BOLIVARIAN REPUBLIC OF VENEZUELA

MINISTRY OF POPULAR POWER FOR UNIVERSITY EDUCATION

RÓMULO GALLEGOS NATIONAL EXPERIMENTAL UNIVERSITY
HEALTH SCIENCES AREA
MEDICINE PROGRAM

MEDIC
AL
CULTU
RE Bachelor:
Well done Lairet

June, 2020
 INTRODUCTION

Doctors are privileged beings. Their patients share with them some of the most
important moments of their lives. The patients and their loved ones who face physicians
are in a very vulnerable and dependent position and expect from physicians not only the
appropriate level of technical competence, but also a compassionate and empathetic
attitude.

Practiced in a humanistic way, medicine is one of the noblest professions, along

with teaching and the priesthood. The mission of the physician is sacred and we cannot
allow this profession to be degraded to a mere technical and cold exercise, whether in
the name of a misunderstood scientific objectivity or due to economic pressures. It is
important to remember that patients are going through times of extreme vulnerability.

This is why medical culture and the humanistic component of medicine are not
an optional extra, but a fundamental and absolutely essential part of medical practice,
and doctors have an absolute moral obligation to put themselves in the patient's skin as
much as possible, in order to offer them the competent and humanistic treatment they
deserve.
1. MEDICAL CULTURE. DEFINITIONS OF LITERATURE, POETRY
AND MEDICINE.

In principle, every time the term culture is used it must not only be
defined, but also illustrated. In an anthropological sense, culture is, simply, the
set of knowledge, ideas, language, attitudes, social grouping, the way and
customs of life and even rituals of a society, but, on the other hand, there are
also other more specific and limited forms of culture, for example, literary
culture, musical culture, among others. There is also a medical culture, which in
turn can be considered in two aspects, one, relatively little used, comprising the
totality of medical knowledge, reserved for doctors and people of medicine,
epistemologists and historians, and another more lax, referring to the common
people, and which is what we refer to here. This medical culture of ordinary
people understands the set of knowledge that people, whatever the degree of
their knowledge in general or located in other cultures in particular, possess
about medicine. This knowledge is extremely varied, and focuses mainly on
diseases and remedies.

Some people have a certain innate ability to acquire them and reason
about them and even to use them correctly, favored by having previously
suffered from illnesses of their own or by witnessing those of family members,
by kinship with doctors, or influenced by media coverage by journalism, the
advertising announcements of pharmaceutical companies, and the leaflets that
accompany medicines in their packaging. This medical culture is favored by
people whose relationship with medicine is one of sympathy and benevolence;
otherwise, hostility, deformation and ignorance are facilitated.

The integrative knowledge of this medical culture is not easy to

enumerate, its limits, depth and accuracy are uncertain, its statement is confusing
and is often tinged with feeling and emotionality. In stressful conditions that
affect mood, medical culture sometimes helps to cope with the situation more
favorably. With or without stress, many other circumstances can be interspersed
with the finest gradations.
 In reality, medical culture encompasses much more than diseases and
remedies, extending beyond them, directly or indirectly, including university
teaching, medical activity as a science and as an art, hospitals, medical
specialties, research and the institutions where it is carried out, major problems
still unresolved, the high cost of modern medicine, endemic diseases, sexually
transmitted diseases, vaccines, new diseases, the difficulties in extending the
application of high-cost medications and therapeutic and diagnostic
technologies, organ transplants, gene therapy, assisted fertilization, the harmful
effects of tobacco, alcoholism and drugs, contraception, abortion, infant
mortality, hunger, obesity, the fulfillment of the final will of the terminally ill,
and also medical ethics and all its derivations, including cloning, and clashes
with other cultures.

Within this medical culture there is also the unification of different

definitions which exist to academically support this culture in different
dimensions which are the following:

 Literature: is the "art of verbal expression" (verbal being understood

as that "which refers to the word, or uses it") and, therefore,
encompasses both written texts (written literature) and spoken or
sung texts (oral literature). However, there is a medical literature
which summarizes scientific evidence (in contrast to narrative
reviews which mix opinions and evidence) that is increasingly
predominant. These reviews answer questions about treatment,
causality, diagnosis, or prognosis. In each case, the rules for deciding
whether reviews are credible, and for interpreting their results, are
similar.

