(upbeat piano music) (upbeat suspensive music) - Fears are growing that it won't be possible to stop the global spread of coronavirus.

- There's no doubt that sooner or later, we were gonna see a case that we have.

- Public health officials have been warning for a very long time about an impending pandemic.

- Officials say the next few days will be crucial if they're to prevent this outbreak becoming an epidemic.

- The pandemic has sort of exacerbated these longstanding cultural issues that we have in medicine around not showing emotion around the culture of overwork.

- They're very concerned about extreme cases of psychological distress and mental health pressures.

- We're actually seeing significantly increased attention to this problem during COVID as rates of physician burnout and suicide are increasing.

- The health humanities are geared toward using the skills to inform critical thinking and empathy and compassion in the field of medicine.

- Humanities can be kind of curative to the, sometimes, inhumane experiences of being a physician in today's world.

(suspensive music) (gentle music) - The core of clinical medicine is really story.

Storytelling is about a cooperation.

It's about a desire to tell and a desire to listen, I mean, really listen.

- The medical humanities help doctors and other healthcare practitioners learn to be increasingly empathic and compassionate in focusing first on the doctor-patient relationship, but really, spanning out from that in order to think about how that relationship is situated in a broader series of societal patterns and institutional relationships.

- Students in science classes are not often asked to discover things.

They are told what has been discovered.

When students study in the humanities, they are recreating knowledge all the time because their own views and their own perspectives on what they learn are considered to be important.

When you leave the humanities out, you leave out an entire arena of both knowledge building and skills that are important in our world, in general, and important to medicine.

- Before the sort of mid 19th century, medicine was all about care and comfort and then, as we increasingly got into the laboratory, we moved away from the bedside and that brought with it an unfortunate consequence of sometimes seeing the patient as secondary.

So, instead of seeing the patient as a whole person, we started seeing patients as disease processes or as individual organs and so, by the late 1960s, people really wanted to restore some of what had existed before and also expand it and actually, Penn State College of Medicine was the first college of medicine in the whole country to have a department of humanities.

- The development of modern technology in therapeutics meant that, doctors really could do things.

They could be far more successful than they had previously and that raised questions about ethics, it raised questions about fairness and justice and it also raised questions about the changing nature of things that we thought we knew, like death.

Those are questions where there's a perceived need for something more than scientific knowledge and practice.

- When I was a fourth year medical student and I was rotating in the intensive care unit, I found myself gravitating towards patient's families who, when the patients were intubated or in the ICU and very, very sick, the families were just sitting there, sitting vigil at bedside and needed someone to talk to and sometimes, just translate the medical jargon and I found that was my strength, and that was my skill.

That was how I really became interested in the human connection and humanism and end of life issues.

- When I talk to practicing clinicians, what they tell me is that, the science isn't the hard part of medicine.

What makes medicine hard are the people, is the fact that the person sitting across from you in the bed isn't just a diagnosis, they're not just a disease, it's a human being.

- And so, knowing that your own perspectives are limited and often that you have bias enables you to more easily communicate with and relate to the patients who were sitting across from you and that, of course, has all kinds of positive benefits.

Not only is it gratifying for the patient and the physician in terms of their relationship, but research, both qualitative and quantitative, has shown that there are better health outcomes in that situation.

Graphic medicine is the use of comics in the domain of medicine.

More specifically, comics that are used to tell stories of health and illness, comics that are used to help medical professionals understand different perspectives as they think about the wide diversity of their patients.

It's an interesting medium because it's visual and verbal and also, here's a really critical part, it's highly intellectual and highly analytical because when you're accessing a comic, your brain is operating in two tracks, at least.

For healthcare providers, this is a highly engaging and very meaningful tool.

- Our health depends, not just in our encounters with physicians.

Our health depends upon the places in which we live, the environments in which we work, what we consume.

What we are learning increasingly in the wake of the pandemic is, you can't separate out food systems, you can't separate out working environments.

The role that meat packing factories have played in the pandemic.

You neglect the role of migrant workers in the food system.

You neglect the role of all sorts of institutional and systemic factors on individual and public health.

What that means is, we need to move beyond thinking about medical humanities, which are incredibly important, to thinking also about health humanities, to think more creatively about the complex relationships between humans and health and the way humanities may enrich our understanding of those complex relationships.

- We need to take more of a community based approach to the practice of medicine and to solving these big problems.

The process of answering these big societal questions about what to do about the delivery of healthcare, how to deal with the problems of provider burnout, how to deal with the issues that the pandemic is raising in the hospital, those problems are best answered by taking a multidisciplinary approach that includes people from all walks of life and from all corners of the U.S. (upbeat synthwave music) - There was a masking debate in 1918.

There was a debate about whether masks were doing anything and there was a debate about whether or not you could require people to wear a mask.

So, we know all this, we should have learned this from 1918.

The reason why we have these same kinds of debates is because, human nature has not changed all that much.

- Hundreds have gathered here in front of the Washington County Administration Building calling for the end of a mask mandate, saying they are tired of not living their normal lives.

- [Protesters] No more masks!

- Do you wear your mask because you're told to, or do you wear your mask because you have an imagination of community in which you're protecting, not only yourself, but other people?

