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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.

 

The Physical Exam as Refuge by Danielle Ofri

Physical exam

‘Have a Medical Examination: keep sickness away

That’s it put down the computer and your cell phone and spend 15 quality minutes looking at and listening to your patient.  In the Well blog of the NYT’s a piece was written by Danielle Ofri that points out what a physician can learn by touching the patient.  Maybe the term touching has a deeper meaning?  (Read article here)

Removing the “me” from “MD”

workshop 085

One of our FAOH facilitators

Anyone who practices medicine understands the pitfalls of communication (or lack of).  In the JAMA article dated November 13, 2013 (see here) a medical student states that, “Interprofessional communication can be challenging, and medical students should thus learn it throughout medical school. As medicine moves toward team-based models of care, more meaningful interprofessional education consisting of shared patient interactions is necessary.”

Working in a museum and running a series of inter-professional workshops for graduate students in: nursing, medicine, physical therapy and psychology the importance of listening to and respecting one another and their opinions is highlighted.  Students must take turns practicing facilitating discussions about works of art.  Students from all disciplines come at the discussion with similar background knowledge and experience in looking at art. So the playing field is leveled.

Toward the clinical humanities: How literature and the arts can help shape humanism and professionalism in medical education

Save the Humanities-From Themselves

Save the Humanities-From Themselves, by Michael Todd

 

There really is no need to continue trying to make a case for insertion of humanities into medical education after reading the blog of the Arnold P. Gold Foundation titled:  Medical Humanities:  How Literature and the arts can help shape humanism and professionalism in medical education, by Johanna Shapiro, PhD (see article:)

The qualities which make health care practitioners successful; compassion and empathy, are always evolving, and humanities helps this process develop.  Inserting the humanities into medical education also allows ‘space’ for students to reflect upon the reasons for wanting to become part of the complex system that calls itself ‘health care’.

The Process of Care for a Narrative Diagnostic Dilemma

Teaching medical listening through oral histories

The Story of Bhagvadgita, c. 1820-40, From: Bhagvadgitegianu folio 129 verso wellcome Library, London

In trying to sort out how to make connections between what we do and the recent Advanced Workshop, at Columbia University, in Narrative Medicine, I found the document, The Process of Care for a Narrative Diagnostic Dilemma to be very helpful.

Not to put a fine point on it but every patient should be allowed the opportunity to communicate their own narrative about their disease.  And health care workers, in my opinion, need to understand the importance of co-constructed narrative; the ability of health care practitioner and patient, to work inter-dependently on a narrative of a patient’s illness.  It’s the job of a health care worker to be able to interpret, metabolize, analyze and create a story that helps to create a diagnosis and treatment plan.  I believe this requires great skill (editor’s personal perspective here) to “actively listen” and fill in gaps and deal with ambiguities and takes a lot of practice.  So my belief is that Narrative Medicine, as a practice, can be achieved through a number of modalities and looking at, and interpreting works of art, is one way to do it.

See document here

The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School

On Empathy, Marion Wagschal Paints the Figure

The Figure

 

There is no doubt about it people who work in health care MUST have empathy, in order for patient’s to get better.  And without empathy they are merely robots; working day-to-day, on auto-pilot, taking patient’s histories, seeing patients as merely ‘diseases’, and not capturing their stories, that make them human beings.  In the most recent Academic Medicine, volume 84, September 2009, the authors make a case for targeted programs that work towards the maintenance of empathy:

“Profound changes to enhance empathy during medical education should be considered by leaders in medical education as a mandate, not an option, if
the public is to be served in the best possible manner.55 Most of us in medical education advocate empathy, but the effect of simply advocating empathy without embracing it and living with it, and without implementing targeted programs to enhance it, is analogous to
singing a lovely song only in one’s own mind without others ever enjoying it! ”

 

