Humanism or Competence in Medicine

The subject of humanism in medicine has received much attention in recent years. Just what is meant by humanism is nebulous. The American Board of Internal Medicine defines the essential characteristics of humanism as integrity, respect and compassion. Respect means a personal commitment to honor patients’ choices and rights regarding themselves and their medical care.’ Engelhardt defines the humanistic doctor as one who acts gently and kindly with sympathy and consideration for the needs of others.’ Although modern usage of the term has had diverse meanings, John Romano writes that, ‘humanism, in essence, applies to any system of thought or action which assigns a predominant interest to the affairs of men as compared to the supernatural or abstract. It could have been applied to Hippocrates when he insisted that epilepsy was not a sacred disease. In western Europe in the late 15th century, the medical humanists participated in a movement of thought that broke through the medieval traditions of scholastic theology and philosophy, and devoted itself to the rediscovery and direct study of the ancient classics. This movement was essentially a revolt against intellectual, and especially ecclesiastical, authority and is a parent to all modern developments, whether intellectual, scientific or ~ocial.~ Charles Aring puts it more succinctly, ‘Any system or mode of thought or action in which human interests, values and dignity pred~minate’.~ I, like Romano, believe the term humanism is also applicable to a movement, in which some of us participated, that began in the late thirties, and intensified following the end of World War 11. This was a movement in American medicine to provide each medical student with sufficient opportunity to obtain the information and the personal experience that would enable him to grow not only in knowledge of biology, but also in human and social issues. It was closely connected to the field known as psychosomatic medicine. The factors responsible for the renewed interest in humanism are well known and need only be mentioned. They are intrinsic and extrinsic to medicine: technology, specialization, changes in delivery of medical services, rising costs, industrialization of medicine and malpractice suits. These factors have led to the rising power of consumer groups and conversely to a loss of power and authority of medicine and its practitioners. All this has undermined the classical doctor-patient relationship, leading to anxiety, hostility and fear on both sides and at times converting the doctor-patient relationship into an adversarial,