A necessary inhumanity?

Evaluating emotions in medical practice: a critical examination of 'clinical detachment' and emotional attunement in orthopaedic surgery

In this article I propose to reframe debates about ideals of emotion in medicine, abandoning the current binary setup of this debate as one between 'clinical detachment' and empathy. Inspired by observations from my own field work and drawing on Sky Gross' anthropological work on rituals of practice as well as Henri Lefebvre's notion of rhythm, I propose that the normative drive of clinical practice can be better understood through the notion of attunement. In this framework individual types of emotions are not, as such, appropriate or inappropriate, but are evaluated depending on their synchronicity with the specific rhythms of the practice. To set up this proposal, I show how typical arguments about emotions in medicine-what I call emotion-entity focused frameworks-are insufficient. I then draw on ethnographic observations from two orthopaedic departments and interviews with medical practitioners to show (1) how clinical practice is driven by rhythmicity, shaped in the case of orthopaedic surgery by a clinical aim of efficient, controlled intervention, and (2) how clinicians continuously refer to this drive and the flow of rhythms when evaluating inappropriate or problematic emotion. I argue that the use of a rhythm framework rather than ideals of detachment or empathy allows for a sensitivity to the complexity and situation-dependent elements of emotional ideals in clinical practice; and I end by proposing the term 'attuned concern'-which stresses the importance of regulation and adjustment to circumstances rather than of maintaining a constant distance/involvement-as a more fitting alternative to 'clinical detachment'.

"Inform the Head, Give Dexterity to the Hand, Familiarise the Heart": Seeing and Using Digitised Eighteenth-Century Specimens in a Modern Medical Curriculum

Recent years have seen an explosion of interest in digitising museum collections. Among the objects of interest are anatomical and pathological specimens found in medical museums. As researchers increasingly produce digital replicas of these preparations, ways of integrating these resources into the medical curriculum must be explored. This article takes a medical humanities approach to this topical question, comparing the historic use of anatomical specimens to modern intentions, and exploring the potential for using digital anatomy to help integrate humanities into the curriculum. The use of anatomical specimens by William Hunter (1718-1783), whose collection is now kept at the Hunterian in the University of Glasgow, provides a key historic focus. The teaching intentions for his private courses of anatomy are examined, to investigate how specimens were used in an eighteenth-century "curriculum". The motivations behind digitisation and the use of digital anatomy in modern curriculums are then examined and compared. Many of these motivations are shared with Hunter's: the desire to maintain a unique anatomical resource, the need to provide multisensory engagement in learning, and a desire to attempt to show "natural" anatomy without the interference of human processes. The balance between fostering empathy and maintaining detachment is also key for both. Using digital replicas of historic specimens to teach anatomy also opens up a unique opportunity to educate students in the medical humanities in a fully integrated way. Understanding the full story of the specimens they use, as explored in the first half of the article, allows students to place themselves, their dissection subjects, and healthcare as a whole in a historical context. As well as fostering empathy in the dissection lab, the stories behind the specimens can be used to introduce key humanities topics, including ethics, institutional bias, and social aspects of health and disease. It is essential that this potential is explored now while digital anatomy is still a relatively young field, and therefore collaborations between anatomists and medical humanities practitioners can be built and included from the ground up.