Humanism is the basis of medicine throughout history. It aims to provide health care with honesty, empathy, compassion, altruism, and respect to dignity and beliefs of the patients and their families. Humanistic medical care improved health outcomes and enhances patients to adhere to medical advice and treatment options. Clinicians who are more empathetic towards their patients benefit from higher job satisfaction and less malpractice litigation. A lower level of empathy was associated with higher rate of practical mistakes. During the past four decades new technological devices have been extensively incorporated into medical practice. Physicians emphasized on the disease, use of technology, laboratory investigations, treatment and physical recovery and ignore patient psychological status, ethical and social cultures. These events abolished medical humanistic spirit. Teaching of medical humanities becomes a necessity to help medical students in their future career to do what they are already doing but in a more humanistic and empathic attitudes. Medical humanities can be taught through lectures, role modeling, and training in interpersonal skills, literature and arts study. Multiple tools can be used for assessments of humanistic attitudes and behaviors as observations during patient examination or history taking, simulations and quizzes. Medical organizations must value its members by concern for their well-being, growth, and development. It might employ experts having good humanistic knowledge and experience in interpersonal skills to qualitatively evaluate humanism among medical students.

Keywords: humanism, medical education, medical practice, health care, medical organizations

The word Humanism is derived from the Latin concept humanities which refer to friendly behaviors and good attitude towards the others without distinction. It is characterized by personal principles and beliefs towards his/her duties and responsibilities when dealing with the others, especially those in need. The humanistic characters include honesty, empathy compassion, altruism, and care of patients with respect to their dignity and beliefs.^1–3

Humanism represents the basis of medicine throughout history beginning from the time of Hippocrates and the development of the Hippocratic Oath. Medicine has been regarded as a moral profession and carried out in accordance with a set of morals and ethics.⁴

The first conference concerned with humanism; was held at Chicago University in 1933, recommended considering humanistic science as the basis of morality and decision-making in medical practice.⁵

Arnold P. Gold Foundation reported that humanism is characterized by a respectful and compassionate relationship between the healthcare providers and patients. It reflects the respect of the health care members to values, cultural and ethnic backgrounds of others.^6,7 When dealing with colleagues, humanistic behaviors include personal connections, respect, self-awareness, response to emotional expressions.⁸

Sir William Osler (1837-1901); who is considered by many authors as the father of modern medicine, advised his students with these words (Listen to the patient. He is telling you the diagnosis).⁹ Sir Osler also stated that (it is much more important to know what sort of person has a disease, than to know what sort of disease a person has).^10,11

Humanistic beliefs are the spirit of professional activity. No physician can be a true profession without having humanistic attitude.¹² A good physician must possess not only accurate medical knowledge and skills but also he/she must have moral judgment and actions, kind attitude, trusting relationship with patients and their families. Physicians must consider that the patient has a body and soul, emotions, feelings, expectations, and fears.¹³

Clinicians who are more empathetic towards their patients benefit from higher job satisfaction and less malpractice litigation. A lower level of empathy was associated with a higher rate of practical mistakes.¹⁴

Pellegrino¹⁵ stated that medical practice is a relationship in which two individuals interact. However one is in a more weak position than the other. The weight of the responsibility rests on the person with the higher degree of power and authority, and who has made a promise to help the other. Consequently responsibility lies upon the physician who can make the promise to the patient.

Humanistic medical care enhances patients to adhere to medical advice and treatment options, resulting in improved health care outcomes.¹⁶

Sir William Osler stated that the physician-patient relationship could be flourished by good physician’s background in humanistic science. Promoting humanities among the medical practitioners was a battle that they lost. Osler suggested that educating of medical students should combine both medical knowledge and the humanities.¹⁷

One century ago the physicians were among the most educated individuals in their communities both in the clinical sciences and in the science of humanities.¹⁸ However the past four decades showed great advances in medical knowledge and new technological devices have been extensively incorporated into medical practice.¹⁹ Physicians emphasized on the disease, use of technology, laboratory investigations, treatment and physical recovery. They ignore patient psychological status, ethical and social cultures. These events abolished medical humanistic spirit.^20,21 Such dehumanized medicine appears to have no past, no cultural language and no philosophy.¹⁸

The physician-patient relationship had been broken.²² The skills of the physician to interact with patients face to face becomes greatly lost.²³ Computers no doubt increasingly help physicians to find knowledge quickly and easily. However these tools represented major challenges in current world due to the time pressures that may prevent physicians from listening to their patients and to concern to their problems.²⁴ Any interpersonal relationship like medicine or education where human is in-between the patient and doctor, or student and teacher respectively, requires time to grow and flourish. However, in the practice of medicine; as anywhere else, the time has become greatly lacking.^25,26

