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.
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.
“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)
I don’t want this blog to be all about education. I read this piece by Danielle Ofri (author and physician) and was touched. Nobody should have to die alone. It is the responsibility of every health care worker to make sure to try and contact the next of kin (assuming the patient is conscious).
This is a follow-up to the post about Danielle Ofri’s Tedmed talk. The most recent New Yorker Magazine, May 18, 2015, has a book review of Henry Marsh’s Do No Harm. The review spells out the medical errors in Dr. Marsh’s career as a brain surgeon. Although I haven’t read the book I think my takeaway is that although there are many factors which inhibit a physician from discussing his/her medical errors: liability, shame, anger, etc.. there is an imperative to do so. How else can other physicians learn if mistakes are brought into the open?
“Like a stew that’s had hours to simmer, slow medicine hopes to lock in medicine’s best ideas, providing deeper meaning and richer lives to both patients and practitioners. I’m savoring this growing movement, adopting its wise examples in both my teaching and my practice.”
Tedmed talks are somewhat new to me (I have long been a viewer of TED talks). Danielle Ofri’s (author of What Doctors Feel, Medicine in Translation, Incidental Findings, and Singular Intimacies: Becoming a Doctor at Bellevue Hospital) talk, Deconstructing our Perception of Perfection is particularly interesting. She talks about a mistake she made as a Resident. She didn’t read a CT scan on a patient who had a cranial bleed. Fortunately someone else caught it and the patient lived. But Ofri never discussed it for 25 years! And she believes that was a bigger mistake. Her belief is that both doctors and patients need to understand that mistakes in medicine happen. And the only way to learn is to talk about mistakes. Just like anyone doctors need to understand that mistakes can only be prevented if they are understood. But not like anyone doctors also recognize that mistakes can mean life or death.
The article, The Art of Slowing Down in a Museum hits on a basic malaise of our society: the need for instant gratification, the want to have 15 minutes of fame by sharing selfies, and the overabundance of distraction. Museum goers have long felt the anxt of not-being-able-to-see-everything in one visit. A psychologist, Dr. Haizlip and clinical professor at the School of Nursing and the Division of Pediatric Critical Care at the University of Virginia, was taken to the Barnes collection, while studying at University of Pennsylvania. She was “skeptical” about taking time to look at one work of art. But it turned out that that experience led her in a completely different career direction.
“I was trying to figure out why she had such a severe look on her face,” said Dr. Haizlip. As the minutes passed, Dr. Haizlip found herself mentally writing the woman’s story, imagining that she felt trapped and unhappy — yet determined. Over her shoulder, Toulouse-Lautrec had painted a window. “There’s an escape,” Dr. Haizlip thought. “You just have to turn around and see it.”
“I was actually projecting a lot of me and what was going on in my life at that moment into that painting,” she continued. “It ended up being a moment of self-discovery.” Trained as a pediatric intensive-care specialist, Dr. Haizlip was looking for some kind of change but wasn’t sure what. Three months after her encounter with the painting, she changed her practice, accepting a teaching position at the University of Virginia’s School of Nursing, where she is now using positive psychology in health care teams. “There really was a window behind me that I don’t know I would have seen,” she said, “had I not started looking at things differently.”
In the NYT’s Well blog dated April 30, 2015, Dhruv Khullar makes the case for more interdisciplinary education while students are in graduate programs. Students are not practicing medicine alone when they are in the clinics so why not include more exercises for students in healthcare that include all disciplines? “Data evaluating whether interprofessional training improves teamwork, communication and leadership is still preliminary, but promising. A study of over 600 medical, nursing, physiotherapy and occupational therapy students enrolled in an interprofessional training course found that all student groups gained knowledge of other professions’ work, but also developed a deeper understanding of their own professional role. Other research suggests that joint clinical simulation and facilitated debriefing sessions can improve confidence by providing collaborative care for a rapidly deteriorating patient and enhance communication by increasing providers’ ability to identify various professional roles, “close the loop on patient care,” and correct others in a constructive manner. Similar results have been found for medical and nurse anesthetist students in operating room simulations.” (Doctors and Nurses, Not Learning Together)