In my ongoing stream of consciousness about art and medicine a new connection has worked its way to the surface. Medicine it seems, is in a state of flux, a state of change and evolution. The hubbub about this is alive in Twitter feeds and on many physicians’ blog sites. The dialog has been centered on the role of media in healthcare, of the use of the internet in patient care, the grooming of new medical students to be our future leaders. The path forward towards the grand new world of health 2.0 is a shifting one with moments of clarity and moments requiring innovation and faith all discussed hotly in the world of social media.
This flux is nicely brought to life in a work of art I recently enjoyed. The artist Charles Sandison produces digital installations of grand physical and philosophical scale. Moving, flowing, changing and in the case of his “Origin of Species”, evolving. This piece is made of points of light swirling around the walls and corners of a darkened room. The lights coalesce at times, into words and form – two words at a time – the entire text of Darwin’s manuscript on evolution. As words meet each other they form the next words in an unscripted display that will take two years to be completed.
when the word man meets the word woman, the word child is produced; and when man or woman bumps into the word threat, the word dead replaces them ~ Ken Johnson
This seems a fine metaphor for our collective musings on the path forward for medicine. The lights in our heads form words that meet in the blogosphere to merge and change into the next iteration of ideas. This forward progress may take some time but – won’t it be great to watch? I would love to see what Sandison would come up with to display our collective efforts as we evolve.
Perhaps on the wall of lights that describe healthcare 2.0 in words two by two we would see that:
“social” and “media” will merge into “expected”
“empowered” and “patient” will merge into “reality”
I am having a bit of a free association sort of rainy Sunday. Funny about our minds isn’t it? The way we can unconsciously shift through the bits and pieces of what we read or hear during the week to come up with a theme of sorts. What follows is the intersection of learning about the great dance choreographer Twyla Tharp, the painter Caravaggio and thinking about a few failed interactions I have had with patients through the years.
Twyla Tharp explains in her book “The Creative Habit” that she prefers to divide people in her world into two distinct categories: acceptable or not, good or evil, “committed or missing in action”. While I find the book well-written and find myself inspired by her advice, I was bothered by these comments. I recognize that for her this commitment to embracing the extremes rather than the grey zones is artistically motivational but for me, it grates against my own approach to people. I prefer to work in a grey zone embracing the nuances of the personalities I find around me.
Michelangelo Merisi da Caravaggio was an Italian Baroque painter in the late 16th century. He is known for dramatic, dark, richly and realistically depicted paintings of an often religious theme. He is also known for having been a murderer. Good (artist), evil (killer) and yet, to view him fully as one of these extremes we would miss the other side to his story and miss the influence these complex components of his persona have on each other. We would make an error of judgment.
As doctors, we give our best care and make our best diagnoses when our minds are open. I remember a professor in medical school telling me to begin my care for every patient by imagining that the patient’s illness was a tree that I stood at the foot of. A tree full of possibilities. As I tried to figure out their diagnosis I was to consider climbing along a branch chosen after a pruning of other possibilities by listening to their history. The physical exam would allow a deeper cut of the choices, lab tests, xrays and time allowing me if fortunate, to end up on the right twig with the right diagnosis.
I read a blog post today about errors made when “hysterical” E.R. patients’ complaints are dismissed. Someone loudly and dramatically requesting that they want a certain pain medication in a busy E.R. does tend to get ignored or, written off by the doctors and nurses who care for them. These patients are judged rather than treated in the grey zone of acceptance and this judging can lead to medical errors. This brought me back to two times in the past when such bias crept into my patient care. In both cases I was “warned” before entering the exam room that the patient or parent was difficult in some way causing me to walk into the room seeing a tree with already pruned branches. And indeed, I ended up on the wrong twig at the end of the visit.
Twyla Tharp is a supremely talented artist whose approach to slotting people into good or bad fails me both creatively and humanistically. Caravaggio was a troubled man with a gift; art influenced by his turmoil or, a man of grey shades. Patient care is best done with a clear eye towards the complexity of human nature.
Medicine and art. Art and medicine. A long paired combination but why? Indeed Medicine is termed an art and the influence of studying art on the developing skills of doctors is currently increasingly touted. I have been thinking about this combination and began to write out my thoughts but, while doing so found a beautiful piece to share. The Journal of the American Medical Association features works of art on the cover of every issue. The long-standing cover editor, M. Therese Southgate, MD had the words below to say about why JAMA has kept art so central to its mission. Her words at least in the consideration of the connection between visual art and medicine, are so complete and beautiful they seem to have gotten me out of having to write much more of a post today!
The question I have been most frequently asked during my years with the JAMA covers is: “Why art on the cover of a medical journal? What has medicine to do with art?”
Let’s look at what medicine and art have in common:
First, they share a common goal: to complete what nature has not.
Second, they have a common substrate, the physical, visible world of matter.
More significant, however, are the similar qualities of mind, body, and spirit demanded of the practitioners of each, painter and physician.
Chief among them is an eye: the ability not only to observe, but to observe keenly — to ferret out the tiny detail from the jumble of facts, lines, colors — the tiny detail that unlocks a painting or a patient’s predicament.
Observation demands attention, and this is the key to both art and medicine. Attention is nothing more than a state of receptiveness toward its object, the artist to nature, the viewer to the work of art, the physician to the patient. It is no accident, I believe, that clinicians — or treating physicians, as they are often called — are referred to as “attending physicians.” “Attention” and “attend” are both derived from the same Latin root meaning “to stretch toward.”
Many more “affinities” exist between medicine and the visual arts, but I will close with just one: Medicine is itself an art. It is an art of doing, and if that is so, it must employ the finest tools available — not just the finest in science and technology, but the finest in the knowledge, skills, and character of the physician. Truly, medicine, like art, is a calling.
And so I return to the question I asked at the beginning. What has medicine to do with art?
I answer: Everything.
That’s my opinion. I am Dr. Therese Southgate, Senior Contributing Editor of JAMA.