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Background Rapid advances in the field of genetics continue to present medical educators with significant challenges. Whilst there is undoubtedly a pressing need to educate doctors about genetic disorders, research and therapies, there is a parallel need to provide a context for all of these. Content An interdisciplinary, arts and humanities based approach, responding to this need, is described. This teaching has been successfully delivered both as optional and core undergraduate teaching, and as part of continuing professional development. The human perspective: stories not histories Understanding of the patient's perspective can be significantly improved by drawing on both written and oral stories of illness. The historical perspective: learning from the patient Experiential learning provides insights into the social history of developments in genetics, thereby placing the current concern and debate about the new genetics in context. The role of the media: the power to persuade Critical reading skills can be developed and the power of the popular press to influence the reader acknowledged by analysing and employing the skills of the journalist when reporting developments in biotechnology. Learner assessment and evaluation Assessment, both formative and summative, demonstrates sophisticated insights and perspectives into the lived experience of genetic illness. Learner evaluation of the teaching is high. Conclusion Medical humanities offers a powerful way to convey an understanding of how genetic disorders impact on the lives of patients and families, and to set this against the background of a history rich in the uses, and abuses, of knowledge of heredity.

Stem cell research, if successful, could provide a means of replacing damaged tissue in patients with diabetes. Controversially, the best stem cells for research and possible therapies seem to be those harvested from embryos, cloned or otherwise. As a result the morality of undertaking such research is hotly contested with vocal champions both for and against this work. To help clinicians and scientists reach their own conclusions about whether stem cell research using human embryos should be sanctioned or not, an impartial overview of the moral arguments offered by both sides is provided.

Ted Shotter's founding of the London Medical Group (LMG) 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics (JME) in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship (after which 5-year appointments extendable for up to 2 further years were instituted!). Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and Soren Holm in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities (MH), was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors. From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric (one Anglican, the other Presbyterian), were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind. Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who (‘up to the elbows in blood’) could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine . …

Sometimes, perhaps more often than most of us like to admit, it can feel like we’re just pawns in some giant chess game. Too small and insignificant to influence the players, we worry instead about how the game will end, cherishing those moments when, just occasionally, for a moment or two, we seem to be in control of what’s happening around us. For the ancient Greeks the players of this all too often cruel game were the gods, a group of individuals whose petulance, power and pride demanded attention and respect. And no matter how hard some might try to thwart the gods, few doubted that fate would out in the end with the only choice available to mere mortals being about how one lived, not how, when or why one died. Watching the events of the last nine months unfold, as natural and manmade disasters have wreaked havoc around the world, as individuals and their leaders have sought to give a voice to the feelings of powerlessness that these events have engendered, and as fears of social unrest have raised haunting spectres from the past, the echoes of Greek tragedy haven’t seemed that far away. And as more and more people around the world are forced to learn to adapt to these changed circumstances the human need to understand what it all means can be overwhelming. The search for meaning and the drive to create meaning where none appears to exist is perhaps central to what it means to be human. And it is in our one to one encounters with each other, with the world around us, and with our own sense of self that this search for meaning begins. For patients, families and doctors the challenges and uncertainties that accompany serious illness can provide an unwelcome impetus …

“‘ . . .before you get spoilt by it all. Before you become a fully qualified doctor, just give me a helping hand as a human being.’ (Kostoglotov: cancer patient)”1 Are human beings irreversibly “spoilt” by medical training or merely disengaged from “normal” human interaction? If what is desired is a doctor who reaches out as a human being to his or her patients then it is important for educators to know why that sometimes fails to happen. Is the end product of medical training (sometimes) incapable of stretching out its hand or instead just disinclined to do so? If the latter, then presumably we should focus our energies on motivating practitioners to reach out by, for example, inspiring empathy. If, however, medical …

“He never entered into relation with the picture as a whole—never faced, so to speak, its physiognomy. He had no sense whatever of a landscape or scene.”1 Medical humanities provides one way to get a sense of the landscape in which individuals and societies experience sickness and health. In this issue's Education and debate section Ruth Richardson, an interdisciplinary historian, uses a highly topical subject to show that an appreciation of medical history can illuminate current thinking in medicine. Her paper is offered, therefore, not simply or even primarily as an historical account but rather as a complementary perspective within the multifaceted approach offered by medical humanities. An education broadened by the humanities is, of course, no guarantee that a better …

We describe a humanities-based, special studies module (SSM) exploring the impact of cancer on the lives of patients, families and professionals. Literature, film, art and drama provide third year medical undergraduates with vicarious experience of all of these perspectives in a format that has proved highly acceptable to students and tutors. The development, delivery, evaluation and evolution of this humanities-based course are described and we highlight some important elements of course organisation that emerged as being integral to its success.

