Engaging with Shakespeare to humanise medicine

Earlier this month Dr David Jeffrey, writing in the Journal of the Royal Society of Medicine*, suggested that a study of Shakespeare’s plays may be a creative way of enhancing empathic approaches in medical students. Dr Jeffrey, of the Department of Palliative Medicine at the University of Edinburgh, has written this companion piece for RSM Engage that explores how studying the playwright’s empathic approach could play a role in restoring the human face of medicine.
 

There have been calls over the past forty years to restore the human face of medicine, but little has changed; evidence-based medicine is the priority while psychosocial aspects of the patient’s experience are undervalued (1). There is a need to redress the imbalance between scientific and psychosocial care. The recent Covid-19 pandemic, with the need for personal protection, social distancing and video consultations, has created further challenges to establishing empathic humane relationships between patients and doctors.

Shakespeare enhances empathy

Shakespeare’s empathic approach reveals a sensitivity to psychological and social concerns. His plays are concerned with the ethical dilemmas of everyday living, leaving moral judgements to his audience. Studying his works can extend a doctor’s understanding of a patient’s suffering by developing imaginative reflective practice and extending clinical curiosity.

King Lear: a small group seminar

A seminar focusing on empathy and the nature of suffering as depicted in King Lear could offer doctors ways of connecting with the inner world of others in a safe, supportive environment. Shakespeare’s tragedy confronts our mortality and in doing so interrogates related notions of suffering, pain, family and identity: concepts central to clinical practice (2). By attending the seminar, doctors would be mirroring the availability of the empathic clinician to emotional connection with a patient. There would be an opportunity to share with colleagues, to reflect and to experience empathy. Some examples of topic discussions include:

Kent urges Lear to “see better”, not simply to make better moral choices, but to explore the reasons behind another’s behaviour, not to react to things at face value (3).

Some of the most acute suffering experienced by a patient is caused by the anticipation of future incapacity. At the end of Act 1, Lear makes his first reference to madness: ‘O let me not be mad. Not mad, sweet heaven! I would not be mad. Keep me in temper, I would not be mad’ (Act1 Scene5).

Lear dreads the onset of madness, but it is through this ‘madness’ that he gains insight into his own humanity. He feels what the poor of his kingdom feel: hunger, cold and despair. ‘Unaccommodated man is no more but such a poor, bare, forked animal’ (Act 3 Scene 4).

Shakespeare considers the question of appropriate intervention at the end of life. When King Lear dies, Edgar steps forward to revive him, but Kent stops him, ‘Vex not his ghost; O, let him pass. He hates him That would upon the rack of this tough world Stretch him out longer’. (Act 5 Scene 3).

Medical decisions at the end of life regarding withholding or withdrawing treatments are concerned with the difficult issues of balancing a wish to prolong life at any cost with a humanity which recognises that it is sometimes appropriate to allow natural death(2).

A Shakespearean learning environment

There needs to be a culture change to shift from an authority-led hierarchy to an emphasis on a common humanity in the delivery of health and social care. By focusing on the patient’s subjective experience of their disease, the patient becomes the teacher. Embedding empathy into practice and training also requires attention to the clinical context. It is not sufficient to train doctors to practice empathically and expect them to work sensitively in situations where they are stressed, lack time or receive little support. Time should be allocated not only for the teaching of empathy, but also for trainees to reflect on humanising medicine. Medical trainers should have time allocated for teaching, which is valued by the administration. Doctors need support throughout their careers; mentoring should be available for all doctors, not just those found to be struggling.

Conclusion

One of the aims of studying Shakespeare is to disturb prejudices; exploring his work together enables healthcare professionals to appreciate that often that there is no single right answer. A seminar on Shakespeare is one way of promoting interdisciplinary learning by creating a space where healthcare professionals can step back from clinical duties and think deeply about other people and their lives (4). Shakespeare also encourages trainees to engage a sociological perspective when thinking about the patient’s story, encouraging them to see the world through the other’s eyes, to empathise.

*Download the original JRSM paper: Shakespeare’s empathy: enhancing connection in the patient–doctor relationship in times of crisis

References

1. Gillon R. Restoring humanity in health and social care – Some suggestions. Clinical ethics. 2013;8(4):105-10.
2. Jeffrey E, Jeffrey D. Vex not his ghost: King Lear and end-of-life care. J R Coll Physicians Edinb. 2009;39:15-9.
3. Maguire L. Where There's a Will There's a Way. London. Nicholas Brealey Publishing; 2007.
4. Kumagai AK. Beyond "Dr Feel-Good": A Role for the Humanities in Medical Education. Acad Med. 2017;92:1659-60.