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The isolation, loneliness and helplessness of being homeless
  1. Deborah Kirklin
  1. Correspondence to Dr Deborah Kirklin, UCL Division of Medical Education, Whittington Campus, Highgate Hill, London N19 5LW, UK; d.kirklin{at}

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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 of the ethical issue of the treatment of homeless people in the NHS system and the community’.1

Having been privileged with the task of judging the entries for this prize, it is self-evident that I was impressed by the calibre of Rory's submission. That is not, however, to say that I found engaging with it easy. Rather, I experienced a visceral sense of shame at my own complicity, as a doctor, in the poor care that homeless people all too often receive in the UK and elsewhere.

Touched as I was by the isolation, loneliness and helplessness captured in these beautifully executed works of art, I have no doubt that others will be similarly affected. But does that mean that it is possible, let alone credible, to claim that Rory's work will change anything?

On one level, it is impossible to know, let alone to prove such an effect exists. Yet, on another level, I find it entirely plausible that changes in attitude and consequent realignment of priorities and outcomes can be effected by art.

I would be the first to admit that such changes, if they do indeed occur, will be extremely subtle. Taking place under the evidence-based radar, they will be unquantifiable and yet, to my mind at least, no less clinically significant.

But is that enough? Would it be right for the journal to encourage authors to lay claim to such speculative change, upfront at the time of publication? Probably not, and yet, if we could find a way to signpost potential clinical links to the papers we publish, it might be of some value.

As in so many other areas of scholarships, medical humanities research often raises as many questions as it answers, as evidenced by Leslie Swartz's paper.2 Drawing on his own experience—as a privileged white professor in South Africa, employing poor black women to care for his dying mother—the author asks a wide range of questions about the care industry.

With its focus on the politics of care, and specifically the potential for the care environment to be one characterised by dependency and exploitation, Swartz's paper makes for a refreshing, if sobering, read.

Challenging readers to ‘think more clearly and more visibly about the politics of care work’, Swartz leaves us, in no doubt, that it is all too easy to focus on the dignity of a person being cared for, while ignoring the dignity and needs of those undertaking the care.

Interestingly, although Swartz explores some of the practical realities of delivering social care in South Africa, this deeply philosophical paper speaks to the cultural, economic and political underpinning of power relations within every society.

Alan Bleakley and Rob Marshall's paper also offers a philosophical take on a very practical, patient-centred problem, namely the avoidable medical errors that occur as a result of poor communication.3

Bleakley and Marshall note that ‘despite 30 years worth of explicit attention to teaching communication skills at undergraduate level’, there has been a well-documented decline in medical student empathy.

Drawing on the works of Homer for inspiration, and specifically Homer's lyrical aesthetic, they suggest this decline may be symptomatic of ‘the repression of the lyrical genre in medicine, where the epic, tragic and dark comic genres dominate’.

One consequence of this repression of the lyrical genre within medicine is that doctors sometimes fail to recognise patients as the very individual people that they are. By contrast, ‘framing medicine as lyrical work challenges undue emphasis on ‘cure’ at the expense of humane ‘care’’.

Again, these are subtle arguments, which take time and effort to appreciate. However, I would argue that what Bleakley and Marshall are saying is of profound clinical significance, although it is far from easy to explain what I mean by that, in just a few words.

To fully appreciate the clinical significance of this interesting paper, you will need to read it in its entirety, and I would encourage you to do so, along with all of the fascinating papers that make up this issue. Only some of these papers have an overtly clinical overtone. All of them are guaranteed to make you think.


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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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