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.
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)
“The transition of a medical students or a nursing student into a health care practitioner requires many changes. Among these is the development of an appropriate professional identity, which assists in the establishment of a sound base for professional practice and therefore should be a focus for health care professions educators.” What this means is that the introduction of other modalities, focusing on patient-centered practice, is essential in the successful collaboration in the clinic. Professional identities are formed in the educational years leading up to professional practice. Habits of mind are set. How nurses relate to their patients and other health care professionals can make the difference in successful outcomes for their patients. Nurses who are confident in their roles are less likely to quit their jobs. And doctor/nurse relationships benefit their patients and health care teams. (Read article in Academic Medicine. 2015;90:00-00 doi: 10.1097/ACM.0000000000000714, Academic Medicine, Vol. 90, No. 6/June 2015.
My 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: )
No need to describe this TED talk video except to say that metaphors aren’t not the only way to communicate with a patient. Dance, art, poetry writing, story telling can be very effective tools to ensure a patient’s trust. You can see the video here .