**1. Introduction**

#### **1.1 Technology and humanism: finding a new balance**

We live in an era in which outcomes, guidelines and clinical trials are at the forefront of medical training. We observe well-trained technological physicians with a reduced humanistic perspective which leads to attitudes that lack ethics and professionalism. It is necessary to overcome the dichotomy that scientific knowledge is objective, while everything that is subjective - of the subject, of the patient - is second-class information. This statement is not only false, but also an obstacle to alleviating suffering [1].

The vocation of doctors is to care for patients. Nevertheless, the frequent dissatisfaction of patients points more to the human deficiencies of medical professionals than to their technical shortcomings. Complexity comes mostly from patients, not from diseases. While technical knowledge helps in solving diseasebased problems, the patient affected by these diseases remains a real challenge for the practicing doctor.

There is a growing concern about the human dimension of the future physician and how it can be taught or reinforced in the educational environment [2]. Medical students - often young people learning to be doctors as they develop as human beingscould have their attention captivated by emerging technology. It is up to educators to be attentive to overcome this challenge and facilitate a balance in student's education, using humanities and culture in general. It is well known that while technical dimension and knowledge grow through training and study, improving attitudes, developing virtues and incorporating values require reflection.

Researchers on this subject [3] comment on the balance that always existed in medicine, between the two inseparable facets that compose it: medicine as science and medicine as an art. The vertiginous scientific advances would require, to maintain that balance, an extension of the scope of humanism, that is, a humanism at the height of scientific progress. And it would be this expansion of humanism, adapted to the current days, in a modern version.

When this humanist update is missing, it falls into a disproportion that is reflected in technically trained professions but with serious human deficiencies. Deformed professionals, with hypertrophy, without balance, who naturally do not conquer the confidence of the patient who expects a balanced doctor. It would be, therefore, a function of the University and the academic institutions, to expand the humanist concept in modern molds, without the aroma of mothballs, knowing how to open horizons and new perspectives. For achieving this goal methodology, systematics, and relearning to do things are required; specially when these things are too many, wrapped in high technology, and commanded by the scientific progress that advances for seconds [4].

The French thinker Gustave Thibon [5] brings together in a volume a set of essays, to which he gives the title "Balance and Harmony." The balance is the composition of opposing forces, compromise solution, resulting from vectors that cancel each other out. Harmony is the perfect fit of the parts into a whole, so that they collaborate for the same purpose. And, quoting Victor Hugo, he comments: "Above balance is harmony, above the balance is the harp".

When we look at the actions that seek to humanization - without achieving it - we realize that the mistake is, perhaps, in seeking balance and not harmony. The balance assumes that the forces are antagonistic, that modern science supported by evidence has to be seasoned with humanitarian attitudes such as, for example, hearing the patient's history with love and feeling compassion. We recognize that this is already enormous progress and an advance on what, unfortunately, we contemplate daily, where the patient is a mere adjuvant that often disturbs the doctor's practicing. But that balance is insufficient, it lacks consistency. They are still two attitudes that do not mix, like water and oil. The clear water of the evidence, and the comforting oil. But each of them with its density and applied each to its time and in its moment. This "medical performance schizophrenia" is unsustainable in itself, it lasts for a short time, and when the doctor gets tired, he will pay attention to one to the detriment of the other.

Medical science, cutting edge medicine, demands a new humanism [6]. A position that knows how to place liver function and neurological sequelae in the same reasoning, with the meaning of life; transaminases and albumin combined with humiliation, suffering and loss. A science that is an art and therefore manages to place in the

#### *Reflections in Medical Education: Empathy, Emotions, and Possible Pedagogical Resources… DOI: http://dx.doi.org/10.5772/intechopen.101832*

same equation dimensions so different, that apparently do not mix. In truth, they are completely mixed in life: prothrombin and discouragement, neurotransmitters and tiredness of living, hepatocytes and indignation.

