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What is the Fine Art of Healthcare?

picture of me in FAOH wkshpI have developed an innovative and interdisciplinary program at the University of Miami that uses art to hone observation and communication skills in the service of clinical diagnosis. Working in partnership the Lowe Art Museum, Miller School of Medicine, School of Nursing and Department of Psychology have filled a gap in medical education to strengthen healthcare.

Over the last five years I have read over 100s of publications, watched a number of videos, and listened to webinars that explore ideas, challenges and solutions for healthcare in the 21st century. Through weekly blog posts I look forward to dialogue on these issues.

 

Love, Death and Spaghetti

 

Love, Death & SpaghettiMy grandmother had Alzheimer’s and had been bed-ridden for a long time.  My mother kept trying to get her to eat and drink. Ensure was the drink of her choice.  Finally the doctor said, “why are you trying to get her to eat and drink when she clearly wants to go”.  So my mother stopped.  And not too long after my grandmother did die.

In the NYT’s an article, written by a nurse, Theresa Brown, called Love Death and Spaghetti describes the how the wife of a man who is terminally ill wants to try and get him to eat.  We associate food and calorie intake with life.  And when someone stops eating there is a fear that they are not well or that they are consciously or unconsciously choosing to end their life.  Difficult doesn’t begin to describe watching someone who is in pain not eat.  It means that there is no longer a ‘taste’ for living:  the body is shutting down, the body wants to stop, and that means those we love will no longer be with us.  But Ms. Brown goes on to explain that we can help this passage by making the patient more comfortable: giving them ice chips to prevent the mouth from drying out, holding their hand, or reading to them, and keeping them pain-free.  Nobody wants to see those we love die.  But everyone, at some point in their life, will have to.  Nobody gets a pass. (see article here: )

5 Simple Habits Can Help Doctors Connect with Patients

Were it so simple!  I’m not sure that there are only 5 but it’s a good place to start.  Something as simple 5 simple habits....as sitting down with the patient, in the clinic, can send the message, ‘I’m on your level’.  Active listening includes checking back with the patient to make sure there is an understanding.  Asking open-ended questions tells the patient that the doctor is leading the patient; that the patient is an active participant in their own health care.

See article here

How to Teach Doctors Empathy

“BeinBenefit of Empathy 01 - Carl Rogers  feels damn goodg a good doctor requires an understanding of people, not just science.” The sentence almost seems too simplistic.  I mean doesn’t everyone think they are “good with people”. To me being a good doctor, being empathetic, means actually touching that person, not just physically but emotionally, connecting with patients through their stories.  And I believe that takes a lot of time, patients and patience, and an understanding of what it means to heal.  Some illnesses can’t always be cured but a doctor can do their very best to make sure to be empathetic.

(See article here)

 

Honing the Art of Observation and Observing Art

Harvard, Stanford, Yale, all Ivy League schools with medical schools that are infusing art into education.  In the article Honing the Art of Observation and Observing Art (see here)  author makes a strong case for how and why art is an important tool when it comes to clinical skills: art is ambiguous, art is open to multiple interpretations and art is nuanced; one needs to observe what is not there as much as what is apparent.  Just like  an x-ray, art has a lot of positive and negative space.  So students benefit from spending time in an art museum, not only are they able to hone their observation and communication skills they are able to slow down the process.  This is very important for health care practitioners as burnout is pervasive in the medical field.

Frontline program on Atul Gawande and his book Being Mortal

Frontline-Atul GawandeEveryone is going to die but some are going to die sooner than others.  Isn’t it part of a physician’s job to have that conversation with terminally ill patients and their families?  I understand that the creed of physicians is to “do no harm” but why should a patient be hooked up to machines, only to prolong the agony, or to appease the family?  As hard as it might be to say ‘goodbye’ don’t we owe it to people to explain the options? Instead of being hooked up to a ventilator patients, according to studies, would rather die at home  home  surrounded by their things and the comfort of their families, and loved ones?  Hard questions but ones that Atul Gawande explores in this Frontline piece, 

EVERYONE SHOULD WATCH THIS VIDEO! (Warning: this is not an easy thing to watch but it is reaffirming)

Teaching Doctors the Art of Negotiation, by Dhruv Khullar

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author: Dhruv Khullar

Doctors are constantly negotiating; with their patients, with other doctors, with nurses and the article in the New York Times highlights that part of learning how to do this centers around communication skills, and learning communication skills is becoming de riguer in medical schools around the country.  The following paragraph is particularly relevant to me:

“Negotiation, in this context, is not about winning or losing, or haggling over price or scare resources. It’s about exploring underlying interests and positions to bring parties together in a constructive way. It’s about creative, innovative thinking to create lasting value and forge strong professional relationships. It’s about investigating what is behind positions that may seem irrational at first to understand the problem behind the problem.”

Negotiating is building upon relationships and developing trust with colleagues as well as patients.  see article here:

The sooner medical faculty learn the importance of building that trust within the structure of health care the faster medical students will learn the art of negotiation.

Doctors Enlist Paintings to Hone Skills

Most of us who do any investigation into medicine now realize that medicine is not a science; there are too many unknowns, too many questions, too many rare diseases, that haven’t been researched and written about.  So why not use all the tools available to become more adept at finding the answers to medical mysteries? And maybe using art to hone diagnostic skills is not a bad idea.  According to an article in the Wall Street Journal called, Doctors Enlist Paintings to Hone Skills, “More physicians are offering a different perspective on paintings by ‘diagnosing pieces of art.” (see article here)Raphael The School of Athens

Doctor, Shut Up and Listen

Mouth ShutFunny title but not so funny if you are sitting in your doctor’s office and he/she isn’t listening to you!  Apparently this happens more often than not; doctors interrupt patients every “18 seconds”, often they don’t let their patients know what their final diagnosis is before they leave the hospital, and often they are rude, when they are in a hurry.  We all know that there are huge restrictions on doctors these days: insurance companies, CEOs, etc.. but that doesn’t preclude being compassionate and opening one’s eyes and ears when sitting in front of a patient.  (see article here)

Clearing the Lens, by Mallory Raymond

Mallory Raymond, a fourth year medical student, at the University of Miami, has been an active participant in our Fine Art of Healthcare workshops.  She wrote a great piece in the most current issue of Academic Medicine, “Part of what went wrong was a system’s failure—a long wait, an exhausted resident—but part lies deeper, resting on the roles of health care providers as humans, communicators, relators, and reflectors. Although we may notalways pay attention to the subtleties of language and emotion, the gravity of what medicine stands for should hold us to higher standards, for the sake ofour patient’s safety, comfort, and health.
Medicine demands that we not only understand and apply science to our treatments but also teach and care for our patients, through a deeper understanding of their socioeconomic status, culture, and capabilities. Medicine demands that we pay attention, analyze, and observe.”

see article here