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Holistic Doctoring

The Spark finds out how medical students are learning to diagnose from an holistic perspective

Medical students in their first year at the University of Bristol are taught to tackle medicine from a holistic point of view. The human side of medicine may seem like 
common sense, but as many of us who have been patients will attest, this can be seriously lacking at the doctors' bedside. With 35 per cent of these medical students going on to become GPs it's vital. "It's quite a leap from the scientific," says Trevor Thompson, who is Consultant Senior Lecturer 
in Primary Care at the university. He developed the unit, called Whole Person Care, about seven years ago. "Some of the big themes are working 
at a higher chunk of understanding and offer a very different perspective from lectures on 
anatomy or disease."

One of the main themes is systems thinking. Lots of different things can be described as systems: a charity, for example, or society as a whole or a human being. All systems have component parts and sometimes these parts are invisible. In a group of people, for example, one person's role may not beimmediately obvious. In medicine, the human body is normally approached from a linear, 
cause-and-effect point of view, or as Trevor describes it, a "lesional" understanding where 
illness is visible and measurable. Systems thinking however, takes into account the things a doctor can't see and quantify, such as the patient's family life and emotional circumstances. Trevor says it's an effective hook that draws in the sceptical 
students as it appeals to their analytical minds. "We're very keen to stress that systems exist on very different scales," says Trevor. "You have the scale of the body and a tremendous amount of effort is put into studying the body, and then you have the scale of the family, of society, of whole nations. The cause of a health problem can exist a long way from the actual site of the problem".

Nicola Harker is a practising GP in Whorl who 
lectures on the course. She says, "It's knowing your clinical medicine and knowing your science, but it's also knowing and understanding how 
people work and think, and getting to the nub 
of the problem." The concept of emotional intelligence is an 
encompassing theme here, and the students 
explore different behavioural models and the idea that their own emotions play a vital role in their relationship to their patients and their diagnosis. This is far removed from what they will have learnt so far. "

I think emotional intelligence is gaining ground in education," says Trevor. For example braininess is one type of intelligence and physical coordination is another. "Emotional intelligence is how a person recognises and deals with their own emotions and particularly the way in which that affects how well we function with others, so somebody may have problems with being too dominant or too withdrawn."

The Whole Person Care unit is designed to tease out these issues and help the students to overcome them so they will not be in their way as doctors. This is based around the idea that the diagnosis is as important as the treatment, that there are valuable healing affects coming from the relationship between the doctor and the patient as well as from any prescribed medicine.

"Their mind and emotions are like a diagnostic instrument and in many ways quite literally the most 
sophisticated they'll ever operate," says Trevor. Another aspect of the Whole Person Care unit is using the arts as a communication and healing tool. "Medicine is about loss, death, readjustment, birth, healing…" says Trevor. "Literature, painting and 
poetry reflect 
medical themes."

Bristol is one of the few universities that teaches their medical students this by getting them to be creative. They are required to produce two to three pieces of artwork as part of their course work: free writing and painting, cartoon, embroidery, poetry, film, whatever they like. "Why do we do that?" Trevor asks. "Well, yes, partly because it's a bit of fun, but also because we think it's a way of getting beneath the surface of the clinical situation."

This is a simple but radical idea and it's hard to see how it can be incorporated into a ten-minute appointment at the GP's surgery, but apparently there is a way to make use of the arts. When she thinks that patients might be open to it, Nicola suggests they go home and write poetry, as it's therapeutic when they're having trouble 
articulating what's going on. "Often they look at me as if I'm a bit bonkers, but a high percentage come back and say, 'I thought you were mad but 
it was really interesting'," she says.

She's also found it an invaluable tool in saving consulting time when they come back for their 
follow-up appointment, as it gives her more to go on. She's found this particularly useful with people who have brain tumours or have suffered a stroke, but stresses that it won't work for everyone. "You have to be sensitive to where people are at."

Trevor also advises his students to look after their own health, as if they're overworked and stressed they won't get the most out of their job and they won't be able to offer their patients good care.

The Whole Person Care course seems to lean 
more towards personal development than medical training, so what do the students make of it? "It's not so much that people aren't already aware of these ideas – a lot of it is common sense, but 
the course gives us the opportunity to begin to integrate these holistic views into our wider 
medical education," says Tania Longman, a mature student on the course. "It gave me a really valuable framework for reflecting on and even creatively expressing particular clinical experiences." Whether it improves their bedside manner or not, having more GPs who are self-aware and can think creatively can only be a good thing.

To find out more about the Whole Person Care unit of the medical degree email or call University of Bristol on 0117 928 9000


Written by Hannah Latham

First published issue 56 (Spring 2009)

Disclaimer – details were correct at time of going to press, but may now have changed. Please make your own checks.

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