a conversation and make yourself appear smart. It was used to great effect by Ayn Rand, who influenced mainstream culture by writing novels instead of peer-reviewed philosophy articles. She tends to seek out and attract the sort of readers who dismiss the liberal arts education that would have equipped them to detect her bullshit.

How ironic! Like rain on your wedding day!
posted by AlSweigart at 7:53 AM on January 25 [16 favorites]

I mean, this is anecdotal, but my favorite doctors (who have actually made an effort to see me as human and treat me like someone deserving to be treated) are the ones who have noticed whatever book was in my purse and asked me what I 'm reading.

I don't know if you can teach empathy, but I think books and art, and the humanities writ large, tend to help and hone its development. I also think if you are incapable of imagining or accepting or valuing someone else's pain or trauma, you have zero business in a profession where your actual job is addressing it.
posted by thivaia at 8:28 AM on January 25 [10 favorites]

Med schools have been trying to teach those characteristics for decades. But I'm with Modest Mouse. Some folks got 'em and some don't. I'm not sure how well they can truly be taught. Like anything else, people in the field are not of one kind.

The editorial makes the point that this education needs to happen earlier than medical school, in the undergraduate curriculum.

I teach at a LAC where biology is either the largest or second largest major (a lot of students get pre-med advising, although far fewer than actually end up going). There is a certain type of student who feels like they need to be tracked into pre-med from day one of undergrad (some of it is family pressure, surely -- utterly understandable -- some of it is just a feeling like they need every edge to be competitive for med school admission) -- and that the liberal arts curriculum they're expected to do is a distraction. My friends who teach biology are constantly pushing back on this mentality, trying to integrate 'no, you're going to be treating human beings, we should think about what it means to be a human being' into their classes and advising (particularly because the set of students who THINKS they will go to medical school is much larger than the set that will actually do it in the end). But it's tough. To the extent that med schools and the AMA (1) actually recognize the value of the liberal arts and (2) communicate that in their admissions decisions and preparation (not to mention in the science curriculum at the undergraduate level and before), I think that's a good thing.
posted by dismas at 8:41 AM on January 25 [13 favorites]

How ironic! Like rain on your wedding day!

I see what you did there

Some folks got 'em and some don't. I'm not sure how well they can truly be taught. Like anything else, people in the field are not of one kind.

I don't fully disagree with this but would argue the following:
1. Some folks got 'em but they have been either discouraged or actively prevented from developing them by programs run along the most arrogant STEM-only lines
2. Some folks don't but could absolutely, one hundred percent be taught to FAKE them, which in the case of, say, bedside manner and clear communication, is more than half the battle
3. Some folks truly cannot acquire OR convincingly fake these skills and honestly it's worth knowing so they can be steered toward a path that doesn't rely so heavily on them.

And if nobody even ever suggests to you that any of these things are worth your time, you have no idea which one you are!
posted by We put our faith in Blast Hardcheese at 8:43 AM on January 25 [14 favorites]

Thanks for posting this! This is slightly tangential, but a hill I will die on is that number of majors is a horrible way to measure the importance of a discipline. More students may be majoring in STEM, but that doesn't mean they don't value the humanities. I've spent a fair bit of time with college students in the last decade (between TA'ing and teaching) and while many do feel pressure to have a practical major, they also have passions or curiosities they want to pursue outside their major - I don't really care if they major in my field – I mean, it's cool if they do, but some of my most perceptive/engaged students weren't majors, and I get as much feeling of satisfaction from mentoring/teaching them as I do with any motivated student.
posted by coffeecat at 8:43 AM on January 25 [13 favorites]

That's exactly the kind of horseshit you end up saying when you think of liberal arts as nice-to-haves instead of critically important. When you are profoundly ignorant of your own profound ignorance.

Seriously? Responding to a thread about the humanities and medical training with an extensive rant about Zuckerberg, Musk and Sam Bankman-Fried seems kind of horseshitty itself.

The editorial makes the point that this education needs to happen earlier than medical school, in the undergraduate curriculum.

I know some med schools specifically look for candidates with that kind of background. But it is tough. Those aren't always the candidates who actually want to go into medicine.

1. Some folks got 'em but they have been either discouraged or actively prevented from developing them by programs run along the most arrogant STEM-only lines

That is terrible when that happens, but my anecdotal experience tells me that STEM folk are remarkably unlike the shitty stereotype that seems to get repeated about STEM-types.

