What is the Fine Art of Health Care?

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.

 

Overkill, by Atul Gawande

tortoise and hareSo 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.

How the University of Miami Trains Future Doctors

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=

Giving Doctors Grades, NYT’s, Sandeep Jauhar

gradesIs 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.

Living with Cancer: curses and blessings by Susan Gubar

Hollis Sigler

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

When Doctors Don’t Talk to Doctors

Native American-Indian-Medicine man

“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)

Documenting my Patients’ Next of Kin, by Danielle Ofri

Memorial Table
Doctors Documenting My Patients’ Next of Kin By Danielle Ofri, M.D. May 21, 2015 10:06 am May 21, 2015 10:06 am Photo A memorial table for David Michael Greene contained his hat and cowboy boots. A memorial table for David Michael Greene contained his hat and cowboy boots.Credit Danielle Ofri

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).

Read article Documenting my Patients’ Next of Kin

Do No Harm (New Yorker book review, May 18, 2015)

Henry Marsh, NYMThis 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?

(see NYM review Anatomy of Error