 Poetry: As a main definition we have that it is a literary composition

that is conceived as an artistic expression of beauty through the word,
especially that which is subject to the measure and cadence of the
verse.
 In the loom of history, medicine and literature-poetry have been interwoven in
every possible way. So much so that Arthur Conan Doyle proposed to write a
memoir about the use of medicine in popular novels, a memoir that has now grown
considerably in size, given that in the last century the relationship between illness
and literature is such that it has even been suggested that “there is a point at which
they are the same thing” (Juan José Millás), since many times the masterpiece arises
from extreme situations in life, “painful crossroads where we sense the unavoidable
presence of death” (Ernesto Sábato).

It is worth noting that the medical culture of ordinary people can provide its best
service in the relationship between the doctor and his patient, and vice versa. Before
this relationship was predominantly paternalistic, the doctor asked, explained,
ordered, the patient told, was in pain, listened, answered, asked - generally not very
much -, complied with what was ordered, or did not comply (the doctor doubting
whether to do so or not). Today, the patient, whatever the extent of his knowledge,
exercises his right to ask questions that he did not ask before, to accept or reject the
doctor's proposal, and in accordance with his culture, to discuss not only the
proposed treatment but also the diagnosis, and even the etiology and nature of his
illness. Previously, the doctor could avoid this conversation with silence or a soft
moo (at one time it was said to be "as dumb as an ox"). The harmony and benefit of
this dialogue exerts a literature that is now inevitable, and is favored not only by the
medical culture possessed by the patient, but also by the new medical-social habits
and obligations breathed by society. The implosion of the Internet in the field of
medicine allows the dissemination of information on a scale previously undreamed
of. However, an indiscriminate dissemination of references about diseases,
individualized patients and remedies will not always be beneficial, since an excess
of information without sufficient knowledge and reasoning on how to use and
combine it leads to confusion, and that is where medical culture means the good use
of the remarkable technological advance provided by the Internet.

One aspect that should not be overlooked when discussing this medical culture
concerns the two types of medicine that have long been competing for control of
treatment: orthodox medicine, or "official" medicine, taught at the university and
accepted by all, and marginal medicine, advocated by different groups and guided
by its own principles and technology, including homeopathy, acupuncture,
chiropractic, and possibly up to a hundred others. It would seem logical that people
should know which of these procedures are acceptable and how effective they really
are. The situation is complicated by the tendency to rehabilitate some of these
procedures, which have gone from being marginal to being parallel or
complementary, or at least to subject them to critical re-examination, an undertaking
in which some Nobel Prize-winning scientists are engaged. In any case, it is the role
of medical culture to guide ordinary people on this permanently difficult path.

For the sick (and certainly not only for them), consciously or displaced to the
depths of unconsciousness, two worlds exist. That of the sick and that of the doctors.
For some, both worlds live at a distance, separated, but in harmony, with occasional
approximations. For others, there is hostility, ruthlessly illustrated in literary works
by authors such as Petrarch and Montaigne, to name just two of the most famous. As
in so many processes of human relations, hostility, or just separation or simple
distancing, are highlighted by the differences in language, evident, in this case, in its
simplest expression, in the attempts to translate the calligraphy of the recipes, with
the resentment preserved latent from the time when they were written in Latin and
quantified in ounces and grains. If people became familiar with reading medical
texts, access to medical culture would be easier.

The medical language in which these texts are written is our own language, in
which the difficulties are imposed by the terminology, but the grammar is the same,
and the terminology is relegated to a matter of dictionary, the rest is only practice.
Unlike learning a language, medical language in the restricted sense that I am
referring to here, it is only a matter of learning the text in front of you. There is no
question of talking about it, which would expose one to serious risk. Mentioning
other aspects of culture, and not only specifically medical, in its projection on the
training of the doctor, such as humanistic and literary culture, which seem to have
lost some of the meaning that was previously conferred on them, but this is no
longer the medical culture of the common people, but the culture of the common
doctor.

2. A DOCTOR'S CAREER AND LITERATURE.

Within the world of doctors who have written, surprisingly, they are,
among all the liberal professions, those who have given the most writers to
humanity. Only the clergy has produced in the past as many writers as medicine,
perhaps because there has been a constant communication between God and
man, and this has contributed as material for inspiration.

