Putting the Human Back in Health

Rethink your definition of health by considering all the factors that allow us to live longer, healthier, higher quality lives. Professor of Philosophy Dien Ho, PhD, explains the shift in modern medicine toward holistic care.

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Welcome to Massachusetts College of Pharmacy and Health Sciences Podcast, the Secret to Living to 200. My name is Jennifer Persons and I'm your host. In each episode of this series, we will explore different aspects of health and the factors that allow us to live longer, healthier lives. With the help of a thought leader from the university this year, MCPHS is celebrating its 200th birthday, and what better way to kick off our bicentennial celebrations than with a podcast about longevity? Joining me in the studio today is Dr. Dien Ho. He's a professor of philosophy and healthcare ethics, as well as the director of the Center of Health Humanities. Welcome, Dien. Thank you so much, so proud and happy to be here. So before we dive into our conversation, we're going to start with a question just to get comfortable, get our minds going. So if you had a time machine and could travel 200 years into the future or 200 years into the past, which would you pick and why? Man, that is a tough question. I wish I can split the difference a hundred for the past and a hundred for the future. I think there's a lot of really interesting people past, but I also would like to see what amazing discovery inventions people will have 200 years from now. So it is a toss-up, I'm going to go with the future because hopefully, well, certainly in the past they didn't have antibiotics and that's kind of important. So I probably want to go to the future for a quick visit. There you go. I like that answer. I think about this question a lot, and for me it always changes. All right, so we're talking about longevity, we're thinking about health. From a health humanities perspective, that's a very broad idea. And when we traditionally think about how we become healthier, how we live longer lives, we're not just talking about our physical conditions. So for those who aren't familiar, what are the health humanities? Health humanities is essentially a research area that draws from a number of diverse disciplines such as medicine, philosophy, sociology, literature, history, and the goal is to come together and investigate concepts in health and healthcare that are fundamentally important for both the humanities and for medicine. I like to think of health humanities as a discipline with very fluid boundaries. It's relatively recent, it's relatively new, but it's certainly has become an integral part of medical education and clinical medicine in addition to a growing field of scholarly research. And since it's more recent, how much weight would you say it's being given in the current field compared to the science and the more clinical aspects of it? That's a great question. It's definitely emerging and becoming a much more important element of, for example, medical education. I can tell you without any hesitation, that number of medical schools have clearly increased the amount of health humanities in their medical curricula. In addition to that, MCATs, which is the standard medical school exam, are now incorporating a lot more humanities questions in sociology of medicine, history of medicine than they did prior to that. I think the recognition of the importance of the humanities in medical training and the practice of medicine, it's definitely of reality these days and can only go upwards. I want to talk a little bit more about that. Professionals who are trained in the health humanities. What's the difference when they enter the workforce, if they have these backgrounds with sociology and history and philosophy? Absolutely. So I don't know if you know this, but as a philosopher, I always like to take the opportunity to brag about the fact that the highest percentage of acceptance among all undergraduate majors into medical schools is actually philosophy. And I think a part of that is the kind of critical reasoning that is fairly common in the humanities. Those skills are so easily translatable from a class in literature to a class in anatomy. Critical thinking is not topic specific, so to speak. And I think part of the value of the humanities in medicine, as a lot of people have recognized, is precisely that to practice medicine, you really have to be thinking about some of the most basic questions about humanism, for example, where it is to be human. What is a disease as opposed to a normal variation of human experiences? A concrete example would be something like autism. Is autism a disease or a disability that is in search of a cure? Or is autism a kind of neurodiversity, a different way of thinking about the world, different kind of cognition. And that has concrete implication not only in terms of clinical practice, but also in terms of things like policy, funding, research direction, let alone the day-to-day experience of people with autism and their loved ones around them. It's not surprising that the language of autism advocacy borrows heavily from the language of civil rights movement. And in addition to that, a number of studies have shown that when clinicians have familiarized themselves with what they call patient narrative, they get a much better sense of empathy and understanding from the point of view of really understanding what it feels like to have that experience. So for me part of good clinical care depends on concepts that are really familiar to those who are in the humanities. Things like understanding the voice from a different point of view. You can think about even art history, the ability to look at a painting and observe and see things that you otherwise not be able to see. That kind of observation skills translate beautifully into medicine. In fact, art historians do teach classes in medical school to teach students how to see how observe carefully. So there are lots of really interesting overlaps that I think are absolutely essential for good medicine. It's training them to gain a new perspective. Another word that kind of comes to mind is holistic in a way. It's absolutely a holistic approach to care. Absolutely. Looking at patients not so much as what I would like to call a bundle of physiological conditions, each needing to be tweaked, adjusted, treated, but rather looking at an individual as a whole person. And that approach of what they call patient-centric care has been really the forefront of clinical medicine for the last 30 or 40 years. And health humanities has always been a part of it, but I think the formal recognition of the importance of humanistic concepts in clinical care is now being more formally recognized. Have you seen as more of these clinicians trained in health humanities with the patient-centric perspective, have