Invited Commentary
Medical Humanities: The Rx for Uncertainty?
Danielle Ofri, MD, PhD
Abstract
While medical students often fear
the avalanche of knowledge they are
required to learn during training, it is
learning to translate that knowledge into
wisdom that is the greatest challenge of
becoming a doctor. Part of that challenge
is learning to tolerate ambiguity and
uncertainty, a difficult feat for doctors
It was just one nonfiction manuscript
out of hundreds that were being
considered for the Bellevue Literary
Review. The essay was ragged at the edges,
and it almost didn’t make the first cut.
The narrator was a college kid on spring
break in Florida. She was dancing at a
disco, trying to pick up a guy. The Bee
Gees were playing, the disco lights were
flashing, the hormones were percolating.
So far, standard chick lit.
But then, during one particularly
exuberant dance move, the narrator’s
prosthetic leg disengaged and went
spinning across the floor. Horrified, she
dropped down to see where it went. She
crawled along a floor sticky with beer,
worming her way around sweating,
gyrating bodies. Desperate to find her
leg, she shimmied through the crowd on
her elbows, trying to stay focused despite
the flashing lights and thudding beat. All
the while, her date blithely boogied on,
entirely oblivious to her terranean quest.
As an editor, it’s a special thrill to happen
upon a diamond in the rough. Working
with an author to coax a story into its
final form is literary epinephrine. As
a physician, though, a story like this
D. Ofri is associate professor, Department of
Medicine, New York University School of Medicine,
and attending physician, Bellevue Hospital, New
York, New York.
Correspondence should be addressed to Danielle
Ofri, Bellevue Hospital, 462 First Ave., Suite 2B,
New York, NY; e-mail: danielle.ofri@nyumc.org;
Twitter: @danielleofri.
Acad Med. 2017;92:1657–1658
First published online October 3, 2017
doi: 10.1097/ACM.0000000000001983
Copyright © 2017 by the Association of American
Medical Colleges
Academic Medicine, Vol. 92, No. 12 / December 2017
Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
who are taught to question anything that
is not evidence based or peer reviewed.
The medical humanities specialize in this
ambiguity and uncertainty, which are
hallmarks of actual clinical practice but
rarely addressed in medical education.
The humanities also force reflection and
contemplation—skills that are crucial
is educational gold. “Breaking Point”1
became my go-to essay when I want
to encourage my students to think
about how we inhabit our bodies and
to contemplate the blindness of those
unaffected by illness or disability.
Somewhat akin to that famous
description of pornography, we know
good doctors when we see them, and
we know lousy doctors when we see
them. We all know doctors with brilliant
medical knowledge—but we’d never send
our family members to them.
Typically, it is medical knowledge that
students fear the most—memorizing
all those diseases, passing the tests,
not looking stupid on rounds. There
is no doubt that mastering the facts of
medicine is intolerably humbling and
Sisyphean in its relentlessness. But that,
in fact, is the easy part of medicine. Or at
least that’s what many of us have realized
once we’ve gotten past the avalanche that
is medical training.
The hard part is how to translate that
knowledge into wisdom. We don’t just
want doctors to be smart; we also want
them to be wise. We want doctors not
just to be good but also to be great—the
kind of doctor your grandmother writes
home about. Translating knowledge into
wisdom is one of the greatest challenges of
medical education, and it’s not something
easily achievable with a PowerPoint
presentation or a 1-to-7 Likert scale.
A key element in developing wisdom
from knowledge is learning to tolerate
ambiguity and uncertainty. This is a
frustrating experience for most people
but especially for doctors. The girder of
to thoughtful decision making and to
personal wellness. Beyond that, the
humanities add a dose of joy and beauty
to a training process that is notoriously
frugal in these departments. Well
integrated, the humanities can be the
key to transforming medical knowledge
into clinical wisdom.
medical culture is scientific certainty,
and we rightly deride anything that isn’t
evidence based or peer reviewed. But
actual patient care—real people with real
diseases—is steeped in uncertainty.
Living with uncertainty can feel like being
on a slow-moving carousel—the vague
unsettling sensation of not quite knowing
where you are, your brain slightly
muddled by cheery yet sinister carnival
music, your stomach hovering just shy of
nausea but still several degrees beyond
comfort, your eyes disoriented from
the absurd images that are moving too
quickly for focus though not fast enough
to qualify as a blur.
And then, in that state, doctors are asked
to make serious and profound decisions,
ones that may gravely impact the lives of
fellow human beings. They are expected
to render these decisions in a concise,
definitive manner, with all the cool-
headed flair of a person in charge. None
of that namby-pamby waffling.
Indeed, a large part of our medical
maturation is facing the uncertainty
and then accepting it into our fold,
getting acclimatized to the carousel and
gathering our bearings in a disorienting
world. This is far harder than memorizing
all those rare diseases.
The humanities can offer doctors a
paradigm for living with ambiguity
and even for relishing it. Great works
of literature, art, theater, and music
specialize in ambiguity, confusion, and
frailty. Unlike medicine, the humanities
do not shy away from uncertainty. They
revel in the depth and breadth that
ambiguity affords.