As clinicians become time exhausted and overburdened they become multi-taskers (McCartney; 1995). They may do more than one duty at the same time. The quality of everything they do become simultaneously worse and diluted in the expense of the number of tasks they did.^27,28

Hunt et al.²⁹ Serwint³⁰ noted that physicians burn-out, fatigue, emotional exhaustion, depersonalization and decreased feelings of personal accomplishment can develop due to long working hours. Burnout dramatically affects the physician-patient relationship with consequent loss of empathy and distancing from patients whom feel a sense of abandonment and dissatisfaction with the health care providers.

Since 1970 there was a trend towards incorporating medical humanities modality in undergraduate curriculum both in the United States and Europe^31,32 and in many parts of the world.^33,34

In (1919) Sir Osler described the relations between basic science knowledge and the humanities stating his famous equate (The humanities are the hormones which do for society at large what the thyroid gland does for the individual).³⁵

Lewenson & Londrigan³⁶ reported that modern society cannot flourish without health care professionals exhibiting strong background in medical humanities as they interact with the people from birth to death, in health and illness so they must be reflective, flexible, and comfortable with the care of their patients and communities.

Medical students begin their January in medical schools with great empathy and desire to help others. But the medical schools teach them solid basic sciences and escape the challenges concerned with human issues.³⁷ Empathy among medical students declines as they proceed in their medical school.³⁸ Current medical students lack the essential humanistic behaviors, such as empathy and communication skills.³⁹ Incorporating medical humanities in medical school curriculum helps the students in their future career to do what they are already doing but in a more humanistic and empathic manner.⁴⁰ It can foster critical thinking, understanding of personal values, empathy, cultural competence, leadership, and teamwork activities. Thus it prepares medical students to respond appropriately to complicated clinical problems.^20,41 It advocates the medical students to achieve good behaviors into their future practice.⁴² Teaching humanistic values becomes a priority in medical education.⁴³

Medical humanities modality is concerned with the understanding of the socioeconomic, ethnic and religious background of patients and their families.⁴⁴ In 1993, the General Medical Council in the United Kingdom reported the importance of the medical humanities and released its report; termed (Tomorrow’s Doctors) Downie⁴⁵ This report proposed a curriculum formed from interdisciplinary subjects including philosophy, anthropology, religion, law, history, cultural studies, arts and communication skills.^46,47 The Council advised integration of this curriculum in the undergraduate medical education to promote skills, ethical and legal issues relevant to clinical practice and rights of patients in all aspects.⁴⁸ The curriculum in medical humanities should be longitudinal and expanded throughout all years of undergraduate study as well as in continuing medical education.^49,50

Humanism and medical humanities can be taught to medical students through lectures, role modeling, training in interpersonal skills, literature and arts study and listening to video recordings of students encounters with patients.^3,51 Small group teaching standardized patient exercises, clinical rounds, conversations and service-learning experiences can also be used as learning methods for humanism.^52,53

The role model is a term refers to a person or physician who is followed by students or learners to imitate his/her clinical experience, humanistic behavior, and teaching skills. It is a longstanding educational method and has been recommended for promoting humanism in medical students.⁵⁴ Positive role models had high degrees of skills and knowledge. They emphasize the psychological and social aspects of medical care. They respect their patients and listen to them with attention and respond to their feelings and emotions. During teaching, they establish a reflective atmosphere with their students and win their trust as they are appropriately interested in and concerned for their students and patients. They can associate the human and moral dimensions of health care in the learning process of basic and clinical medical knowledge.^51,55

Multiple assessment tools can be used for assessments of humanistic attitudes and behaviors among medical students. These methods include observations during patient examination or history taking or objective structured clinical examinations (OSCEs), simulations and quizzes.³ Qualitative assessment methods are preferred to determine the perception of students in the humanistic values and attitudes. These methods highlight the fact that the professional practice and humanistic values integrate disease and illness, thoughts and feelings. Medical educators must not forget that humanism is an interdisciplinary subject intermingled with the basic biomedical sciences.

