How Vulnerability Can Heal Medical Education and Practice
304 pp., 6 x 9 in,
- Published: January 19, 2018
- Publisher: The MIT Press
- Published: January 12, 2018
- Publisher: The MIT Press
How medical education and practice can move beyond a narrow focus on biological intervention to recognize the lived experiences of illness, suffering, and death.
In Afflicted, Nicole Piemonte examines the preoccupation in medicine with cure over care, arguing that the traditional focus on biological intervention keeps medicine from addressing the complex realities of patient suffering. Although many have pointed to the lack of compassion and empathy in medical practice, few have considered the deeper philosophical, psychological, and ontological reasons for it. Piemonte fills that gap, examining why it is that clinicians and medical trainees largely evade issues of vulnerability and mortality and, doing so, offer patients compromised care. She argues that contemporary medical pedagogy and epistemology are not only shaped by the human tendency to flee from the reality of death and suffering but also perpetuate it. The root of the problem, she writes, is the educational and institutional culture that promotes reductionist understandings of care, illness, and suffering but avoids any authentic confrontation with human suffering and the fear and self-doubt that can come with that confrontation. Through a philosophical analysis of the patient-practitioner encounter, Piemonte argues that the doctor, in escaping from authentic engagement with a patient who is suffering, in fact “escapes from herself.”
Piemonte explores the epistemology and pedagogy of medicine, examines its focus on calculative or technical thinking, and considers how “clinical detachment” diminishes physicians. She suggests ways that educators might cultivate the capacity for authentic patient care and proposes specific curricular changes to help students expand their moral imaginations.
I am wholly refreshed by Nicole Piemonte's beautifully crafted argument. She shows precisely how medicine can be learned such that it opens doctors to acute sensitivity rather than hardening their hearts.
Alan Bleakley, Emeritus Professor of Medical Education and Medical Humanities, Plymouth University Peninsula School of Medicine; author of Thinking with Metaphors in Medicine: The State of the Art
In this insightful book, Nicole M. Piemonte maintains that without a shared sense of vulnerability to the slings and arrows that flesh is heir to, encounters between patients and doctors are likely to amount to little more than transactional exchanges. She deftly demonstrates how studied attention to philosophical conceptions and literary representations of lived experiences of illness can transform such exchanges into healing encounters. Afflicted is a necessary addition to medical humanities literature and required reading for students who aspire to rewarding careers as caregivers.
Ronald A. Carson, Professor Emeritus, Institute for the Medical Humanities, University of Texas
Nicole Piemonte's Afflicted powerfully confronts a signature challenge in the delivery of healthcare: how to embrace and grapple with the suffering of both patient and physician. She argues that we cannot expect physicians simply to intuit how to care well for patients in the face of mutual vulnerability, or even to recognize their own vulnerability and so care well for themselves. Instead, medical educators must dare to humanize the practice of medicine throughout the formation of physicians. Philosophically accessible and clinically well-grounded, Afflicted integrates compelling stories with incisive analysis to create a sense of genuine hopefulness about the future of healthcare.
Jason Scott Robert, Lincoln Chair in Ethics, Arizona State University