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 Invited Commentary
When I read “Breaking Point” with
my students, we are thrown, quite
viscerally, into the beating heart of
human vulnerability. Issues of disability,
body image, and health no longer seem
quite as clear-cut. Disabled versus abled
doesn’t seem so binary any more, nor
does illness. Most medical students—and
most doctors, for that matter—have
never grappled with these uncomfortable
shades of gray. But our patients do, every
single day.
The more familiar that doctors, and
patients frankly, are with these states of
discomfort, the more we realize that such
states are normal. The more we allow
ourselves to recognize these states of
ambiguity within ourselves, the wiser and
more nuanced we can be in our approach
to patients.
In clinical practice and medical
education, we spend our days plumbing
the depths of the human body and its
discontents. However, we rarely have the
time or the emotional space to grapple
with the ramifications of what we do.
Slowing down is something doctors do
not do well. We demand rapid results,
from our diagnostic tests, from our
patients, and most mercilessly, from
ourselves. We rarely permit ourselves
to wait in solitude, to allow the poetic
subtleties and convoluted irrationalities
of patient care to sink deep within us. It
is both awkward and daunting to stop
and wait. And so we walk and talk at a
feverish clip to keep the reflective silence
at bay.
When I think about the role of the
humanities in medical education, I return
again and again to this reflective silence.
Reading a poem, gazing at a painting,
listening to a concerto—these all demand
reflective silence. They force us to step
back from the in-the-moment experience
into the buffer zones of contemplation.
Medicine is too often practiced only in
the moment. This lack of contemplation
coarsens our decision-making process,
and it is our patients who suffer.
The reflective silence that the ambiguity
of the humanities forces on us is salutary
for our patients, but it is also beneficial
1658
Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
for us. Exhaustion, numbness, and
burnout, sadly, seem to be sine qua nons
of medicine. Everyone, at some time or
another, has felt drained to the point of
incoherence or has felt like an automaton
mindlessly clicking boxes in the electronic
medical record. Nearly everyone has,
at some point, sunk into that abyss in
which patients are viewed as the source
of pain and the only goal is to get rid
of them as expediently as possible. One
commonality in these situations is a lack
of reflective silence; we are generally left
to stew alone in our wretchedness and
ignominy.
The humanities allow us to develop
the underused mental muscles of
reflection and contemplation. They
foster perspective and questioning. They
emphasize context and provenance. They
confront and relish ambiguity. Imagine
having such tools at hand in the depths
of one’s misery. They certainly don’t
erase the realities that cause such states,
but they offer balms for the pain, and
occasionally the needed boost up to that
first rung of the ladder out.
In some ways, the medical humanities
function as a photographic negative
for clinical practice, bringing light to
places that are normally dark. In doing
so, they allow doctors to explore the
deeper context of what it means to be
“in medicine.” They leaven the thought
process to promote more nuanced
thinking, something that stands to benefit
both patient and doctor alike.
All of these pedagogical imperatives
are indeed crucial. They fit approvingly
into mission statements and grant
applications. But beyond all these
laudatory goals, there is the simple
truth that the humanities bring joy.
The academic medical path is known
for many things, but joy isn’t typically
one of them. If literature, art, music,
and theater bring a measure of joy to
our students who are waterlogged by
pyruvate kinase, renal tubular acidosis,
and terminal illness, that alone is a cause
for celebration. Beauty and pleasure
are rarely articulated as part of medical
training. But there is a beauty in the
complexity of the human body, and there
Academic Medicine, Vol. 92, No. 12 / December 2017
is intense pleasure to be mined from
the human connections that we are so
fortunate to be privy to.
And so when I give advice to medical
students and interns, I stay away
from recommending cardiology over
nephrology, or hospital practice over
private practice, or New York over Boston.
These young doctors are all smart and
they will all land on their feet. Rather, I try
to advise them on ways to stay engaged in
the world. I ask them what their passion
is, or what it was; what their hobbies
are, or what they used to be. Most have
wistful recollections of things they used
to do, things they used to love, and it
nearly always involves some aspect of the
humanities. I press them to think of ways
to stitch a little bit of these back into their
lives, just enough to remain engaged, just
enough to help keep their souls intact.
If you spend five fewer minutes reading
the New England Journal of Medicine,
I promise them, you’ll still be a good
doctor. You won’t kill any patients for
missing those five minutes. But if you
squeeze in five minutes of Brahms or
Noguchi or Louise Gluck or August
Wilson, if you find five minutes to pick
up your French horn or your watercolors
or your tap shoes, then you will be more
fully engaged in the world. You’ll stretch
those off-the-beaten-track neurons that
then will be there for you the next time
you confront an inscrutable diagnosis, an
uncertain treatment plan, or a seemingly
unreachable patient. You might just find
in the palm of your hand that nugget of
creativity that squeezes you past a block
that stymies others. You might make that
transition from being a smart doctor to a
wise doctor, from a good doctor to a great
doctor. And not only will you be a great
doctor, but you’ll also be a great person.
And then your grandmother will really
have something to write home about.
Funding/Support: None reported.
Other disclosures: None reported.
Ethical approval: Reported as not applicable.
Reference
1 Cronin ME. Breaking point. Bellevue Lit Rev.
2008;2:58–61.