Medical institutions depend mainly on technological principles. They are designed to deal with medical and surgical procedures infection control, nursing and security. Physicians become humanistic-ally inclined. The medical school must support teaching of humanistic values.⁵⁶ Also standards and educational principles of the medical institutions must reflect humanistic values. They also must pay an attention to and maintenance of patient satisfaction with the outcome of healthcare services.^24,57 An organization culture must value its members by showing concern for their well-being, growth, and development.^58,59 The medical organizations could employ experts with good humanistic knowledge, skills, and experience in the interpersonal skills to qualitatively evaluate professionalism and humanism among medical students.

None.

The author declares there is no conflicts of interest.

1. Pellegrino ED. Humanism and the Physician. Knoxville, Tennessee, USA: University of Tennessee Press; 1979.
2. Branch WT. Supporting the moral development of medical students. J Gen Intern Med. 2000;15(7):503–508.
3. Libby GC, Youmna AS. Twelve tips on teaching and learning humanism in medical education. Med Teach. 2014;36(8):680–684.
4. Miles JL. Humanistic medicine or values-based medicine...what’s in a name? Med J Aust. 2002;177(6):319–321.
5. Grafton, Anthony. Bring Out Your Dead: The Past as Revelation. Cambridge: Harvard University Press; 2004.
6. Cohen MB. The healing hand. Hum Pathol. 2012;43(10):1538–1540.
7. Lee WK, Harris CCD, Mortensen KA, et al. Enhancing student perspectives of humanism in medicine: reflections from the Kalaupapa service learning project. BMC Med Educ. 2016;6:137.
8. Weissmann PF, Branch WT, Gracey CF, et al. Role modeling humanistic behavior: Learning bedside manner from the experts. Acad Med. 2006;81(7):661–667.
9. Silverman ME, Murray TJ, Bryan CS. The Quotable Osler. Philadelphia, PA: American College of Physicians; 2007:317.
10. Hojat M, Louis DZ, Markham FW, et al. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(3):359–364.
11. Sylvia LG, Hay A, Ostacher MJ. Association between therapeutic alliance, care satisfaction, and pharmacological adherence in bipolar disorder. J Clin Psychopharmacol. 2013;33(3):343–350.
12. Lee YM, Ahn DS. A preliminary study for exploring the attributes of being a “Good Doctor”. Korean J Med Educ. 2007;19(4):313–323.
13. Donatella L, Paolo RS, John PD. Music and medicine. J Multidiscip Healthc. 2010;3:137–141.
14. Livinson W. Physician–patient communication: A key to malpractice prevention. JAMA. 1994;273(20):1619–1620.
15. Pellegrino ED. Toward a reconstruction of medical morality. Am J Bioeth. 2006;6(2):65–71.
16. Steinhausen S, Ommen O, Antoine SL, et al. Short- and long-term subjective medical treatment outcome of trauma surgery patients: the importance of physician empathy. Patient Prefer Adherence. 2014;8:1239–1253.
17. Marek HD. Physicians, scientists, and the wider culture: Sir William Osler. Clin Chem. 2014;60(5):800-801.
18. Gourevitch D. The history of medical teaching. Lancet. 1999;354 Suppl:SIV33.
19. Taylor JC, Martin HC, Lise S. Factors influencing success of clinical genome sequencing across a broad spectrum of disorders. Nat Genet. 2015;47(7):717–726.
20. Evans M. Reflections on the humanities in medical education. Med Educ. 2002;36(6):508–513.
21. Macnaughton J. Medical humanities' challenge to medicine. J Eval Clin Pract. 2011;17(5):927–932.
22. Bertman S. Pursuing humanistic medicine in a technological age. J Patient Exp. 2017;4(2):57–60.
23. Egnew TR. Suffering, meaning, and healing: challenges of contemporary medicine. Ann Fam Med. 2009;7(2):170–175.
24. Frankel R. Computers in the examination room. JAMA Intern Med. 2016;176(1):128–129.  
25. Ventres WB, Frankel RM. Shared presence in physician-patient communication: a graphic representation. Fam Syst Health. 2015;33(3):270–279.
26. Ventres WB. Building power between polarities: on the space in-between. Qual Health Res. 2015:26(3):345–350.
27. Eyal O, Nass C, Wagner AD. Cognitive control in media multitaskers. PNAS. 2009;106(37):15583–15587.
28. Cheshire WJ. Multitasking and the neuroethics of distraction. Ethics and Medicine. 2015;31:19–25.
29. Hunt JE, Lick D, Boura J, et al. An exploratory study of resident burnout and wellness. Acad Med. 2009;84(2):269–275.