This seems to be the time to invoke the construction of harmony, and know how to play, with different strings to get the perfect chord. Balance is to assume a monotonic composition, or science, or art, a bit of albumin and measured doses of affection. Harmony is to put each competence in its place and have the soul of an artist to know how to play in the harp of life - of that person who is unique - the strings of different shades. These are the chords that allow the doctor to travel the path between the sick person and the meaning that the disease has for the patient, which is a way of being in life. A way of life that has its own language and must find, in the sensitive physician, the receiver necessary to properly decode the meanings. This implies for the doctor to have an attitude of active anthropology: Humanism and anthropology are possibilities of his self-demand, challenges to his rational thought, levels of knowledge in style and ascending aspiration of nonconformity [7].

Humanism is thus a source of knowledge that the doctor uses for his profession [8]. Knowledge is as important as those acquired by other paths that help you in the desire to take care of the human being who is sick. Humanism in medicine is not a temperamental question, an individual taste, not even an interesting complement. All that would lead to place "humanist attitudes" on the scale, to compensate for the excesses of science. Humanism as harmony, as musical virtuosity is, for the doctor, a true work tool, not a cultural appendix. It is a scientific attitude, weighting, the result of a conscious effort of learning and methodology [9, 10].

The doctor's inspiration will often come from the cord of compassion that vibrates easily in a heart willing to help. That will be the note that will give the tonality for the further development of its performance, for the harmonic chords of clinical reasoning. Gregorio Marañón, a humanist doctor and a profound connoisseur of this harmonic symbiosis, warns: "The doctor, whose humanity must always be alert within the scientific spirit, must first count on individual pain; and although he is full of enthusiasm for science, he must be willing to adopt the paradoxical position of defending the individual, whose health is entrusted to him, against his own scientific progress" [11].

In this context, the narratives and life stories, now complete and harmonious transaminases and distresses, albumin and heartbreak - have their true space and function: to approach the human being who suffers and awaits our care. Once more Marañón gives us a reflection in the perfect chord: "On several occasions I noted to those who work by my side, that a pure diagnostic system, deduced exclusively from analytical data, dehumanized, independent of the direct and endearing observation of the patient, it implies the fundamental error of forgetting the personality, which is so important in the etiologies and to stipulate the prognosis of the patient and teach us doctors what we can do to alleviate their sufferings" [11]. We know well from our own experience how difficult this harmony of action is: how to govern technique and humanism with expertise so we can offer a true symphony of health care [6].

The first step that the doctor must take if he wants to humanize medicine is admitting that he must humanize himself first. And for this, he cannot give up his efforts to reflect, to look for solutions and find resources that allow him to integrate technical science - which grows every second - with the humanism that medical practice requires [12].

Hans Jonas, with his ethics of responsibility [13], points out that what distinguishes human beings from animals is a tripod constituted by the tool, the image and the tumulus. The tool is the technique, and in this there is no doubt that we distinguish ourselves from animals, because when we are born, we quickly incorporate all the

techniques accumulated in the history that precedes us. Animals lack a scientific heritage, and each one has to be built from scratch, without taking advantage of the experiences of the ancestors of their species. We can evoke Ortega [14] when he says that the current tiger is the same tiger of thousands of years ago, and that only the human being is born on a history that precedes him, the history that sets together with the technique and the corresponding progress.

The second element that distinguishes us from animals is the image, which includes the ability that mankind has to represent reality through art. Art and humanities are ways to better know the reality in which the human being is immersed and to know himself, in his bodily and spiritual dimension. Finally, the third leg of the tripod is represented by the tumulus. Only the human being has an awareness of transcendence, and the representation of death is what puts him in contact with a dimension that extends beyond his own being.

It is not difficult to conclude that if, as far as technique and progress are concerned, being noticeable the distance between mankind and animals, the other two elements of the tripod have been atrophied; and if not for that reason we necessarily become animalized, there is no doubt that the human equilibrium presents itself with dangerous instability. The man – the doctor, in the case at hand – stops frequenting the arts and humanities and deprives himself of ways of knowing the world; loses the ability to admire and feel that most of the phenomena that surround him are independent of him. And, not least, he loses the sense of transcendence, the spiritual dimension, the sense of eternity and the duration of time around him and his own. The consequences are alarming, because of not frequenting "the tumulus, door of transcendence" it becomes difficult to maintain the sense of mission, and the need to feel useful in this world, as part of the happiness we pursue. This reflection opens the way to the next point: the necessary contingency of the human being, surrounded by suffering and death.
