RAMB - Agosto 2016

edicine

and

humanism

ssoc

ras

2016; 62(5):387-388

387

EDITORIAL

Medicine and humanism

edicina

humanismo

uro

iglio

Full Professor of Hematology and Oncology, Faculdade de Medicina, Fundação do ABC. Coordinator of the Service of Clinical Oncology of Instituto Brasileiro de Controle do Câncer (IBCC) and Hospital do Coração (HCor),

São Paulo, SP, Brazil

http://dx.doi.org/10.1590/1806-9282.62.05.387 aurodelgiglio@gmail.com

“The practice of medicine is an art, based on science.”

William Osler

The history of humanity alternates between cycles of dom-

inance of the human element or of technical knowledge.

While sentiment and religion prevailed in the Middle Ages,

during the Renaissance the power of man through the

discovery of new lands and the progress of science brought

expertise to the forefront. In the 19

century, Romanti-

cism reclaims the emotion so that, years later, Positivism

resumes the praise of technique. In the 20

and 21

cen-

turies, after two World Wars, after stepping on the moon,

sequencing the human genome, and developing treat-

ments for many illnesses personalized at a molecular lev-

el, we end up facing the same duality: technical expertise

versus

humanity. If the technical knowledge shows us how

to do things and what we can achieve, the human element

raises questions such as why we do things, what the pur-

pose of our actions is and what they mean.

The answers to many of these questions cannot be in

the realm of technical knowledge, the progress of which

allows us to glimpse achievements previously unimagi-

nable for disease prevention and healing. Technical knowl-

edge does not allow us to judge, just act. The same exper-

tise can either save lives or torture and kill, as witnessed

in the various wars and revolutions experienced by man-

kind throughout its history.

Those who suffer seek a multidimensional understand-

ing of their suffering through their assisting physicians.

Suffering has a physical dimension that can be attributed

to a biochemical disorder, tissue damage caused by an ex-

ternal agent, and more. At the same time, it presents a psy-

chological, social, economic and spiritual side. If the one

suffering is a family man who loses his job due to the lim-

itations imposed by the illness, and is no longer able to fi-

nancially support his family, we can anticipate the many

ramifications that will transcend the original biochemical

disorder to more complex levels. In order to understand

this human being and the multidimensional totality of his

suffering, we need to hear his story, to understand its ram-

ifications into the other spheres of this individual’s life.

Martin Heidegger (1889-1976), German philosopher, de-

scribes the “Dasein” as the living being in the world, in the

several forms of its expression. Then, disease would restrict

the expression universe of “Dasein” and such limitation

would be the cause of suffering. Only the doctor who is in-

terested in listening to the patient will understand his suf-

fering to a greater extent. Listening is, thus, the essence of

history taking in this Humanistic Medicine, focused on a

broader understanding of the patient’s suffering.

If listening is so important, how do we learn to listen?

We will not find the answer among the techniques

described in medical textbooks. The first step is to have

interest in the other. Martin Buber (1878-1965), in his

book I and Thou, brilliantly explains that human rela-

tionships can be of two types: a) objective (“I-It”), which

is when we try to take advantage from it, using it as a

means to achieve our purpose; and b) personal (“I-Thou”),

when we see others in their totality, recognizing their de-

sires and personality. Maintaining an “I-Thou” relation-

ship with our patients would then be the basis to arouse

our interest in listening to our patients. Medical doctors

learn how to listen early in life, as they interact with their

relatives, fall in love, read, or watch movies and plays; that

is, live life to the fullest. It is out of all of these experienc-

es that one emerges as a being interested in life, in the un-

certainties, sorrows and joys that inevitably accompany

every one of us in our experiential path. A physician who

cultivates this curiosity and refines it with culture be-

comes an ideal listener, for every patient who seeks him

or her will reveal yet another fragment of the endless web

which is living.

And if listening is the core of history taking, what

would then be therapeutics in Humanistic Medicine?

Giving advice to our patients. Since ancient times,

even when our technical ability was very limited, timely

advice, a wise word at the right time, can relieve much

suffering. This ability we have to selflessly guide our pa-

tients not only with regard to the remedy they should