**Abstract**

Patient-centered care means organizing health care that is respectful and responsive to the patient needs, preferences, and values, and ensuring that the patient values guide all clinical decisions. Teaching of medical humanism becomes a necessity to help neurosurgery residents in their future practice to do what they are already doing but in a more humanistic and empathic attitudes. A training programme to teach medical humanism core values through lectures, role modeling, and training in interpersonal skills, literature and humanities study can improve attitudes and behaviors. A set of 10 medical humanism values relevant to contemporary challenges, research, and practice of neurosurgery practice that can help residents and practicing physicians to maintain humanism behaviors in their practice are presented. A humanistic neurosurgeon provide a skilled, compassionate, and empathic care to her/his patients, and demonstrates respect for their values, autonomy, beliefs and cultural backgrounds. Neurosurgery is an apprenticeship profession, where humanism values can be taught and behaviors associated with humanism can be learned.

**Keywords:** humanism, medical education, neurosurgery, patient-centered care, professionalism, values

## **1. Introduction**

Patient-centered care means organizing health care to serve the patients. In this context, and in order to respond to the new demands of society for the reliability of doctors in the 21st century and seeking greater adaptation and development of professionals, Competence Based Training (CBT) was developed [1]. Humanism in medicine, a central aspect of professionalism, combines scientific knowledge and skills with respectful, compassionate care that is sensitive to the values, autonomy, beliefs and cultural backgrounds of patients and their families.

According to Jean-Paul Sartre, "humanism is a theory which upholds man as the end-in-itself and as the supreme value". Man is the point-of-care, the thingof-focus, and the centerpiece of our attention. Medical humanism, or humanistic medicine, is an interdisciplinary field which aims to address problems in health care. According to The Arnold P. Gold Foundation, it is "characterized by a respectful and compassionate relationship between physicians and their patients" centered on several ideals, including integrity, excellence, compassion, altruism, respect, empathy, and service [2].

Humanism represents the basis of medicine throughout history, beginning from the time of Hippocrates and the development of the Hippocratic Oath.

Medicine has been regarded as a moral profession and carried out in accordance with a set of morals and ethics [3]. The first conference concerned with humanism, was held at Chicago University in 1933, recommended considering humanistic science as the basis of morality and decision-making in medical practice.

The past four decades showed great advances in medical knowledge and new technological devices have been extensively incorporated into medical practice. Physicians emphasized on the disease, use of technology, laboratory investigations, treatment and physical recovery. They ignore patient psychological status, ethical and social cultures. These events abolished medical humanistic spirit. Such dehumanized medicine appears to have no past, no cultural language and no philosophy.

Sir William Osler (1837–1901), considered as the father of modern medicine, advised ¨Listen to the patient. He is telling you the diagnosis¨. Sir Osler also stated that (it is much more important to know what sort of person has a disease, than to know what sort of disease a person has) [3]. Marañón's words provide us with the following reflection "… a mere diagnostic system, deduced exclusively from analytical data, dehumanized, independent of direct and endearing observation of the patient, carries the fundamental error of forgetting the personality, which is so important in etiologies and to stipulate the prognosis of the patient and teach us, doctors, what we can do to alleviate his sufferings" [4].

Humanism is an essential component of the art of Neurosurgery that allows the science of Neurosurgery to prosper. Without humanism, medicine is no longer; without medical science, medical humanism has no vehicle. The practice of Neurosurgery is both a science and an art. Contemporary Neurosurgery is based on scientific rigor but good medical practice should be 'an art that uses science as one of its tools'. It is the art of Neurosurgery that facilitates teamworking, communication, partnership with patients and maintenance of trust—key elements of professional guidance on good medical practice—whereas science upholds evidence-supported practice.

#### **2. Humanism core values in neurosurgery**

The young resident begins the residency full of dreams and desires to take care of patients, full of idealism; and by a process that has not been explained sufficiently ends up becoming indifferent to human suffering, gets used to the disease, unleashes the sufferer and becomes "dehumanized". The question is: what skills and qualities do neurosurgeons need to practice a humanistic patientcentered care?

Knowing how to care for the sick in all their human dimensions is the main challenge facing medical education today. This is the construction of a new medical humanism capable of harmonizing the care that the patient needs. A training programme was conducted to teach medical humanism core values through lectures, role modeling, and training in interpersonal skills, literature and humanities study. Improvements in medical humanism attitudes and behaviors were attained after successfully completing the course through lectures, role modeling, and training in interpersonal skills, literature and humanities study. A humanistic neurosurgeon provides a skilled, compassionate, and empathic care to her/his patients, and demonstrates respect for their values, autonomy, and cultural backgrounds. Neurosurgery is an apprenticeship profession, where medical humanism can be taught and behaviors associated with humanism can be learned.

A set of 10 humanistic values that can help residents and practicing physicians to maintain humanism behaviors in their practice are presented here [5]. A proposal of a new model of medical humanism in neurosurgery, resulting from harmony that perfectly combines the science of modern neurosurgery with the art of care, which involves understanding the sick as a person, focusing on the patient.


The only man who is educated is the man who has learned how to adapt and change—the man who has realized that no knowledge is secure and that only the process of seeking knowledge gives a basis for security. The goal of education, if we are to survive, is the facilitation of change and (life-long) learning.


The humanities incorporated in the academic training process are an important resource that allows developing the human dimension of the physician. In coexistence with these realities, the humanities help and, above all, they educate. Educating is much more than training skills: involves creating a thoughtful attitude and a continuing desire to learn.

Teaching medical humanism today implies facing the challenge of promoting a true philosophical reconstruction of the physician, which is the anthropological position. And thus building "bifocal" neurosurgeons, who are capable of caring to their patients with a professional, technical and humanistic competence, in harmony, taking advantage of the best that progress offers them, to serve them in their physiological and human needs (**Table 1**).

#### **Figure 1.**

*The 5 steps of evidence-based medicine process (5 A's) based upon the Sackett et al. model [10]. Integrating the best available evidence with clinical expertise (proficiency and judgment) and patient values, beliefs and preferences.*


• Humanism as antidote to burnout: Treating patients humanistically can be "the antidote" to burnout.

#### **Table 1.**

*Factors that help sustain humanism in medical education and patient care (modified from Chou CM et al. [11]).*
