Editor’s Note: This article is a report entitled "Standardized Training of Residents and Cultivation of Humanistic Literacy" given by Academician Wang Chen of China Academy of Engineering at the 2016 Summit Forum on Standardized Training of Residents.
At this stage, everyone is emphasizing that humanistic quality is indispensable for the growth of doctors. Apart from medical technology, what can doctors bring to patients, what are the ways for doctors to care for patients, and what patients can get from doctors? These are important issues worthy of our consideration.
1. The characteristics of medicine: science, but also human science.
Xunzi said: "fire and water are alive without life, plants are alive without knowledge, and animals are knowledgeable without meaning;" People are angry, alive, knowledgeable, and righteous, so it is the most expensive in the world. "It shows that as a person, treating people requires thinking and kindness. As a doctor, it is even more necessary to know the humanities and be full of affection in practicing medicine. In addition to the scientific and technological relationship, the humanistic relationship is extremely important in the doctor-patient relationship. Patients need to get spiritual feelings from doctors, and doctors also need to take care of patients with humanistic care, so that their body and mind tend to be "well-being". Medicine is a science, and at the same time, it should be noted that medicine is a human study. When doctors treat diseases, there are many other factors that can affect patients’ feelings, diseases and health besides scientific and technological means. Doctors in any era should know that science and technology, which is regarded as very high-end in the present age, will be superficial and ridiculous in the future. What patients can get from doctors in this life and in this life is not only relatively "high-end" technology, but also the relief and philosophy that may be obtained from doctors. Therefore, doctors must not only pay attention to technical problems. Medicine was born in the ignorance period when human science and technology were not developed. At that time, the medical model was "deism medical model". The so-called "homology of medicine and witchcraft" refers to the fact that doctors mainly influenced patients mentally to alleviate their pain in the absence of technical means.
2. The importance of humanistic education: teaching doctors to pay attention to people, not just technology.
As we know, modern medical education is divided into three stages: college medical education, post-graduation medical education (including standardized training for residents and specialists) and continuing medical education. In China’s current medical education system, science and technology education runs through, such as anatomy, pathology, pharmacology, microbiology and so on. According to the proportion of humanities courses in China medical colleges published by the Ministry of Education, China (7.54%) is far lower than that in Europe and America (20%~26%). In the clinical education stage, which needs to pay more attention to medical humanities, the humanities course is only 5%. In this way, the doctors we train are more concerned with technology, while others are concerned with the care of people. To be a good doctor, a doctor’s humanistic quality is very important, and its formation should run through all stages of medical education. As mentioned above, the cultivation of China doctors’ humanistic quality is obviously lacking in the stage of receiving college education, which needs to be reformed in the future. At present, can we make up for it in the post-graduation medical education, first of all in the standardized training stage of residents? Obviously, this is a feasible way, the goal of our efforts and the theme we are talking about today.
3. Humanities mainly include literature, history, philosophy, religion and art.
ACGME, the authoritative organization of international post-graduate medical education, puts forward that doctors must have six core competencies, namely, medical knowledge, patient care, interpersonal communication and communication skills, professionalism, practice-based learning and improvement, and practice based on professional system. This includes a lot of content related to humanistic quality. All medical societies, medical education societies and medical industry associations in the world, without exception, emphasize humanistic education in medicine and humanistic quality of doctors.
The so-called humanity, that is, humanity and education, is human spiritual culture. Humanism refers to all disciplines (philosophy, art, language, religion, etc.) and knowledge that explore human emotions, morality, reason and behavior through observation, recording, analysis and rational criticism, accumulate and innovate human thoughts, and guide human behavior, or it is called humanities. China’s traditional humanistic concept refers to various attributes of human beings: "Astronomy is the principle of heaven; Humanities, the way of people is also. " "Humanism, the order of humanity, and the view of humanity to educate the world". Humanities contains many aspects, among which "literature, history and philosophy" is its basic field.
Literature can have a great influence on life. People’s direct experience is limited, and literature can expand their careers, increase their knowledge, comprehend, guide and even change their lives. Be sure to read some literary works and novels. Leave some time for literature and don’t spend a lot of time watching TV series, that’s after retirement. Whether you have read classic literary works, whether you have reading experience and habits, your ideological realm is different.
History carries human experience and experience. "Take history as a mirror and learn from it" and "Historical experience is worth noting". Only those who know history can understand the laws of human beings and human society. As a doctor, no matter from general history or medical history, we will think and learn from the laws of society, disease, medical development and medical treatment, which will make our thoughts more insightful and enlightened. Every disease has its natural course, and most diseases are self-limited and can be "cured" by time. Doctors should master the measure and opportunity of intervention, weigh the role and effect of this intervention, and apply it in a timely and appropriate manner, but not abuse it. You should know that time is the greatest doctor.
