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The humanities offer great potential for enhancing professional and humanistic development in medical education. Yet, although many students report benefit from exposure to the humanities in their medical education, they also offer consistent complaints and skepticism. The authors offer a pedagogical definition of the medical humanities, linking it to medicine as a practice profession. They then explore three student critiques of medical humanities curricula: (1) the content critique, examining issues of perceived relevance and intellectual bait-and-switch, (2) the teaching critique, which examines instructor trustworthiness and perceived personal intrusiveness, and (3) the structural/placement critique, or how and when medical humanities appear in the curriculum. Next, ways are suggested to tailor medical humanities to better acknowledge and reframe the needs of medical students. These include ongoing cross-disciplinary reflective practices in which intellectual tools of the humanities are incorporated into educational activities to help students examine and, at times, contest the process, values, and goals of medical practice. This systematic, pervasive reflection will organically lead to meaningful contributions from the medical humanities in three specific areas of great interest to medical educators: professionalism, "narrativity," and educational competencies. Regarding pedagogy, the implications of this approach are an integrated required curriculum and innovative concepts such as "applied humanities scholars." In turn, systematic integration of humanities perspectives and ways of thinking into clinical training will usefully expand the range of metaphors and narratives available to reflect on medical practice and offer possibilities for deepening and strengthening professional education.

For parents, the experience of having an infant in the NICU is often psychologically traumatic. No parent can be fully prepared for the extreme stress and range of emotions of caring for a critically ill newborn. As health care providers familiar with the NICU, we thought that we understood the impact of the NICU on parents. But we were not prepared to see the children in our own families as NICU patients. Here are some of the lessons our NICU experience has taught us. We offer these lessons in the hope of helping health professionals consider a balanced view of the NICU’s impact on families.

Reality medical television, an increasingly popular genre, depicts private medical moments between patients and healthcare providers. Journalists aim to educate and inform the public, while the participants in their documentaries-providers and patients-seek to heal and be healed. When journalists and healthcare providers work together at the bedside, moral problems precipitate. During the summer of 2010, ABC aired a documentary, Boston Med, featuring several Boston hospitals. We examine the ethical issues that arise when journalism and medicine intersect. We provide a framework for evaluating the potential benefits and harms of reality medical television, highlighting critical issues such as informed consent, confidentiality, and privacy.

Fostering appropriate attitudes toward patients begins with recognition of the physician's personal biases and preferences about patients. We sought to assist second-year medical students to identify those patient attributes that may influence their clinical behavior, especially in difficult patient encounters. This study's objectives were (1) to identify the principal patient characteristics reported by students to evoke negative or positive affective reactions sufficient to compromise the quality of patient care and (2) to examine differences between male and female students on these patient characteristics.An anonymous survey was made of all second-year medical students attending a seminar on medical errors. Students recorded the three principal patient characteristics that might evoke in them a negative personal reaction sufficient to compromise the quality of clinical care. Students then recorded three principal patient characteristics that might evoke a positive reaction sufficient to compromise the quality of clinical care. The data were analyzed to identify the primary concerns of the entire group of students and any significant differences between male and female students.Information on negative attitudes was provided by 67 of 71 (94%) students and on positive attitudes by 70 of 71 (99%). Content analysis identified four general categories of patient characteristics associated with negative attitudes (patients who are rude, contributed to medical problem, are abusive to others, and other attributes). Five general categories (patients with whom students have personal connection or patients who have physical and/or social attractiveness, vulnerability, power/influence, and other) were associated with positive attitudes by the students. The leading patient attributes reported as likely to influence clinical behavior were the positive attributes of "personal connection" and "attractiveness." These were reported by 60% and 53% of the class, respectively, compared to the leading negative attributes of "rudeness" and "contributed to own condition," each reported by 51% of students. Significant differences between male and female students only occurred in the categories of "rude" and "attractive."Students are willing to disclose specific, personal attitudes toward patients that they perceive as sufficiently serious to influence the quality of clinical care. More than half of the students anticipated difficulty in providing optimal care to patients who exhibit certain characteristics. More students reported concerns about positive affective reactions to patients than about negative reactions. Medical education should address these issues in strategies to adequately prepare students for practice.

Families making difficult end-of-life decisions in the intensive care unit often do not exercise their autonomy in accord with the individualistic philosophic and legal models that currently prevail. Instead, they try to avoid responsibility and deny complicity, even for decisions that they ultimately approve. This paper examines two novels and a recent case from a neonatal intensive care unit that reveal how people actually make tragic decisions for family members. Dostoevsky's The Brothers Karamazov and Kenzaburo Oe's A Personal Matter explore the patterns of communication by which people in such situations test complicity and share or submerge accountability. The psychological similarities between the novelists' portrayals and the actual processes that families undergo in the ICU have practical clinical implications for the ways physicians approach discussions about do not resuscitate (DNR) orders with patients' family members.

Introduced to U.S. medical schools in 1972, the field of literature and medicine contributes methods and texts that help physicians develop skills in the human dimensions of medical practice. Five broad goals are met by including the study of literature in medical education: 1) Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people; 2) great works of fiction about medicine enable physicians to recognize the power and implications of what they do; 3) through the study of narrative, the physician can better understand patients' stories of sickness and his or her own personal stake in medical practice; 4) literary study contributes to physicians' expertise in narrative ethics; and 5) literary theory offers new perspectives on the work and the genres of medicine. Particular texts and methods have been found to be well suited to the fulfillment of each of these goals. Chosen from the traditional literary canon and from among the works of contemporary and culturally diverse writers, novels, short stories, poetry, and drama can convey both the concrete particularity and the metaphorical richness of the predicaments of sick people and the challenges and rewards offered to their physicians. In more than 20 years of teaching literature to medical students and physicians, practitioners of literature and medicine have clarified its conceptual frameworks and have identified the means by which its studies strengthen the human competencies of doctoring, which are a central feature of the art of medicine.