2. Some folks don't but could absolutely, one hundred percent be taught to FAKE them, which in the case of, say, bedside manner and clear communication, is more than half the battle

That is definitely taught in med schools. Some are more willing to fake it in their careers than others.

3. Some folks truly cannot acquire OR convincingly fake these skills and honestly it's worth knowing so they can be steered toward a path that doesn't rely so heavily on them

These folks seem to pretty well steer themselves. But I'd be wary of a system that's steering people in such a way.
posted by 2N2222 at 8:58 AM on January 25 [3 favorites]

This is slightly tangential, but a hill I will die on is that number of majors is a horrible way to measure the importance of a discipline.

100X yes. And from your mouth to the Board of Governors ears. Just because you graduate fewer Acting BFAs than Comptuter Science majors, does not mean you tear down the fucking theater. I wrote plays as an undergrad and two of my favorite actors at the time are now software developers.
posted by thivaia at 9:04 AM on January 25 [10 favorites]

Over the course of my film studies undergrad I unfortunately internalized a certain degree of that "advanced basket weaving" mockery and dismissal of the value of non-STEM degrees, but now I'm a 50 year-old man and have a much better understanding of what I got out of my academic experience. The shortest answer is: critical thinking skills, which holy shit a lot of people basically completely lack. Can't really put that on a resume, though!
posted by The Card Cheat at 9:31 AM on January 25 [2 favorites]

That is terrible when that happens, but my anecdotal experience tells me that STEM folk are remarkably unlike the shitty stereotype that seems to get repeated about STEM-types.

Yeah that's why I said "along STEM lines" and said nothing whatsoever at all in that comment about STEM types. Programs that end up discouraging exploration outside of the subject can happen both intentionally and unintentionally -- sometimes just through a workload that makes any sort of additional coursework unsustainable. (That is an arrogance you can find in a LOT of university programs, of all disciplines, actually.)
posted by We put our faith in Blast Hardcheese at 9:43 AM on January 25 [2 favorites]

I know some med schools specifically look for candidates with that kind of background. But it is tough. Those aren't always the candidates who actually want to go into medicine.

Well, obviously not every humanities student wants to become a doctor, that...would be insane? Of course many of them actually want to work in humanities-related fields. But if a more rounded, humanities-inclusive curriculum were simply the standard at most universities, as the article argues, the majority of med school candidates would have that grounding by default. I feel like you're arguing about this backwards; the point isn't to go find English majors and make them doctors, it's to make sure doctors know something about the human beings they're going to spend their lives treating.
posted by We put our faith in Blast Hardcheese at 9:52 AM on January 25 [4 favorites]

Also like just for the record a huge, huge amount of doctor-patient interaction these days is via emails in these stupid-ass web portals, and if doctors are shitty at reading and writing they are going to fucking beef it on understanding and helping their patients.
posted by We put our faith in Blast Hardcheese at 10:08 AM on January 25 [6 favorites]

I studied theater. I know a hell of a lot of people who are using what they learned in their theater degree to do totally different things.

I have two and a half theatre degrees, and I work in IT. All the performance and voice classes have helped tremendously when I'm in meetings and doing presentations and interacting with less-technical people.
posted by Mr. Bad Example at 11:30 AM on January 25 [5 favorites]

At a previous job at a tech company you've heard of, I worked with a job function (I'm being a bit obscure here) where the traditional training was library science, but there were also linguistics people. I got on with them fabulously, unlike virtually all other engineers. At some point, one of them asked if the reason I "got" their work was because I'd taken a ton of German in college. No, I said, it's because I was a math major and it's a similar kind of thinking. This is not the only case where being the person without a CS degree was been to my advantage at work. It's not necessarily about interpersonal relationships (God knows 10 years in math departments killed my social skills) or particular knowledge, it's about not being cut from the exact. same. freaking. mold as everyone else. Ignoring whether the humanities have some intrinsic "value" (of course it does, all subjects do), some of the upside of forcing med students to step off the pre-med conveyor belt for a second is that they're not all the same.
posted by hoyland at 1:18 PM on January 25 [4 favorites]

Thanks for posting. This is literally my day job; at the risk of doxxing myself, I am Director of Medical Humanities at a US medical school you have definitely heard of. It takes a lot of grit to keep fighting the good fight despite the ever-increasing widgetification of clinical medicine, and medical education, I might add. If I never have to write another multiple choice question it will be too soon.