One of the hotly debated questions, at the journal's recent editorial board meeting, was how to communicate, to our readers, the clinical relevance of the papers we publish. It is an interesting question, and one moreover that begs several others, not least amongst them being whether it is appropriate to expect a medical humanities scholarship to be directly, or indirectly relevant to patient care and clinical practice. Laying that old bugbear to one side, I would like to argue that one of the strengths of medical humanities is its ability to shine a light into some of the darker, and more neglected corners of medicine and social care, and thereby revealing what can be uncomfortable truths. Take, for example, the cover image for this issue, featuring Homeless 1 , by medical student Rory Hutchinson, one of the winners of the inaugural MDU Mark Brennan Prize (Visual Arts category). Rory's work was ‘inspired by the treatment of homeless patients within the medical system’, and aims to ‘raise awareness …

Objective To investigate whether the observational skills of doctors and nurses can be improved by arts-based observational skills training. Methods We carried out a cluster design, controlled trial involving 42 general practitioners and 26 primary care nurses in 12 primary care practices in London. Six practices were allocated to the intervention arm and 6 to the control arm. The intervention group received 90 minutes of arts-based observational skills training. The control group received practical training in the management of psoriasis. Before and after this, control and intervention participants were asked to describe 3 dermatological photographs. Descriptions were scored blindly against a predetermined marking key. Participants completed a questionnaire about the intervention, and about their own confidence in diagnosing and referring suspicious pigmented skin lesions. Results Post-intervention scores were significantly higher in the intervention group compared with the control group (P

This paper explores how current devel- opments within medical humanities might provide a way to both understand and address the origin of recent events that have left the profession branded as arrogant, out of touch and mis- guided 2 . The arts provide a powerful medium to improve the understanding of the experience of illness. Furthermore the understanding obtained is qualitatively different from that acquired in the traditional doctor- patient encounter. In addition medical humanities can create a space for doctors to reflect on their own practice and experiences. The benefits of using this space are illustrated with four examples of arts-based education deliv- ered to groups of practitioners at different stages in their professional lives.

In this issue’s Editors choice , Aoife Moran, Anne Scott and Philip Darbyshire1 ( see page 70 ) argue that the process of living on haemodialysis, while waiting for a kidney transplant, is one in which time is both killed and wasted. Rather like the lives of the protagonists in Beckett’s Waiting for Godot , the lives of people on dialysis are ones characterised by existential boredom. Moreover, their patience will not always be rewarded, because, as dialysis patients know all too well, many of them will die before they receive a kidney. And yet somehow, in spite of all the physical, emotional, social and economic costs incurred in living these lives of existential boredom and uncertainty, their authors must search, as humans always have, for meaning and purpose within that existence. That search can be lonely and demoralising. It would be less lonely, argue Moran et al , if the healthcare professionals most intimately involved in the care of dialysis patients—nurses—could be helped to remember this. It’s a reminder, a lesson, that everyone whose work takes them into contact with people living with chronic illness would benefit from, and especially, perhaps, those who have been working with patients for a long time. Because, no matter how much any one individual might have understood about human suffering before he or she became a doctor or a nurse or a porter or a radiologist, it doesn’t take long before the conversations they have with patients are liberally spattered with the word “just”: “You just need a blood test/a colonoscopy/an MRI/a small operation”, “It’ll just be a little uncomfortable/a while until you feel better/a small disruption to your normal routine”, “I just need to ask you some questions/examine you/refer you/tell you something”. Except that for the …

Suffering, grief, and marginalisation are just a few of the human experiences closely observed by authors in this issue of Medical Humanities . None of these are easy to endure or to witness, and yet the latter is exactly what these scholars have chosen to do. Using, among others, the prisms of literary studies, social history, and film and television studies, they ponder the role of healthcare practitioners—for good or for bad—in responding to what Barker and Buchanan-Barker term “problems in human living” ( see page 110 ).1 According to Barker and Buchanan-Barker, as a society and as healthcare professionals, we have lost sight of what is required of us in the face of human suffering. When an individual is no longer able to cope psychologically with the challenges life offers, we no longer understand “what exactly are we called to do as people —whether as professionals, friends or fellow travellers”.1 Rather than focusing resources and energy on simply containing or attempting to control those affected in this way, they suggest instead that the primary concern should be to help people to address and live with these problems. This proposed reframing of what is currently known as mental illness echoes the reframing of disability as a social rather than a medical concern, reminding us that “people need to be agents rather than patients ”.1 Caring for people rather than controlling them will, they suggest, take courage—courage that Barker and Buchanan-Barker find sadly missing in their own profession of psychiatric nursing. Instead, they judge it to be intoxicated with the narcissistic allure of academic success and driven by political and economic imperatives. This apparently harsh evaluation has implications far beyond nursing, challenging society as a whole to answer the charge that fear—and not a desire to care—dominates the provision …