you seen changes in the industry or heard stories about absolutely how organizations have changed? Absolutely because of it? Absolutely. So actually health humanities in this case is closely related to public health. One of the more amazing thing about public health advocacy in the last 25, 30 years or so is the recognition of social determinants of health. The idea that their social conditions of the patient that can significantly impact their health outcome. And this could mean at a population level, but it could also mean at an individual level. So a few years ago, I was talking to an executive in one of their areas, hospitals, and she mentioned that in their emergency room, six patients use up to 50% of their annual budget, six individuals. And once she was hired, she started looking into why this was, and one of the things she noticed was that one of the patients, for example suffered from diabetes, and he is also someone who does not have access to permanent housing. When he's discharged from the emergency room after a acute diabetic episode, he's given the instructions and the insulin to monitor and moderate his diabetes, but because he lacked refrigeration, the insulin became essentially useless for him not recognizing the fact that poverty the lack of secure housing was in his way of managing his health, essentially made conventional medicine incongruent with his reality. To me, not recognizing his social needs is as bad as not recognizing that he's allergic to penicillin. It is a extremely important part of identifying the appropriate care. So when you look at a patient not just as physiological conditions that need to be adjusted, but as a human being with needs, with aspirations, with deficiencies, with strengths, then you can really understand what would be the appropriate care. And that understanding of social determinants of health, the complexity of individuals, private life and their reality, that is something that health humanities very much recognize and see it as a integral part of what it is to look at a person as a patient. Absolutely, and I think a lot of those kind of situations and social scenarios that you mentioned, a patient might not always be forthcoming with those. So it's not only up to the clinician to kind of get those, but also possibly observe the cues that are telling them things Absolutely. About their social situation. Absolutely. I mean, think of it this way, if you are unfamiliar with the history of medicine in the United States, you might be unfamiliar with the racial disparities and not knowing that will blind you to hesitation of why certain members of vulnerable population might not be so quick to trust organized medicine. That to me is critically important because not knowing that bit of information history of United States medicine will make you a bad clinician. It will be as blind as going into take care of a patient without being aware of their other physiological conditions. So for me, something like knowing the history of medicine, knowing about the sociology of medicine, the anthropology of medicine are absolutely critical in a country that has such a diverse, rich and disparate experience in healthcare for a lot of different people. Yeah, absolutely. It's fascinating to think about all the different facets that play into our health and how we improve it and improve the quality of our lives. In an ideal world, just bear with me, where all the physicians and care teams are trained in the health humanities, what does that look like for patients? What could that look like for our health system overall? How could that lead us to a healthier future? I think one of the hallmark of modern science driven medicine in the last a hundred years or so has been the focus on the physiology and the biology of patients conditions. In the seventies, there was a movement to migrate away from the scientific model of disease and medicine and include with it the sociological and elements. So rather than thinking of the biological model of medicine, you now think of it as biopsychosocial model of medicine. I would love to see that the idea of not just biopsychosocial but also humanistic medicine, and that requires to ask some very deep questions about what is the purpose of medicine, what are we striving for? The WHO (World Health Organization) was very, it's very clearly revise its definition of health as being more than just the absence of disease. We really should be focusing on the concept of wellbeing, where it is to live a good life. And that is a question that can trace all the way back to Aristotle. This is the oldest question, how do I want to live my life? Medicine plays a critical role in managing our physiology, but medicine is not the only thing that will be important to living a good life. So for me, in an ideal world, we will be having conversation not just with physician, but with almost like your personal guru, a confidant, someone who can help you explore how you want to live your life and what are the means to get you there, and how can we as a society ensure that everyone have an opportunity to live the best possible life that they would like to live. And we've talked a lot about the clinician's role in that, but as patients ourselves, what are things that maybe we can do to encourage our providers or seek providers who give that kind of care? Yeah, certainly. I think to pick a provider, not because this person has extensive experience or got some good rating on a website, but that understands your values, where you're coming from, understands why certain things are important to you, why are you willing to trade, for example, five year survival. You might have a lower five year survival rate with this particular kind of cancer treatment, but with a higher quality of life and understand and be able to guide you through that process. I think that to me is far more important than any credential or ametric that you can read on a website. In the olden days, it was a lot easier because clinical interactions usually lasted longer than the eight to 10 minutes that we have with our primary care physician. You have the same doctor for the better part of your life, and they used to even make house call. They'll come over, have a cup of coffee, talk to you. Those days are unfortunately long gone. But having said that, I think it's important to feel comfortable with your physician as someone who understands and appreciate your values, and that is difficult to do for a lot of patients. It's hard enough to find a decent doctor, but to find someone who actually understands you, that's super hard. I like to think of physicians, especially primary care physicians as your health advocate. So think of the analogy with a lawyer. A lawyer is essentially your legal advocate is you plus a whole lot of legal knowledge. Your doctor is really just you plus a whole lot of medical knowledge, and this person