In primitive society, the doctor was an artist and therefore, doctor and
artist had a common historical trunk. Perhaps that is why Hippocrates compared
the practice of medicine to a drama where there were three comedians: the
patient, the doctor and the disease. These actors have been like imperceptible
threads that have been intertwined with literature, maintaining an everlasting
union; since both parties - literature and medicine - have been interested in the
life and adversities of man. In primitive society, the doctor was an artist and
therefore, doctor and artist had a common historical trunk. Perhaps that is why
Hippocrates compared the practice of medicine to a drama where there were
three comedians: the patient, the doctor and the disease. These actors have been
like imperceptible threads that have been intertwined with literature, maintaining
an everlasting union; since both parties - literature and medicine - have been
interested in the life and adversities of man.
In the 17th century, Voltaire complained: “Doctors prescribe drugs about
which they know little to cure diseases about which they know even less, in
people about which they know nothing.” If he were alive today, the French
thinker would have to admit that doctors have learned a lot about the drugs they
prescribe and the diseases they treat with them. Scientific advances in the field
of medicine have been dazzling. Today's doctors have much more precise
knowledge of the mechanisms of diseases and have access to powerful and
effective drugs that would have seemed miraculous to the doctors of Voltaire's
time.
Despite the long relationship between the two, it was in the second half
of the 19th century when medicine, now a science, began to be the object of a
more rigorous and respectful treatment by literature, and when some authors
discovered in all its dimensions the wonderful task of the doctor, not skimping
on praise for the commendable work of caring for the person who seeks help, as
well as the "literary power" of illness and the sick man. Previously, it had been
Miguel de Cervantes who was in charge of bringing a certain equanimity when it
came to handing out criticism and praise: while in Don Quixote he states that “I
will place wise, prudent and discreet doctors over my head and honour them as
divine persons”, in Licenciado Vidriera he refers to bad doctors, assuring that
“there are no people more harmful to the republic than they”.
Medicine and literature have some things in common: to practice them
well, a deep study of nature and the human condition is needed. People who are
unable to understand human emotions, needs and suffering, and the heroism and
greatness of which human beings are capable, will never be able to practice
humanistic medicine or write quality literature.
Doctors have the unique privilege of closely observing and
accompanying their siblings during the most important and dramatic moments of
their lives. Patients reveal their secrets and deepest feelings in a way they do not
do with anyone else, except perhaps their closest relatives or friends.
If there is a real need to humanize or re-humanize medicine, we can
explore the possibility of trying to achieve this through the study of the
humanities. There has always been an interesting relationship between medicine
and literature. The number of important writers who were also physicians is
surprising. The list is impressive and includes figures such as Pio Baroja,
Torcuato Luca de Tena, Chekhov, Rabelais, Somerset Maugham, Arthur Conan
Doyle, Tobias Smollett, John Keats, Oliver Goldsmith, AJ Cronin and William
Carlos Williams. Other famous writers studied medicine without completing
their degree, including James Joyce, Bertold Brecht and Henrik Ibsen.
Well, if we go to the case that a doctor must know how to write in
different ways, Dr. Felix Martí Ibañez (Doctor, Founder of the MD magazine in
Spanish) says that "the doctor has the duty to write, and to do so he must learn to
meditate, having to distance himself from the tumult to concentrate on the search
for that inner light, almost extinguished currently by the artificial lights of the
city." For this reason, writing requires solitude, being thus the loneliest of
occupations. And this creative leisure is a luxury item for the physician, unless
he sacrifices hours of rest or work.

Writing a good clinical history is practically being a clinical novelist,

because by observing in detail and describing with precision, you make the
reader unconsciously identify with the patient, just as a good novelist makes the
reader identify with the protagonist. A certain number of doctors at different
times have timidly given vent to a secondary hobby, which has been writing, but
this suddenly takes on great proportions and becomes overwhelming, driving the
doctor down a different path than the one he had followed, thus making
literature his true vocation, no longer secret and intimate. "This has been the
reason why many have wanted to divorce their wife – medicine – to marry their
lover and thus legalize their "scandalous" passion for literature."