Because hey guess what, the so-called "soft" skills, the ability to take in a complex mess of a story, distill it to its essential elements, and use those elements to make a diagnosis and treatment plan -- that's what separates a competent doctor from a great one.

I have seen this second-hand through a family member who has spent 2023 dealing with a serious illness. I see it every day I'm in clinic and someone comes to me for a third opinion and honestly it's just that no one ever asked the patient "What's going on?" Or maybe they asked but did not listen -- actually, really, truly LISTENED -- to the response. This is not rocket science, folks (though sometimes it is brain surgery! #sorrynotsorry) I see it in the first-year medical students, who are WAY better at taking a history during their first week of medical school (seriously, day 3, we have them take a history from me, the attending physician pretending to have stomach pain or a headache or whatever), than the second-years who have already had this fundamental conversational skill beaten out of them in favor of some algorithm or other.

Anyway. Humanities knowledge at the college level is fundamental, way more useful than chemistry, and I say this as someone who double-majored in Biochemistry and Comparative Literature. But humanities application in a clinical setting is the critical piece that will help them understand (1) who their patients are and (2) who they are becoming in this trial-by-fire we call medical school and residency.

The students are better at understanding the need for this than the administrators -- the course we started in 2020 with just 12 med students now enrolls nearly a quarter of the class. One of our inaugural cohort gave me a card the other day that spoke to how this course, this program, saved her in medical school, and I nearly cried because I am a Hot Mess right now. I taped the card above my computer for when I feel especially blue/overwhelmed/angry. 2023 was been a terrible year for me, and I would not have gotten through without my community of colleagues and students who give me courage that there is another way.
posted by basalganglia at 3:10 PM on January 25 [30 favorites]

Zuckerberg has thrown away billions (thousands of millions!) of dollars because he read Snow Crash when he was a teen and wanted to make the Metaverse.

Mark Zuckerberg went to the kind of high school where people study Latin, and did.
posted by atoxyl at 7:12 PM on January 25 [1 favorite]

Mark Zuckerberg went to the kind of high school where people study Latin, and did.

And yet he picked a Greek prefix.
posted by Dip Flash at 7:20 PM on January 25 [1 favorite]

Medical humanities is cool. I keep wanting a seminar or a book or something on the philosophy of diagnosis… We need humanities in medicine in part because cross pollination helps us stay strong. Just like we need more lawyers and politicians with science and tech backgrounds.
posted by eirias at 7:27 PM on January 25

number of majors is a horrible way to measure the importance of a discipline

True, it's only one metric. But a drop in the number of majors (and minors) can mean an important shift in a humanities program, from being a full degree department to a service one. In the latter case it's about providing general education classes and electives. Which is cool, but can make it harder to hire faculty who want to teach majors, and can represent a reputational hit internally.

Now, total enrollment in a department's classes overall - gen ed and majors - is another metric, and one used to cut faculty and close departments.
posted by doctornemo at 11:09 PM on January 26

On TFA, I agree with much of it, as someone who taught in a liberal arts college and worked with hundreds of them. But there are some points I'd argue.

"liberal arts" doesn't always = "the humanities." A liberal arts college or program emphasizes the humanities and arts, but also includes social and natural sciences. (Ah, how do you define liberal education? That's a classic academic argument chestnut)

"a dip in the college-age population" - it's not a dip in the United States. American higher enrollment grew steadily until around it peaked about 2012, and declined every year since then until fall 2023, when it grew slightly. We're still seriously down from that boom time. Not a "dip." (Note that the title of the article linked to uses the word "crash.")

"the best approach to teaching empathy may be through literature, art, music, and other humanities... Liberal arts studies nurture crucial human capacities, including curiosity, critical thinking and analysis, empathy and compassion, ethics and integrity, appreciation for diverse perspectives" - it's worth remembering that "may" does a lot of work here. Humanists can fail at this task. A casual glance through the past century turns up humanists supporting total war, genocide, etc.
posted by doctornemo at 11:15 PM on January 26 [1 favorite]

Visiting the Doctor feels more like an interrogation than a healing process.!
Many traditional cultures see healing as a spiritual process which is uncomfortably at odds with western diagnostics.
posted by Narrative_Historian at 8:35 PM on January 28 [1 favorite]