A visit to the post-impressionist museum doesn’t sound like an average day at a medical school. And yet, some of the world’s top universities are now teaching their med students to analyze paintings. This is how art is transforming doctors into insightful people, while nurturing their interpersonal skills.
How often have you gone to the doctor when you were ill, just to then heard them say “Oh, its probably just a virus. If it doesn’t go away in a couple of days, come back again”. How does such a visit make us feel? Are we reassured because we feel we’ve been observed and checked, or did the good doctor just follow some generic checklist without really noticing the person in front of them – us?
There are many types of doctors, and they are all considered experts. Some of them may treat you as a caring father would, others may be cold and distant like a machine. But both may bring us good results, or not. Of course, there is a whole prism of doctor types in between these two extremes. After all, medicine is a science that naturally wraps its professionals with a mechanistic, calculated flair, which already starts to show when they are just students. After they enter the health system, these tendencies become fully ingrained in their character and approach, because like any other large system, it operates like an industrial factory.
The communication and analytical skills of the observing doctor
As patients, this isn’t always bad for us. We do want our doctors to be calculated. They are not supposed to be our shrink or best friend – they need to know our physical condition and be able to maintain it as healthy as possible. On the other hand, an injury or illness makes us very vulnerable, and if a doctor only sees us as an fact sheet, they may not really help in healing us fast. The reasons for this are twofold: first, healing has a proven psychological aspect, and second, when doctors enter into ‘checklist mode’, they may overlook an important piece of information that’s hiding beneath the surface, from the nuances of each individual patient.
That is why, in recent years there is a growing trend in many medical schools to merge between the two types of doctors – the mechanistic and the humane. Some of the world’s leading faculties have found a surprising and creative way to do this, by bringing-in Van Gogh and his friends. Harvard and Yale are just two examples of academic institutions that are now adding art courses into their medical school programs, with the goal of training doctors to be more compassionate, and also more professional. By analyzing artwork, they teach the doctors of the future how to see the small details that lay beyond, and how to communicate better with patients. So perhaps, we can name the new type of doctors – which are the love child of the marriage between mechanistic and humane – the observing doctor.
Prof. Michael Flanagan, MD, the Assistant Dean of Penn State College of Medicine, believes that interpersonal skill is the top priority for doctors, and that it must be honed and nurtured. To teach medical students the importance of quality communication, he initiated an art course in which they learn to paint and analyze paintings by Van Gogh, Cezanne, Gauguin, and others, and then apply this experience to improve on their own interpersonal dynamics.
Joe Andrie, a medical student who took the course, describes one of the important exercises that helped him connect with his peers, and practice his communications skills. This activity was done in pairs, in two stages. First, one student described the painting, and the other draws it on a canvas, but the description must only be done through closed-end questions, to which the answer can either be no or yes. Then, in the second stage, the activity is repeated, but this time around the person drawing can ask open-ended questions. “It was amazing to see how difficult it was to create a painting based on closed-ended questions”, explains Andrie in the video capturing the program, “because you really don’t get that much information and it’s really hard to see how things fit together, see how the composition of the painting is, based off of these closed-ended questions”.
In the second stage, the open-ended question led to much better results, because the information they reveal is more integral. As Andrie describes, doctors may have to ‘sacrifice’ the speed of communication, but this will enable them to “walk away from the patient encounter […] with a pretty good idea of that patient’s life, that patient’s story”. Quality communication in itself has added value, benefitting the patient experience. When the doctor speaks with the person, and not with their medical records, they can improve their interpersonal relationship. This would probably lead to the patient leaving off from the visit at the doctors feeling much better, because they were really observed, and not just another slot in the doctor’s busy schedule.
Medical students started seeing things that would have previously gone unnoticed
But this is also beneficial on the medical level, too. The courses don’t only develop the emotional side of the students to make them more service oriented, but also offer them an added professional aspect: artistic analysis, it seems, helps improve analytical capabilities. Flanagan explains that the course also takes a look at the “awareness of the preconceptions and cognitive biases that we all possess, and how that might affect our interaction with the patient”. Prof. Eugene Marsh, MD, a neurologist at that same university, believes that the course helps students develop an objective thought. By analyzing the artwork, they learn to go deeper, consider the details, and then take another, broader look at the bigger picture , seeing it in a different light. He explains that this enables a doctor to take a step back, and suddenly see “that the first diagnosis that came to you like this [i.e. easily], or perhaps the one that you had seen yesterday that you are thinking you are seeing again,” is not accurate after all.