With regard to trends, medical thought has influenced writers, and

therefore literature, in various periods of civilization. In classical antiquity,
Homer clearly showed in his poems how before Alcmaeon and Hippocrates,
medicine was empirical and magical (Alcmaeon was the initiator of
"physiological medicine" and Hippocrates its true founder).

In this period of classical Greece, poetry and medicine appeared closely

linked to each other, hence one of the first European poems is a hymn to Apollo,
god of poetry and medicine. Also because of that common trunk the doctor
studied and wrote about philosophy. Hence, classical medicine was born in
temples and it would also have been the place for meditation. This is why
classical physicians devoted themselves to philosophy in their free time. This is
what Aristotle did, who studied medicine, although he did not practice it.

Medieval medical philosophy held that illness was a punishment for sin;
this is reflected in Dante's work. Likewise, centuries later, Claude Bernard's
Positivism influenced Emile Zola. He maintained that each novel should be like
the clinical history of a case, or a provoked experiment. Among the medical
class, the cultivation of Latin poetry was a tradition that lasted for hundreds of
years. Poetry had served since ancient times to educate memory, thus remaining
alive throughout the Middle Ages and the Renaissance, with treatises on poisons
and venomous bites being translated into verse, authored by the physician and
poet Túnico Nicardo. The most famous of the medieval didactic poems was
"Regimen sanitates salernitanum", written by the Salerno school between the
11th and 13th centuries.

The attitude of doctors and medicine has also been observed in each
period of history, significantly influencing literature:
 The Middle Ages: It was a time of "collectivism", therefore, collective
diseases such as plague, leprosy or fevers abounded; for this reason works such
as "The Decameron" by Boccaccio, or "The Journal of the Plague Year" by
Daniel Defoe were written.

The Renaissance: On the contrary, it was a time of great "individualism",

therefore, individually contracted diseases such as syphilis were abundant. This
disease was the subject of several poems and literary works, being a favorite of
writers who suffered from it such as Baudelaire, Maupassant and Daudet.

In the 18th century: doctors were the target of satire, as can be seen in the
play "The Doctor Beaten" by Moliere. This left an ironic study of iatrogenic
diseases. (Diseases caused by the negligence of the same doctors).

In the Romantic era: there was great interest in the use of Laúdamo (a
medicine based on opium) by different artists, even giving it the name of the
potion of Romanticism.

In the 19th century: the trend changed a little. The doctors mentioned by
Balzac in his works were generally upright and impartial, models of devotion
and generosity.

In the 20th Century: With the exception of Bernard Shaw, writers portray
doctors in a heroic manner, fighting against ignorance and the temptations of
money and the flesh.

In any case, both the medical writer and the doctor who is a writer bring
to the literary task the scientific basis, the methodological rigor, the capacity for
observation and that extra knowledge of the human being that comes with the
study and practice of medicine, as shown by some authors, such as Carl Gustav
Carus, who maintained that the doctor must know man “from all the dimensions
of his life, in his weaknesses and in his strengths, in his prudence and in his
madness” and, in that domain, he assured that more benefit could be obtained
from the books of poets because “with an authentic visionary gaze, they
penetrate the depths of human nature”, or like Thomas Mann, who affirmed that:
“A doctor who possesses the art of the writer will know how to better console
the one who wallows in agony: conversely, a writer who knows the life of the
body, its juices and forces, poisons and faculties, has a great advantage over the
one who understands these things”.
 CONCLUSION

Great literature is more than mere entertainment and reading it should

change us in some way and enrich our vision of the world and human existence.
It allows us to see inside the lives of others. In the words of American writer
Dorothy Allison: “Fiction is the great lie that tells us the truth about how others
live.” Fiction is a lie in the sense that it does not tell real facts, but is an
invention of the writer, but it tells us profound truths about the human condition.
The fact that mere words written on paper can allow us to almost live the lives of
others, or at least better understand the lives of others, regardless of how
different those lives may be from our own, is almost miraculous.

Not only can studying literature help doctors understand the human
beings in front of them more deeply and treat them with more empathy, but it
can also help them make more accurate diagnoses more easily. The doctor's
ability to make a correct diagnosis depends largely on his ability to listen
carefully to what the patient tells him and interpret it correctly.
 LITERATURE.

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