could only represent and figure out what is in your best interest if you fully trust this person and vice versa. You have an open dialogue, very much like you have attorney client's privilege. You really do need to have an open dialogue with your doctor in a non-judgmental, respectful way. And that requires both patients being comfortable, finding the proper clinicians, and also clinicians being willing to listen and being aware of all the diverse values in the world that might not be the one that you grew up with. And that that's not an easy process. It would take time. It probably takes a lot of patience and trial and error, but if we all kind of put a maybe 15% more effort into seeking somebody like that sounds, that could make a huge difference Absolutely. In our lives. Absolutely. I would gladly try someone with more experience for someone who has a better understanding of why I care about the things I care about, because at the end of the day, living a long life is far less important than living a good life. Longevity per se is surely valuable. You can't do a whole lot if you're dead. That much is true. But I would say, yeah, I would say confidently, all of us would gladly trade some of our live expectancy for high quality of life. I wanted to take this back a little bit to our M C P HS students and the people you are teaching. What do you see in them as you're trying to instill this perspective and these values that you may not have seen with past generations? So certainly when I started teaching, this is actually my 30th year of teaching. Congratulations. Thank you. That's. Amazing. My first class was as a senior in college, I was a TA and a professor just gave me the class to teach. So that was 30 years ago. You can do the math and figure out how o I am. Okay. When I started teaching and I used to teach not only at the undergraduate level, I also taught at medical schools, medical ethics was seen as the cherry on top. This was extra. So you can be a doctor or you can be a nice doctor. I think the idea that ethics is optional is most certainly gone the way of the dodo birds. I think now we think of ethics as being a defining characteristic of what makes for clinical care. You cannot be a doctor if you are unethical. You can fix people, but you ain't a doctor. So I certainly see that change, and I would like to continue to communicate to my seeing healthcare ethics as a defining quality of clinical care. I think it's important for me to ensure that my students think about some of the deeper questions about life in general. They certainly think about how they want to live their lives. That's clearly a question that all of us think about what I want to do with the rest of my life. That's a philosophical question. And one of the things that I like to communicate to my students is that you won't really know how to choose to live alive if you don't know what are the possible choices before you. So part of where it is to live a good life is to be informed of the options, and that means educating yourself in areas that you otherwise might not be interested in. I mean, one example is you don't know if you want to spend the rest of your life as a musician until you pick up an instrument and try it without trying it. That choice is moot. It wouldn't occur to you. And going back to something that we said earlier, what education does, it's like what an art historian can teach you. You'll see a painting and how new light you'll notice things that you never noticed before, that kind of living in higher fidelity, so to speak. It's the very nature of education. So for me, teaching healthcare ethics and health humanities and philosophy medicine and so on is as much about the content as it is about cultivating this habit of learning new things. Not just because they're fun to learn, but because they'll empower you to make the choices about how you want to live the rest of your life. Otherwise, you don't even know that there's a whole other side to this buffet. Absolutely. And that goes for all of us, not just Yeah, absolutely. Not to students in your Absolutely not in your classes. Thank you so much. This is a great conversation. I learned a lot, and it makes me feel hopeful. Yes, for the future. I'm certainly excited to see the minds that come out of this new generation of thinkers. And I can say without any hesitation that I got into this business, not for the fame and glory, I got into it because I firmly believe that I want the next generation to do the better job than our generation. And that is, that's the hope that keeps you going. Absolutely. All right. Well, before we let you go, we've come to a fun part of our segment called Red's Rapid Fire. So I'm going to ask you a short series of questions, and the goal is to answer them as quickly as possible. Some are fun, some might take you an extra second, but just whatever comes to your brain we want to hear about. Okay. All right. Are you ready? Yep. All right. So what is your favorite color? Green. Who is your personal hero? My personal hero? Oh my goodness. There are so many people I respect and admire. I have to say. David Hume, a great deal of the philosopher, the Scottish philosopher. Yep. Yep. Yep. Okay. What did you have for breakfast today? I had oatmeal. Yum. <laugh>. Would you ever go to space? Absolutely. Cats or dogs? Both. Wow. I like that answer. If you could have dinner with any famous person, dead or alive, who would it be? Wow. If my personal safety could be guaranteed, it'll be kind of awesome to have dinner with Kinga Khan to see what it was like in the company of these historic favorites. Only if safety is in story. Only if safest shore. Only if I can guarantee I get out of there. There. You go. Yeah. If you could travel anywhere in the world right now, where would you go? I would love to see the pyramids. The pyramids of Egypt. Beautiful. Coffee or tea? Tea. What is the scariest thing that you've ever done for fun? I went mountain biking the first time with a person who's a semi-professional, and I had no idea how difficult it was. And there were moments that I really thought I was not and I really thought I was going to fly off the cliff and that would be it for me. But you made it? I made it, and I was pretty much in one piece mostly <laugh>, and I had a great time. I had a great time. I went out and bought a new mountain bike the very next week. Yeah. All right. This is the last one. What is one piece of advice that you would give your younger self? That's good. I would tell my younger self, always remember to listen and to be kind. Not that when I was younger, I was particularly obnoxious, but I think it's a lesson that we can all benefit from. Be kind and listen. I love that. That's great. Well, thanks again DeAnn, and thank you for listening to this episode of The Secret to Living to 200. We hope you'll join us next time. And as always, stay curious. Cardinals.