Andrea Wershof Schwartz, MD, MPH, is a poet, a geriatrician at the Veterans Affairs Boston Health Care System, and one of the founding members of the Arts and Humanities Initiative at Harvard Medical School. Join us as we talk with her about the role of humanities in medicine, and the ways in which art can build a more resilient and effective generation of physicians.
Traditionally, medicine and the humanities were thought to be nearly mutually exclusive aspects of education. How did you find a way to bring the two together?
At first, I too felt like the part of me that loved humanities and the part of me that wanted to be a doctor were in a little bit of conflict. I was fortunate to find a dual degree program Columbia University had with the Jewish Theological Seminary, so I was able to study premed, history, and Jewish studies. I focused on ancient texts that spoke of the role of doctors in the society, and the way the society thought about illness and healing. For medical school, I was accepted into Mount Sinai’s Humanities in Medicine program, and even in residency, at Brigham and Women’s Hospital, I continued to nurture that connection between art and medicine through mentorship by Dr. Joel Katz, who got me involved in the Arts and Humanities Initiative at Harvard Medical School, which has been an incredible source of community and creativity.
Were you always interested in the arts?
I grew up with the richness of the Jewish tradition. My teachers, parents, and other family members raised me in an environment of storytelling. Judaism is replete with holidays at which we tell and retell stories. I was amazed how the same story could have a different meaning to me depending at what point in my life I had heard it. The power of stories to be interpreted and reinterpreted drew me into appreciation of arts, and interestingly, piqued my interest in medicine, too. We use stories to make meaning of symptoms, and it is how we hear our patients’ stories and how we interpret them that guides much of our clinical decision-making.
What is a memorable moment from your training when you noticed arts and sciences coming together?
In my third year of medical school, we had a class called the Art of Observation, which took us out of the hospital and into the Metropolitan Museum of Arts for half a day. It was such a change of pace, in every sense of the word. We were taken out of the hospital to walk down 5th Avenue to the Met in the sunlight, then given the opportunity to look at paintings slowly, patiently, and mindfully. We’d observe details and talk about that experience and how we might apply it to learn about our patients. Afterwards, we visited older adults who were homebound. Aside from being instructed to assess for their safety, falls prevention, caregiver burden, polypharmacy, and other important geriatrics issues, we were asked to pay attention to the details in the home and to write something about that. That was the first time I wrote a poem as an adult.
It sounds like you received a permission of sorts from your medical program to express yourself creatively. How did you decide on poetry as a genre?
I had always enjoyed poetry. It is an art form that can start with an object, a person, a snippet of experience, and allow one to process complex thoughts and emotions in a gentle way. And poetry can be short! As a trainee in medicine, you’re often pressed for time, so resorting to an art form that can be completed in a short period of reflection is very gratifying.
What benefits does creative expression confer on medical professionals?
Physicians often deal with people who are sick and suffering. That takes a lot of strength and emotional reserve. Finding a source of renewal is necessary in being a good doctor and having stamina to continue to take care of others in the way they deserve. There are many ways to do this, from having a good night’s sleep, exercise, spending time with friends and family, spending time in nature. And the humanities is one of those sources of renewal. Whether it's getting engaged with music, art, or writing, these activities allow you to exercise different parts of the brain, refresh your relationship with life, and can help reconnect you with a sense of meaning and purpose.
Can you give us an example when you used art in this manner?
I remember the first time as an intern I had to pronounce someone as dead. This was a very emotional experience, even though it happened in the blur of paperwork and death certificates. Writing a poem was one of the ways I coped with the disconnect between the mundaneness of the tasks I had to do and the profundity of the moment that somebody was leaving this world.
Have you ever used art in your work with patients?
Yes. I once had a patient who loved poetry, and I remember finding this poem that was very germane to his situation at that time. I approached him and asked if it would be okay to share this poem with him, and he gave me permission to do so. We shared an incredible moment of connection as we listened to the poetry, and this provided a chance for us to talk about some of the things that have been weighing on his mind – his worries about his illness and about what lay ahead.
It sounds like art can be used as a tool in patient care.
I believe so. In my work as a geriatrician, I often have to help patients and their families talk about difficult topics: end of life planning, dealing with frailty, or loss of independence. Sometimes art can help us open up a safe space for difficult conversations. With the use of stories, we can approach difficult aspects of human experience more gently.
You are now teaching first year students at Harvard Medical School in the course called The Developing Physician. Tell us more about that.
We are teaching medical students skills of reflection, taking a step back and reconnecting with the reasons they went into medicine in the first place. Medical school and medicine as a profession are intellectually, physically, and emotionally stimulating and challenging. While keeping up with the pace of the million things that we need to do, we can lose sight of the incredible privilege it is to be a doctor and to be trusted to help people in their moments of vulnerability. This is an incredible gift that the humanities can give to the field of medicine. They provide an opportunity for all of us to be fully present in what we are doing. They let us practice being better doctors and better people.
beneath his food-stained, mis-buttoned shirt
“I won’t take those pills you give me,” he boasts
He grins, with rotting teeth framed between
Crooked glasses and giant ears,
Ears that take up half his head
But are deaf to advice
On the front of the empty fridge,
A yellowed DNR form is taped, askew
(Excerpt from Home Visit by Andrea Wershof Schwartz, winner of national William Carlos Williams Medical Student Poetry Contest; Journal of Medical Humanities, 2008)
Whether we are reading a short story where we are paying full attention to the narrative from the beginning to end, or looking at a painting that opens our minds to a new way of looking at people and things, or whether it’s singing, or playing music, or dancing, creative engagement helps us grow and heals us. And when we decide to share these personal experiences of art with others, we learn to recognize that just about everybody struggles with aspects of medical training at some point or another. Humanities can facilitate having those honest conversations, and they can provide a safe space where we can be empowered to help each other emerge stronger and more resilient at the end of the day.
Medical training is long, and opportunities to take time outside clinical or classroom work vary so much, that it’s easy for students to get overwhelmed and give up on their creative pursuits. What advice would you give physicians in training?
I’d remind them to seek out ways to bring meaning to their work, and to exercise those creativity muscles that will help them be better listeners, better storytellers, and better doctors. You can write a story. It doesn't have to be the best story ever written. You can take your camera and take photographs of the beauty in nature. And the stakes don’t have to be so high on any given thing that you engage with. It might just be reading a couple of pages of a novel before you go to bed at night that is working that muscle of paying attention to the details in the story or just brings you joy and pleasure, which in turn help you have the resilience and the reserve to take care of others. And when you do create something, be courageous, and share it with someone. Know that there are a lot of organizations, places like thirdspace, and people out there that love to experience the unique vantage point medical trainees have.
Are we heading toward a future where arts and humanities will be taught alongside medicine?
I hope so. There is a reason why they're called the humanities. They truly get at what it means to be a human. What is the subject of medicine at its core if not human experiences of what it means to be alive, what it means to be in a body? So, I think they both have a lot to learn from each other.