Those are two different ways of looking at masks and so, giving us stories about how we understand what we're going through is what the humanities do.

- We have better medical therapeutics, we can save more people's lives now.

They did not have respirators in 1918.

What we haven't changed is the way the political system works, the way economies work and the way people believe that their personal freedoms are more important than the government's capacity to restrict them for public health.

(protesters chanting in background) - Any pandemic is going to really show the cracks in a society.

- So, are they vaccinating enough people of color?

- We really need to do much better.

Unfortunately, Black Americans are getting vaccinated at only about half the rate of White Americans.

- If a community has said, we've been taking care of everybody, a pandemic will pull the underpants off that story.

- A lot of people in Black and Brown communities don't have a regular doctor.

They have to use the emergency room.

This is a function of our healthcare system not providing healthcare equally.

This is not just a function of COVID-19.

- These questions of distributive justice, that is, who gets resources in the event of a shortage are tied to much more profound questions of social justice and structural injustice and it's a mistake to neglect those profound questions and health humanities can help us recognize the deep ways in which these profound questions of structural injustice are connected with these questions about the allocation of resources.

Many policy makers and hospitals are now considering employing lotteries in order to address the shortage of medical resources in the wake of COVID-19, to break the tie between otherwise equally ranked patients.

What I'm deeply troubled by when we talk about lotteries is that, a lottery may sometimes cause or lead us to mistake for chance what is actually choice and that's really important because when a choice masquerades as chance, you then fail to take the next step, which is to explore who is accountable for the decisions that have been made, and how can we ensure that better decisions are made in future in order to prevent the situation from arising again or to make us better prepared to deal with it when it does arise.

- There's also another way of talking about the humanities as improving medicine and that's thinking about the humanities as curative to certain kinds of problems in medicine.

One of the ways that that gets articulated is in relationship to the idea of burnout.

- The coronavirus pandemic is causing a mental health crisis among the frontline healthcare workers.

- Hospital staff is being worn to the bone.

- Yeah, there's a new term for that, it's called COVID-19 burnout.

- Part of what COVID-19 has produced for doctors is this pattern of moral injury or moral burnout.

At the crux of moral injury, one really finds the notion of the dilemma, right?

And the dilemma there is between some form of need the healthcare provider wants to respond to, and background conditions that make it impossible for the healthcare provider to actually respond adequately to those needs.

You have situations in which, healthcare providers have deeply held moral beliefs of say beneficence or caring for their patients and because of circumstances beyond their control, structural circumstances, circumstances of chaos in the midst of the pandemic, for example, those healthcare workers can't fulfill the duty that they understand themselves to have.

They can't care for their patients adequately.

No matter how hard they try, the healthcare providers will necessarily fail in one way or another.

- This is the world Mike chose for himself.

This is medicine when the goings hard.

The art that is based on science.

This is the time to keep your mind on the job.

- Medicine has a really distinct culture.

For example, there is a strong culture of stoicism, of not showing your emotions.

- A doctor must be gentle and kind without being soft.

Keep your mind on your job.

- There's a culture of overwork too.

So, when you say like, I didn't get home till 7:00 PM last night, it's not said with shame or disappointment for having missed the family dinner, it's sort of worn as a badge of pride.

- Mike forgot how to be tired.

Yes, here he was coming home from work at nine o'clock in the morning.

He was more weary and worn out than a man should ever be.

- We have been working on explicitly identifying and talking about and trying to change the culture of medicine and I think that the pandemic has only heightened our sort of sense of urgency that those conversations need to continue happening.

- In my ideal world, care would be something that would be valued at all levels and supported.

Doctors and nurses who are facing this overwhelming crisis of COVID-19 would be supported, not simply through receiving proper PPE, but by having a certain value placed upon the labor that they perform, such that there would be public support for that labor beyond applauding.

Ethics of care will focus not only on the individual and the individual's need, but will also focus on the broader network of relationships that either makes that care possible or that stymies it.

- Independence is truly an illusion, in that we all are to varying degrees dependent on others.

Literature, film, arts, all sorts of other humanist disciplines have a role to play in showing that level of dependence.

- We all have bodies, they all fail.

We hope that when we are at our most vulnerable in times of illness, in times of chronic disease, acute disease and maybe even, obviously, as we're facing death, that we show up and be real with one another, we show up with our best minds, with our best spirits and with our greatest compassion and so, that's the advantage, I think, of health humanities.

- It may very well be that humanistic medicine requires us as patients in the world to take on a moral perspective with regard to the type of behaviors we exhibit and how that impacts the healthcare field and if we take the networked relational perspective that humanistic medicine gives us seriously, not only do doctors have obligation towards their patients but the patients probably have obligations towards their doctors to engage in certain behaviors and practices that will help to tamp down that wave if possible, and to an essence care for those healthcare practitioners who are sacrificing so much.

- The care ethics will recognize the significance of those relationships and can help us see the role then that they might play in decision-making procedures within medicine.

- We see in the context of COVID-19, this is incredibly detrimental for all of us who need their care so very desperately.

