I 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.
Getting a diagnosis is a matter of life and death and according to the Institute of Medicine doctors misdiagnose one out of ten or twenty times. The good news is the IOM recognizes that fault doesn’t lie solely on physician’s shoulders; error occurs most often because of faulty communication. In an effort to cut down on misdiagnosis more teams are being put into place with more frequency, “Teams can include a single discipline or involve the input from multiple practitioner types including doctors, nurses, pharmacists, physiotherapists, social workers, psychologists and potentially administrative staff. The role these practitioners play will vary between teams and within teams at different times. Roles of individuals on the team are often flexible and opportunistic such as the leadership changing depending on the required expertise or the nurse taking on the patient education role as they are the ones that have the most patient contact. In support of patient-centred care and patient safety, the patient and their carers are increasingly being considered as active members of the health-care team. As well as being important in terms of issues such as shared decision making and informed consent, engaging the patient as a team member can improve the safety and quality of their care as they are a value information source being the only member of the team who is present at all times during their care.” http://www.who.int/patientsafety/education/curriculum/who_mc_topic-4.pdf
Dr. Rosen wrote a book called Vital Conversations: Improving Communication Between Doctors and Patients. The premise is, and I’m paraphrasing here, all roads to misdiagnosis have to do with lapses in communication: doctors weren’t listening to their patients, or peers, patients weren’t listening to their physicians and the list goes on.
Read Danielle Offri’s article Getting the Diagnosis Wrong
This TED talk video is 18 minutes and well worth watching! It’s poignant, timely, and beautifully presented.
What Really Matters at the End of Life?
Jerome Groopman a doctor/professor at Harvard Medical School wrote about Oliver Sacks, in the New Yorker magazine, and I’m interested in the title of the piece: Oliver Sacks, The Doctor. Not quite sure what the meaning is but my interpretation is that maybe we’ve forgotten the meaning of the title, doctor, and the weight it carries? Oliver Sacks seemed to have lived up to that title; he continued to make house calls when everyone else wasn’t. The article states: “Sacks showed that it was possible to overcome this limited perspective. He questioned absolutist categories of normal and abnormal, healthy and debilitated. He did not ignore or romanticize the suffering of the individual. He sought to locate not just the affliction but a core of creative possibility and a reservoir of potential that was untapped in the patient.”
As a doctor he was not only interested in the science of disease and illness he was interested in what made patients tick and believed, I think, that to tap into that was the only way to connect with his patients.
Read article: Oliver Sacks, The Doctor
So there’s something known as “overdiagnosis” (versus misdiagnosis). The conundrum is when does sending someone out for test(s) become too many tests. Atul Gawande discusses in the New Yorker on May 11, 2015, the idea that there are “rabbits” (tumors that can jump out of control) and there are “turtles” (tumors that are too small and isolated and never going to grow into full blown cancer). He even mentions that maybe they should give these kinds of tumors a name other than CANCER. A doctor who makes a diagnosis and says the word “CANCER” loses that patient pretty quickly to the anxiety/fear/terror hole. He also mentions policy changes: insurance companies and lawyers need to change their policies on malpractice suits.
There was a nice article/NPR piece about how the University of Miami “trains future doctors”, by Alexander Gonzalez, an intern and recent graduate from the University of Miami. I think the piece was well researched. However I’m not sure that “training” is the correct term for what we do. I also think that he failed to incorporate what I think is the most important element of our workshops, the Fine Art of Healthcare. And that is the inter-professional component. Students in healthcare rarely have the opportunity to mix before they are launched into the workplace. The FAOH workshops give them an opportunity to come into a beautiful, non-threatening environment. They are able to step back, slow down, and enjoy looking at and discussing works of art in the Lowe Art Museum’s collection. They work collaboratively and collectively to make sense of works of art which have stories but are filled with ambiguity. There isn’t one right answer!!! Again something which they aren’t used to.
Here is the link to the article/NPR piece: https://urldefense.proofpoint.com/v2/url?u=http-3A__www.tinyurl.com_o4o7gmw&d=BQICAg&c=y2w-uYmhgFWijp_IQN0DhA&r=tK0xAJ3G91cX09z6N0ntmvdqW9jIkuTbnthdqBiC2lo&m=0sewr0y5DuPfUIpE7dtOkTXLmQ4ERNBxrFSVNCcnyHY&s=Dl3u4lwKNhwNrc2X1j9xZG4Vpe6zYg_kINJahVA_3W8&e=
Is it fair to give doctors grades? That’s a question that Sandeep Jauhar MD asks the readers in the NYTs op-ed piece, July 22, 2015. It seems to me medicine is incredibly complex; not a science, but a practice. We may all agree that transparency is critical in healthcare. However, complex data needs a filter in order to explain the nuances of the statistics. The problem in healthcare is much of the information is confusing to the layperson due to comorbitities and other variables. Further, medicine is an applied science and not an exact science. What works well with one patient may not work well with another patient. This is a problem in malpractice cases. The Doctor may have followed all the correct avenues in treating a patient but an adverse result occurred anyway. The patient and their family may believe the Doctor did something wrong and an unsophisticated jury may not understand that the medicine was right. The doctor loses a case in which the care was appropriate. We need a better system for handling liability and we need a better system if we want to grade the sophisticated practice of medicine.
The NYT’s op-ed piece, Living with Cancer: Curses and Blessings, really resonates. Living with someone who has had pancreatic cancer for the last five years certainly provides my family with a different perspective on life. And I have seen all of the moods exhibited by my husband of which the author so articulately writes: the anger, the envy, the joy of everyday things, frustration, profound love.
See the article here
“Miscommunication between a patient’s physicians is a major contributor to treatment and diagnostic mistakes. And too often, doctors who care for a patient in the hospital fail to communicate at discharge with the patient’s primary care provider, sowing confusion about what happened in the hospital and the plan moving forward.” New York Times, June 18, 2015
According to Dr. Rosen, who has written a book called Vital Conversations: Improving Communication between Doctors and Patients, communication is the key to successful healthcare and without it mistakes are made and people die.
The article in the NYT’s Health section is a cry for better communication between doctors and other doctors. (see article: http://well.blogs.nytimes.com/2015/06/18/when-doctors-dont-talk-to-doctors/?ref=health&_r=0)