Ilia Ostrovski
The Silhouette
Hartley Jafine (or simply “Hartley,” as he likes to be called) is a PhD candidate and instructor in the BHSc program whose research focuses on the role of the arts in healthcare settings.
He is concerned with exploring the benefits of theatre in health education and research.
Hartley’s line of work discusses the problems that arise as a result of the day-to-day routine that medical students are subject to and explores solutions to this problem.
“Students typically enter medical school when they are at the height of compassion, and the height of idealism, because, coming from an undergraduate program into a medical school, they want to be healers; they’ve chosen this profession for that very reason … but the problem , from my research and lived experience, is that, when medical students enter third year, they start to lose their compassion and empathy, and this is largely because the realities of medical school systematically convince them that there is no place for empathy,” Hartley said.
The “realities” to which Hartley refers undermine the importance of skills like active listening, appropriate bedside manner and many other issues that are widely recognized as crucial to the healthcare profession.
This defect in the environment of medical education breeds desensitized healthcare practitioners, whose apathy inflicts the patients and destines their students – the next generation of physicians – for a similar fate.
According to Hartley, the solution lies in the arts.
He advocates the widespread implementation of theatre-based programs that offer these students and physicians a unique opportunity to devote time to critically think about the experiences that their patients go through and to evaluate themselves from these patients’ perspectives.
Programs like this can rescue the students’ empathy and in doing so reinforce the importance of recovering skills that they have let fall by the wayside.
Furthermore, Hartley believes that theatre can provide healthcare professionals with a safe environment to do something that is essential to their continuing development – make mistakes.
“In the healthcare world, there is this overwhelming expectation for perfection,” he says. “Now, this expectation is understandable, given the stakes, but it gets to the point that admitting to one’s mistakes or sharing one’s anxieties becomes severely frowned upon.
The inability to discuss one’s fears and anxieties can be extremely detrimental to the mental health of someone in such a high-stress position and to a large degree deprives them of the opportunity to learn from their mistakes.”
Theatre offers physicians a forum to collectively discuss their fears as well as the mistakes they’ve made.
Openly speaking about their worries with other professionals who carry the same burden of responsibility inspires a sense of community in healthcare rather than that of judgment and criticism and ultimately leads to the improvement of their mental health.
This, in addition to discussing the experiences in which they have made errors, especially those that had considerable consequences for their patients, allows the practitioners to return to work unburdened and more aware.
According to Hartley, the shift towards recognizing the importance of the arts in healthcare settings has been underway for some time.
Among various examples of medical institutions implementing arts-based programs into their curriculum, he notes that 2012 will mark the one-hundred-and-one-year anniversary of University of Toronto Medical School’s musical, a persisting testament to the importance of this cause.
However, he asserts that these instances are few and far between. The fact remains that many medical institutions still fail to recognize the importance of this aspect of medical education and thus don’t consider it a budgetary priority.
These circumstances and his belief in his work are what motivate
Hartley to wholeheartedly fight for the establishment of programs that allow medical students to overcome the “realities” of medical education.
Kacper Niburski
Assistant News Editor
The open forum discussion began with the harrowing reality that ten million people die each year due to lack of access to medicine. An expert panel of university professors and pharmaceutical CEOs went on to address the variety of obstacles present in the global campaign to provide universal and equitable medical treatment.
Organized by the McMaster Health Forum Student Subcommittee with support from the Bachelor of Health Sciences Program, the panel of three speakers, Aidan Hollis, Richard Elliott and Philip Blake, stressed that pharmaceutical inequality was not entirely caused by poverty found in developing nations.
People are not dying simply because they cannot afford the price of life. A complex analysis of the situation on the macrocosmic scale yields a much different observation: inequality does not result from poverty, but rather due to the current structure of medical research and development.
As it stands, a pharmaceutical R&D firm’s most motivating incentive is for innovation and the subsequent patents. Because of this primary incentive, if the demand is large enough, a patent allows the firm to profit for innovation into a novel process as opposed to meeting any dire need.
Profit, then, as described by Hollis, professor in Economics at the University of Calgary, “is due to the connection of innovation and price.”
Only the greatest innovation will result in both a larger price on the market and the most significant profit for the company. Just as it is not by the benevolence of the baker that one receives their bread, it is not by the charity of the pharmaceutical firms that one receives their medicines, no matter how necessary they may be.
The panel agreed that such a complex network of private and public partners working to meet their ends has caused much of the global struggle to achieve universal access to medicine. Elliot, executive director of the Canadian HIV/AIDS Legal Network, stressed that, “such price-based incentives have characterized the staggering inequality in healthcare for a long time.”
The panel offered little in way of solution, although a few overarching suggestions were offered in how to “square the circle,” as Hollis described it. Perhaps the most obvious was an explicit need to change the funding paradigm by radically altering incentives to fund research.
By no means did the panelists suggest it would be an easy task, however. Hollis stated that while the means to best do this is a contentious topic, it must be remembered that “companies are run by people who value healthcare just as much as anyone else,” which is inherently true.
Behind the grey walls and the large laboratories are people who would rather a system that rewards them for what they do, not what price they sell.
Philip Blake, president and CEO of Bayer Incorporated, mirrored the ideal. “We need a way to encourage innovation in a reality described by serendipity, and to find motivation balanced by pragmatism.”
Pragmatic as any solution may be, the question of how valuable one life is compared to the net profit seemed inescapable. While all panelists were adamant in their belief that any single life is invaluable, dividends behind the various pharmaceutical industries may have suggested otherwise.
One thing is for certain, though. The solution to a gross inequality in medical access is not found in a cure. Based on current intellectual property rights and capital market systems, there is no money to be had in a final cure.
Instead, profit is found in pills that placate an illness, that opiate the senses, and that mitigate the affects, as opposed to eradicating them.
That is the reality of the global struggle in universal medicine. On one end, people lack access to medication and die.
On the other, people take it for granted and often abuse their prescriptions. It would seem that the current market system does not allow for a middle ground between the two. As Hollis stated, “while companies want to do what’s valuable by improving health, they also want to make money.”