(protesters shouting in background) - There's a very clear us versus them mentality right now but also, not just politically, but about COVID.

- The crowd's crammed outside with placards claiming vaccinations cause injury.

They chanted about COVID-19 being a hoax, despite 364,000 people dying from the disease.

- 30% of the United States population won't take a vaccine.

What are we gonna do about those people who are gonna be resistant to this thing that we think everybody needs to get?

- [Crowd] You are not representing California for all!

- We actually saw the White House Administration actively lobbying and getting involved in CDC and the FDA activity, trying to influence both of those organizations and mess up the very strict regulatory protocols we have around licensing, approving and recommending vaccines.

- Joe Biden said, I trust the experts, I trust the scientists, but I don't trust Donald Trump and the timing of these vaccines coming out on a political timetable versus an efficacy timetable.

- It's always talked about in sort of an othering or an us versus them.

It's always talked about in that, you know, I'm doing what I need to do, but everybody else isn't and I think that the way that we can fix that mentality is by learning from one another and educating each other and supporting each other rather than thinking it's us versus them.

- The concerns that people have around whether or not the data we're gonna get is good data, the real perception, right, of corruption in the process.

Vaccine dissenters have thought, that kind of stuff goes on all the time, right?

So, they feel like their concerns are now confirmed in the current circumstance.

In society right now, we are interpreting the problem we have as a problem about anti-science attitudes, not accepting science and I truthfully do not think that that is the case.

I think it's actually the diminishment of empathy and a diminishment of trust.

So, the problem with science is not anti-science attitudes, it's lack of trust in scientists and especially in government scientists.

- We can't do this without the young people cooperating.

Please cooperate with us, thank you.

- A vaccine will only be effective, not only if it is effective within the bodies of individuals who are vaccinated, but also if there is sufficient public uptake of the vaccine.

But if the public distrust the process, if they distress the approval process, if they distress the partnership process that's given rise to this vaccine, we cannot expect people to take the vaccine and that will have a major impact on the efficacy of the vaccine at a population level.

- Something could be done to stop the ride of death this time.

Science has learned to make war on epidemics.

Mass immunization was to be the first big push.

- And the big problems with politicization of the pandemic itself and now, concerns about the politicization of the vaccine, has taken doctors and nurses out of the picture in some ways.

There are federal leaders and government leaders that can all partner and work together and so, I don't think it's that, it's the medical doctors over the politicians or the politicians over the medical doctors, I think it's working in tandem and that to me is what's really missing and is the essence of health humanities.

I think that what we need in public health is creative solutions that actually reach people where they are.

The iPad has really changed the way that we are communicating with families in the COVID ICU.

It really helps us to communicate with families when we can use technology and the iPad to share with them, you know, what does the unit look like?

Where is my loved one right now?

What does the face of the doctor look like?

Talking on the phone is great but it really changed everything when they were able to see their doctor's face.

It meant a lot.

And I find that drawing on health humanities allows me to display my humanism for my patients when I say, I don't know everything and this is what I think and I may absolutely be wrong, but here's what I think and here's why I think this and that connection is a lot easier to have when you're using an iPad, when you can see someone and they can hear it in your voice but also, see it in your face.

- Just as we want doctors to see patients as particular individuals with different needs and different life stories, we also need to recognize that healthcare providers have their own stories and that they wanna be able to function as respected professionals on all levels who can also be robust human beings with their own full lives.

- Physicians are filled with stories and because of the confidentiality requirements, often, those stories remain inside.

The Penn State Health Physician Writers Group was a brainchild that emerged rather organically and one of the goals of the Physician Writers Group is to offer an opportunity for physicians to process those stories, to bring them out in words, and in a safe community among colleagues and peers.

Their very intimate poems or essays or short fiction have been published in New England Journal of Medicine, the Journal of the American Medical Association, Annals of Internal Medicine.

One of the ways that it's benefited them as doctors is that, they're more mindful of their own presence in a room and what they're thinking of and how their minds are working and how they're interacting with patients.

That's the community of thought and feeling and reflection that they form that ends up being healing and/or meaningful to them.

(gentle music) - I hope in some sense that COVID and the pandemic has a bit of a shadow, a moral shadow that people hold on to these experiences that were so dark and were so difficult and remember what it was like not to be able to connect with their loved ones in any number of ways that were vitally important to them and that, they hold onto it, such that it can spark a transformation of valuing, such that we value differently and support economically institutionally structurally policies and practices that will provide better care all around.

It's almost like a way of holding up a mirror.

We look in that mirror and we can see who we actually are as a society.

- Learning in the humanities is about creating the context for the growth of empathy and people who think differently from oneself.

- And that's something that the humanities is really good at because we're good at opening up spaces for people to imagine things other than they are.

We're really good at being able to say, okay, we understand this is the way it is right now.

Can you imagine for me an other fictional world which we could then try to bring in to being.

(protesters talking in background) - Some of what we're seeing about ourselves in the midst of this crisis in terms of the values that we hold may not actually be the best that we can be and so, absent to the moment of crisis, past the moment of crisis when we reach that point, we may want to think about how to restructure our values and what that might look like for a better future.

(gentle music) (upbeat jazz music)