In the fifth of a series of papers, Alan Bleakley and Rob Marshall1 “use thinking with Homer as a medium and metaphor for questioning the habitual and the taken-for-granted in contemporary [medical] practice”. The importance of being prepared to challenge the status quo has been brought into sharp and painful relief by the on-going scandals about the care, or rather lack thereof, provided to some National Health Service (NHS) patients, most notably in The Mid-Staffordshire NHS Foundation Trust. The status quo in Mid-Staffordshire was one of poor care, high mortality rates and widespread patient concern, compounded by managerial and clinical inaction. Appalling care had, quite literally, become habitual and taken-for-granted. As the inquiry report makes clear, there were many warning signs, but because of “an engrained culture of tolerance of poor standards, a focus on finance and targets, denial of concerns, and an isolation from practice elsewhere”, as well as professional disengagement whereby “clinicians did not pursue management with any vigour with concerns they may have had”, nothing was done to improve the situation.2 With hindsight, it seems all too obvious what should have …

Sometimes editors plan themed issues, sometimes they just happen. With this issue it's a little bit of both. A core of five papers (four companion, one unrelated) together set out to challenge some of the most fundamental premises on which medical humanities has established itself over the last few decades. Starting with a paper by Johanna Shapiro, and moving on to papers by Angela Woods, Estelle Noonan and Claire Hooker, Paul Macneill, and John Harley Warner, our authors are refreshingly forthright, and certainly don't pull any punches. Shapiro begins by suggesting that narrative medicine may be in danger of losing its way. She acknowledges the contribution of scholars in using theories of textual analysis to develop a “more nuanced and multifaceted appreciation” of patient narratives, but goes on to suggest that doing so risks “the unintended effect of de-legitimising the patient's voice because of concerns regarding its trustworthiness”. The irony inherent in her conclusion will not be lost on those working within the field. After all, one of the primary motivations behind the emergence of medical humanities was a growing recognition of the …

If you've accessed this editorial online then I hope you will take time to go back and look at the cover of this issue. Take time to look at Mark Gilbert's extraordinary portrait of Jarad, which is also featured in this issue's Editor's Choice article ( see page 5 ).1 If you do, then I suspect that the experience of looking at and engaging with this portrait of care will be profound, and, depending perhaps on your perspective and your experiences, even a little disturbing. For some of you this will be the first time you have born witness to someone else's experience of illness, and you may be struck by the introspective quality of Jarad's portrait. Others will already know more than they wish to about being ill or of caring for someone who is ill. One way or another, after looking at this portrait of Jarad, at least some of you may feel that you know something about him, or at least know something about what he has lived through, and how it has affected who he is. This sudden intimacy with a stranger is, for many people, an unfamiliar experience, although for many healthcare professionals it is …

“ … the sensitivity of the artist may equal the knowledge of the scientist. Both have the same object, nature, and perhaps in time it will be possible for them to link together in a great and marvellous force which is at present hard to imagine.”1 These are exciting times for medical humanities in the UK, with artists and scientists working hand in hand to help deliver a more humanistic approach to health care.2 The existence of this journal and the wealth of innovative work it reports in this issue bear testimony to the enthusiasm and creativity of those active in the field. Throughout the country educators are taking up the challenge contained in the General Medical Council's (GMC) Tomorrow's Doctors 3 and are developing and delivering humanities special study modules (SSMs) to complement the core medical …

In the first issue of this journal, Education and Debate asked whether medical humanities would help make better doctors or just happier ones.1 That question begs a number of others, among them: what is a good doctor, what attributes might such a doctor possess, and are there different kinds of good doctors that medical educators should be helping to graduate? Appropriately, the focus of much of the published data on arts and humanities based medical education is on equipping doctors with the skills, knowledge, and attitudes necessary for clinical practice. The emphasis, either explicitly or implicitly, is on the doctor/patient interaction, and on the role of medical humanities in enhancing the quality of that interaction. The ability to appreciate the perspective of all those affected by illness, to reflect on one’s own practice, and to contextualise the lived experience of illness, socially, culturally, and historically are among the objectives ascribed to medical humanities teaching. By contrast, the Education and Debate paper in this issue describes a medical humanities …