What does it mean to really see a patient?
This question drives the work of ArtsPractica, a medical education consultancy dedicated to improving the skills of diagnosis with arts learning. I have explored this question in collaboration with expert diagnosticians and in the arts.
Seeing is about longitudinal skill development, multiple perspectives, suspending judgement, and metacognition. It is more than just “visual skills,” and has little to do with perfect vision. In my opinion, many medical errors are a question of seeing or not seeing.
“Seeing patients” is central to medical practice, but it’s an out secret that medical training lacks a consistent model for learning to look. In fact, systemic pressures often justify skipping adequate patient inspection. Too often, treatments and tests take precedent overseeing the problem in the first place—and this is where medicine risks failing on its first promise, to “do no harm.”
SEEING TO LEARN ABOUT ART, PATIENTS, AND COGNITION
ArtsPractica is based on the concept that careful study of art can support the development of skills in diagnostic acumen and in communication. This work stems from a decade of collaboration with Harvard physician-educators on the “Training the Eye” program, an arts-based course that produced published outcomes.
Our research found that learning to view detail in art translates to better skills in observation. Students who participated in seven or more arts-based sessions, for example, made 38% more observations in response to both clinical and art imagery than their peers. They further provided evidence for their interpretations significantly more frequently.
Our qualitative study further showed changes in language. Arts concepts like “contour” or “shading” appeared in students’ clinical descriptions after taking ”Training the Eye,” producing more robust and precise clinical communication. Other studies in medical humanities and arts learning indicate arts interventions link with increases in clinically-relevant abilities, such as critical thinking and tolerance of ambiguity.
Learning to look in art helps practitioners notice their biases, see what others see, discover that what we see is sometimes different from what we want or hope to see, and experience how discussing the vast differences in individual processing are an asset to seeing the whole picture.
CULTIVATING AN ENVIRONMENT WHERE IT’S “SAFE TO ASK”
Let’s face it: medicine is vulnerable to certain pressures—an ethos of certainty, hierarchical inhibitors to communication—which present safety issues. Students and practitioners alike often feel pressure to know everything. Arts experiences are one place where authentic uncertainty is a positive thing, and where effective habits for contending with it can be cultivated.
In art-viewing, colleagues work together to get at truth in ambiguity, as they might in teams on the wards, although the conditions are quite different from those of the clinic. Stakes are low. No one is the expert. Everyone’s perspective is uniquely helpful. It is far easier in this context to cross the boundaries to seeking second opinions. It’s easier to cultivate curiosity about what others have to say, easier to stay a place of not-knowing, easier to inquire, and easier to turn inquiry into action. It is in this way that ArtsPractica aims to help contribute to larger discussions about seeking second opinions.
People look differently at the things that we understand and the things we do not yet understand. In art, we can play with this difference, develop skills, and learn a lot about how we see. It is only in looking together that we can cultivate fresh eyes and see anew.
This post originally appeared on Clinical Curbside, blog of BestDoctors.
Given BestDoctors’ commitment to diagnostic accuracy, I was excited for the opportunity to talk with them about our common cause. Here’s my videochat with Kelli Cleary of BestDoctors:
http://youtu.be/gUDpKtPpYrQ