30. Serwint JR. Humanism through the lens of the academic pediatric association. Acad Pediatric. 2012;12(1):1–8.
31. Goodlad S. The search for synthesis: Constraints on the development of the humanities in liberal science-based education. Studies in higher education. 2000;25(1):7–23.
32. Evans HM, Macnaughton J. Should medical humanities be a multi-disciplinary or an interdisciplinary study? Med Humanit. 2004;30(1):1–4.
33. Bleakley A, Marshall R. Can the science of communication inform the art of the medical humanities? Med Educ. 2013;47(2):126–133.
34. Bleakley A. Medical humanities and medical education: how the medical humanities can shape better doctors. New York, NY: Routledge; 2015:264.
35. Osler W. The Old Humanities and the New Science. Boston: Houghton Miflin: 1920;26–28.
36. Lewenson SB, Londrigan TM. Decision-making in Nursing. Massachusetts, USA: Jones and Bartlett Publishers; 2008.
37. Spiro H. What is empathy and can it be taught? Annals of Internal Medicine. 1992;116(10):843–844.
38. Feinstein AR. Clinical judgment revisited: The distraction of quantitative models. Ann Intern Med. 1994;120(9):799–805.
39. Jung HY, Kim JW, Lee S, et al. A study of core humanistic competency for developing humanism education for medical students. J Korean Med Sci. 2016;31(6):829–835.
40. Fox DM. Who we are: the political origins of the medical humanities. Theor Med. 1985;6(3):327–341.  
41. Bolton G. Medicine, the arts, and the humanities. Lancet. 2003;362(9378):93–94.
42. John MW, Jeffrey FM. Promoting medical humanism: design and evaluation of an online curriculum. Fam Med. 2008;40(9):617–619.
43. Glass RM. The patient-physician relationship. JAMA focuses on the center of medicine. JAMA. 1996;275(2):147–148.
44. Tucker CM, Herman KC, Pedersen TR, et al. Cultural sensitivity in physician-patient relationships: perspectives of an ethnically diverse sample of low-income primary care patients. Med Care. 2003;41(7):859–870.
45. Downie R. Medical humanities: some uses and problems. JR Coll Physicians Edinb. 2016;46(4):288–294.
46. Shapiro J, Coulehan J, Wear D, et al. Medical humanities and their discontents: Definitions, critiques, and implications. Acad Med. 2009;84(2):192–198.
47. Erwin CJ. Development of a medical humanities and ethics certificate program in Texas. J Med Humanit. 2014;35(4):389–403.
48. Tseng FY, Shieh JY, Kao TW, et al. Developing and evaluating medical humanities problem-based learning classes facilitated by the teaching assistants majored in the liberal arts: A longitudinal crossover study. Medicine (Baltimore). 2016;95(6):e2765.  
49. Gracey CF, Haidet P, William TB, et al. Precepting humanism: strategies for fostering the human dimensions of care in ambulatory settings. Acad Med. 2005;80(1):21–28.
50. Rabow M, Remen R, Parmelee D, et al. Professional formation: Extending medicine’s lineage of service into the next century. Acad Med. 2010;85(2):310–317.
51. Branch W, Kern D, Haidet P, et al. The patient-physician relationship. Teaching the human dimensions of care in clinical settings. JAMA. 2001;286(9):1067–1074.
52. Block S. Using problem-based learning to enhance the psychosocial competence of medical students. Acad Psychiatr. 1996;20(2):65–75.
53. Elam C, Sauer M, Stratton T, et al. Service learning in the medical curriculum: Developing and evaluating an elective experience. Teach Learn Med. 2003;15(3):194–203.
54. Mirhaghi A, Moonaghi HK, Simin S, et al. Role modeling: a precious heritage in medical education. Scientific Journal of the Faculty of Medicine in Nis. 2015;32(1):31–42.
55. Molinuevo B, Escorihuela R, Fernandez TA, et al. How we train undergraduate medical students in decoding patients’ nonverbal clues. Med Teach. 2011;33(10):804–807.
56. Inui T. A Flag in the wind: Educating for professionalism in medicine. Washington, DC: Association of American Medical Colleges. 2003.
57. Levenstein JH, McCracken EC, McWhinney JR, et al. The patient centered clinical method. 1. A model for the doctor patient interaction in family medicine. Fam Pract.1986;3(1):24–30.
58. Cooke RA, Rousseau DM. Behavioral norms and expectations: A quantitative approach to the assessment of organizational culture. Group & Organization Studies. 1988;13(3):245–273.
59. Wilkins A, Ouchi W. Efficient cultures: Exploring the relationship between culture and organizational performance. Administrative Science Quarterly. 1983;28(3):469–481.