The earliest runs of such programs were done in the late 90s, in Yale. Linda Friedlaender, the Curator of Education at the Yale Center for British Art and one of the founders of the program, claims that since it started, the program has been imitated by at least 20 other schools. Dr. Irwin Braverman, a Prof. of Dermatology who co-founded the program, says that the idea came to him in a conference he was at, where he experienced how medical residents were not doing a very good job describing certain cases. “I was wondering ‘how could I get them do this better?’’ he shares, “and at that moment a painting popped into my head as being something that would be foreign to most of the residences, and they would probably describe everything in that object because they didn’t know what was important or unimportant”. Braverman joined Friedland, and the two began choosing artwork together from the Victorian era, which are typically characterized by a deep narrative that is hidden under the brushstroke, to show to the medical students in the gallery.
“The instructions are […] study this painting and then describe it in a way that if someone is listening but doesn’t see the painting, they’ll get a mental image of it”, Braverman explains. The students stand in small groups in front of a painting, and deconstruct the scene depicted in front of them. Where is the gaze turned? What is the figure feeling? What can be learned from the background about the possible reasons that created the situation, and so forth. A discussion ensues, which goes into the painting and then out again, in an attempt to decipher it better. The students must identify detail, understand the relationships between things in the painting, and find connections that tell a story – how can a link between two elements in the painting tell the plot or reveal the context of the larger scene on the canvas? Then, all the information is integrated together. This is how the program trains the students to look with analytical eyes, while also honing their medical discourse.
In the second part of the course, the students are given several pictures of skin lesions, and are asked to specifically write down what they see. “After we get to about number nine or ten”, Braverman explains, “the obvious things have been said, and now they are really searching for something different, and in that search for something different, they begin to see things they would have ordinarily passed over”. He concludes, saying that analyzing art crosses many fields, and “once you can do that, you can analyze anything.”
A similar course takes place at Harvard. Dr. Elizabeth Rider from the Department of Pediatrics at Harvard Medical School, says that, “We must train our young doctors, to teach them compassion, and art is a beautiful mechanism to do that”. Here too, the students learn how to observe an artwork, decipher what they see, and analyze what a painted body gesture shows, what the eyes say. “You’d think that arts and humanities are very far from medicine and science, but actually that’s all part of one continuum”, says Dr. Lisa Mei-Inn Wong, one of the program’s leaders. Rider believes that doctors can approach their patients just as a person enters the gallery – stop and contemplate for a minute what it is that they see.
Insightful observation is not an exclusive doctors’ skill
As Prof. Braverman explained, when we know how to analyze art, we can analyze anything. If this method works well for Harvard, Yale, and other universities, it can probably also benefit us in other fields. We all have a routine lifestyle that may hide away the small details. Maybe the marketing plan we wrote is not bringing us results because the target audience had undergone an event of some sort? Maybe the TV isn’t working because the cleaners had moved the furniture and disconnected the cables? Maybe our little child has come back upset from kindergarten just because she is tired, and not because something had happened? Observing things in detail, just as you would an artwork, enables us to reconstruct a richer picture. Much in the same way, we can also develop better communication skills. Stop, and really listen to what is said to us, consider it, think of the inter-connectedness of things, instead of just ticking off the rubrics in our imaginary checklist and presenting something that’s readymade.
It is no secret that doctors do not always have the bets working conditions, and generalization may be doing them an injustice. There are always doctors who are amazing despite the environment in which they work, and others who, even under the best working conditions, would be less compassionate. Art will not solve the challenges of the health system itself, but we can hope it would transform the intimate encounter between a patient and their doctor into something more professional and personal. And if we expect this from our doctors, there is no reason we should not also expect this standard from our own selves.