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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.

 

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

With Electronic Medical Records Doctors Read, When they Should Talk, by Abigail Zuger, M.D.

Technology can be a very very useful tool but it can also be a distraction, especially in the world of medicine.  Electronic Medical Records (EMR) are the way of the future. But can EMRs replace the old-fashioned taking of a patient’s history?  I think not!  The NYT’s had a article in the Health section called, With Electronic Medical Records Doctors Read, When they Should Talk. (read article here)

There is something to be said for a doctor sitting down with a patient and asking and re-asking, if necessary, about the patient’s history.  In my opinion there is no replacing that direct contact and communication with the patient.  EMR’s can only do so much but they cannot replace the relationship that needs cultivation between doctors/nurses and their patients. Man wearing mask

Communication is key!

 

 

jordi on motorcycleSo my husband went into the hospital on September 26 for a blocked colon; painful, but not serious, and he was released on Tuesday, October 1st.  He told the docs that he was “good”.  But the next night we were back in the ER because he was vomiting and miserable.  So they gave him some painkillers, did an x-ray, and he was feeling no pain.  So they let him go.  We were back 24 hours later; again with vomiting, nausea, and this time they did a CT scan and “discovered” the block had grown.  On Friday, October 3 they did surgery to remove the blockage.  He felt better when they inserted the tube to remove a lot of bile that had collected.  And in spite of the surgery he was feeling a lot better.  On Tuesday, October 7th they did an x-ray and a ct scan and discovered he had pneumonia.  So now he has pain from the surgery and on top of it a hard time breathing.  On my way to the hospital the doctor calls and said, “there is a mass on his lung”.  I asked, “is it cancer?” Doctor: “we can’t rule that out”.  So here we are.  A pulmonologist was called in and he asked a lot of questions and listened to my husband’s lungs.  He concurred that there was fluid in his lungs.  However, he told us “no procedures until my husband is better”.  When I spoke to his infectious disease doctor, the next day, he said, “I don’t think it’s a tumor because it is large and it just appeared. But we can’t do anything until he’s better.”

So here we are in limbo-land, again, and we will wait, and hope that it isn’t a tumor and that it was a “mass” or “shadow” that was because of his pneumonia.  But the back and forth and not knowing is the most difficult part of it all!