Deep Listening

The Listener, John Williams Waterhouse

The Listener, John Williams Waterhouse

It somewhat ironic that I just returned from attending an Advanced Narrative Medicine workshop, at Columbia University, and this commentary appeared in the most recent Academic Medicine, June 2014, volume 89, p. 950, titled Deep Listening.  The NM workshop was about “Close Reading” and how medical students can/should/must connect to their patients, through their stories.  We read, a lot: poetry, fiction, non-fiction.  We discussed stories and through stories doctors can connect to patients.  “Deep Listening” involves not only active listening, but filling in the gaps of a patient’s story, dealing with ambiguity, and reflection on those patient’s stories.  Read Deep Listening here.

You’re Never Too Old to be Studied

Older person getting brain operated on

The Anatomy Lesson of Joan Deyna, 1656, Rembrandt Harmenszoon Vanrijn

According to a New York Times article most research and clinical trials are done on younger, able-bodied, white men.  This excludes 13% of the population (in 2014 13% of the American population is over 65 and it’s expected to go up to 20% in 2020).  So how do patients, and their physicians,  who need and prescribe medications , know what the side-effects are going to be and what doses should be prescribed?

The good news is the NIH of health has begun to address this problem and are looking at more older patients, women and minorities, to understand this conundrum.  ( See article here: )

When Doctors Treat Patients Like Themselves

cartoon doctors

‘The Doctor will see himself now’

I love studies; especially ones in which there is no conclusive evidence, like the one called When Doctors Treat Patients Like Themselves, written about in the NYTs (see article here)

I know I trust my gynecologist, not because she ‘looks like me’ but because her appointments are scheduled 45 minutes apart and she takes the TIME to talk to me: she always asks me about ‘me’, my kids, my husband.  I go to her for everything (including getting a prescription for an anxiety reliever when my husband had an 8 1/2 hour surgery).  She also works hard to let me know she is “studying the situation”.  This translates to me:  ‘I am a doctor but I’m also human and don’t necessarily know everything.’

Do we want doctors who are like us: the same race, the same sex, the same same?  For a surgery I would want the best ‘han

When Medical Students Make Errors

Steen_Jan-ZZZIt’s hard enough to admit you’re wrong for ‘normal’ mistakes but when it comes to medicine it can be painful, to the ego, to the pocketbook and most importantly to the patient.  According to the Institute of Medicine’s 1999 report more than 98,000 patients die, annually, due to medical errors.  That’s a lot of mistakes.  But research has shown that patients have a better relationship and there is less chance of liability suits if a doctor admits his/her mistake, Research suggests that patients and doctors hold very different views about what exactly should be disclosed and how it should be done. Patients want disclosure of all harmful errors, as well as why the error happened, how its consequences will be mitigated, and how similar errors will be prevented in the future. They define medical error broadly — as deviations from standards of care, adverse events and poor service. After an error, they want emotional support from physicians and an explicit apology.

To follow up there is a wonderful TED talk, http://www.ted.com/talks/brian_goldman_doctors_make_mistakes_can_we_talk_about_that.  It discusses WHY doctors MUST talk about their mistakes.

“Making Strange”: A Role for the Humanities in Medical Education

Dali

Academic Medicine, Vol. 89, No. 7 / July 2014 posits an interesting idea in medical education: the importance of using art to make the ordinary not ordinary, the idea that medical experts get into habits and by using art these habits or biases can reexamined.  Art can be a portal into the bizarre and if physicians  view art as an expression of humanity and all patients have a ‘story’ and there may be a way for physicians to understand a patient’s unfamiliar story.

“The role of the humanities and the ability of the arts to “make strange” does something else in addition to prompting critical inquiry and action. By forcing us to reconsider familiar ideas, situations, and relationships in new and different ways, this process of alienation and enstrangement frees thought and reflection to pursue entirely new avenues of questioning and discovery. It stimulates us to fully appreciate the wonder and mystery that lie at the core of human interactions during times of struggle.”