About philosophy. Science and medicine can’t know everything, and the so-called mastery of scientific laws is always relative. Science also needs to be guided by it. As mentioned above, today’s "high-tech" will be very crude and ridiculous to future generations, and it is impossible for "contemporary people" to fully understand the laws of nature. But contemporary patients have hope for doctors, who must give him spiritual and physical comfort. Even if the current explanation of the law of disease is not clear, patients must be given a general explanation that represents the general law. At this time, philosophy will come into play. Russell thinks, "Philosophy is something between theology and science. Like theology, it contains human thinking about things that are still uncertain by science; But like science, it appeals to human reason rather than authority. No man’s land between theology and science is philosophy. " In my opinion, philosophy is the overall grasp of the great laws by human beings in the case of "ignorance", and "knowing without knowing"-we don’t know the details, but we can roughly know the general trend and "potential" of things based on limited events, personal practice and ideological speculation, and we can fake it into theory, that is, philosophy. Chinese medicine has grasped this point and formed its theoretical system. The theory of Yin-Yang and Five Elements originated from China’s simple materialistic dialectical philosophy in ancient times, which paid attention to the holistic view in understanding and followed the dialectical theory in treatment. This can not be understood as superficial, but just the way of human wisdom. When science and medicine can’t exhaust the laws of disease and life (-remember, never),Philosophical thinking and grasping are needed to explore the laws of life and health. The ancients said, "it is difficult to cure without knowing the easy." We say, "Know what you don’t know".
As for religion, it has a deep connection with medicine since ancient times. The formation and development of TCM ethics are deeply influenced by Confucianism, Taoism, Buddhism and other philosophical and religious thoughts. Not only believers, but also ordinary people often have psychological effects related to religion in the process of seeking medical treatment. Religious factors in medical practice are a kind of psychological support and prayer for patients when medicine can’t fully grasp, explain and predict their illness. Religion may effectively produce effects, first of all, psychological effects, and then may produce behavioral and physiological effects caused by psychology. The phenomenon and mechanism are far from clear in contemporary medicine. As for doctors, they should convey a philosophical attitude towards life to patients and their families in the process of practicing medicine. Whether the philosophical attitude towards life can run through medical practice and communication, the final result is different, which is also an important embodiment of the different realm of doctors.
Art is an organic component of humanities. Human beings have many indescribable and illogical feelings, which need to be expressed by art to "understand". Doctors should at least be interested in music, painting, photography, drama, film and television, and feel something. This is very important for forming a doctor’s elegant and noble mood and inspiring thinking.
4. The medical profession should strengthen humanities education, and the resident training stage is particularly important.
There are many ways of humanistic education since ancient times. Plato’s humanistic "seven arts" and pre-Qin "six arts" education are mostly humanistic teaching contents. The main purpose of standardized training for residents is to improve doctors’ clinical skills and practical ability, among which humanistic quality is indispensable. Under the situation that humanistic education and social-psychological-biomedical model are obviously insufficient in the current medical education system of colleges and universities in China, it is very important to strengthen it at the resident stage: to truly and firmly establish the concept of cultivating medical humanistic quality; Building a team of high-grade humanities course teachers; Establish a security system and form a long-term mechanism; Standardized, vivid and flexible training content and assessment; Implement humanistic quality training in every specific work (curriculum, teacher allocation, teaching methods, evaluation paths, etc.).
5. "Medical praise and medical prosperity" should become the basic medical ethics and rules.
At present, there is a big problem in the humanistic quality of doctors in China that doctors don’t respect each other enough. There is a saying in the Buddhist world: "Monks praise monks and Buddhism thrives." If monks say no to each other, no one will respect and believe in Buddhism. There is a problem in China’s medical field that should be awakened, and even awakened, that is, some doctors often use other doctors’ criticisms to raise themselves and show "cleverness". It should be noted that doctors’ wisdom is not gained by belittling other doctors. This lack of respect among peers, which has a certain universality in the industry, has caused great harm to the medical profession. Sadly, the industry still seems to be at a loss about this and still "enjoys it". Nowadays, the phenomenon of "shopping around" for medical treatment in society and the phenomenon of mutual suspicion between doctors and patients are all related to this. Doctors should sincerely respect and maintain each other. When your opinion is different from that of other doctors, it is not necessarily that you are right, but that you think you are right and wrong. Even if you are right, you should know that no doctor wants to treat the disease badly, and that doctor’s subjective wish is to help the patient. Saying that other doctors are wrong will not help patients to treat, but will only worsen the already unbearable doctor-patient relationship, increase the difficulty of getting along with doctors and patients, and worsen the practice environment in which they are also located. Remember, "medicine praises medicine, medicine prospers", and if "medicine despises medicine, medicine declines". Kindly maintaining fellow workers is the basic professional ethics, medical ethics and professional rules.
6. Please correct some viewpoints about medical humanities.
·The essence of medical treatment is "care", not "service". Care and service are completely different in connotation and realm.
·Doctors should have a wide range of hobbies, including music, photography, travel, sports, and appreciation of the beauty of the human body, so as to form literacy.
·Among the three magic weapons (medicine, knife and instrument, language) for doctors to treat diseases, language and the humanistic care it represents always account for more than 50%. This is the case in the past, present and future.
·It is inaccurate to say that the doctor-patient relationship is a friend relationship. The relationship between doctors and patients is not reciprocal, but doctors give and patients receive care. There is a master-slave relationship between doctors and patients, so doctors should take the initiative and form guidance, so as to take good care of patients.
·The humanistic quality of doctors should be higher than or at least equal to that of patients, so as to form a good doctor-patient relationship. When the humanistic quality of doctors is lower than that of patients, it will form a difficult situation to face. The high quality of doctors is the key to form a good doctor-patient relationship.
