Teaching the Art and Science of Medical Decision Making Using Art, Literature and Clinical Vignettes Bill Lydiatt, MD Kirk Vaughn-Robinson, Sculptor.
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Transcript Teaching the Art and Science of Medical Decision Making Using Art, Literature and Clinical Vignettes Bill Lydiatt, MD Kirk Vaughn-Robinson, Sculptor.
Teaching the Art and Science of
Medical Decision Making Using
Art, Literature and Clinical
Vignettes
Bill Lydiatt, MD
Kirk Vaughn-Robinson, Sculptor
OUTLINE
Evolution of Medicine
Teaching Difficult Topics
Rational for Visual Art, Literature, Poetry
Teaching Observational Skills
Sculpting with Kirk
Question time
External Disease Concept
Evil spirits -Religious and
superstition based
An imbalance in humors
Observation based
Historical Evolution of
Medicine
Disease of parts
Diseased organ -anatomy based-16th and
17th Century
Diseased cell -microscopically based-19th
Century
Fifth as genetic or epigenetic abnormalities
or insults –lab and technology test-based20th Century
Technology became the hero
Disease Oriented Medicine
Led to disease oriented treatment approaches
Success was defined as diagnosing and curing a
specific abnormal cell or organ
Very effective approach to many types of illnesses,
particularly acute infectious diseases
Knowledge Based Practioners became king
Knowledge
General knowledge in science deals with
populations and statistics
75% chance of successful treatment of
disease works great for population health
Knowledge or more accurately information is
now readily available but…
The patient is either a 0 or 100
Specific knowledge of the patient is more of
an art
BUT it is a
person that has
the diseased cell
or organ
“they hate
cancer more
than they like
people”
Science and Humanistic Concepts
21st Century
Alleviation of suffering
When to treat and when not to
How to balance risks and benefits of treatments and
clinical testing
Suffering
May come from
physical aliments
psychic aliments
disease and its treatment
Hard for individual to predict what will be the major
cause of their suffering
Harder still for caregivers to predict and anticipate
Suffering occurs most often when the aliment threatens
the future or their perception of the future for that
individual
Suffering involves an
assault on personhood
Some aspect of personhood is at risk
Future or current loss of an aspect of the self
Only the person can define whether and how much
they are suffering
Therefore alleviation of suffering is value laden,
complex and nuanced
Health Care Values
Science
Medicine
Value free
Value laden
Based on careful observation
Based on observation
Generalized knowledge
Specific knowledge about the
about diseases
Technology aids
Looking for facts
patient’s disease and the
context of that disease
Technology distances
Looking for relief of suffering
Providers of the Future
Knowledge is important
Psychology is important
Observational skills are important
Values are important
So How Do We Teach This?
Knowledge needs context
Knowledge needs nuance
Knowledge needs perspective
Saving Faces
Ian Hutchison,
Maxillofacial Surgeon
in London
Saving Faces toured
Europe and North
America
Mark became an
artist in residence at
UNMC and now
earned a PhD
Graphic Image
Ahead!
Extended Maxillectomy
Virginia Aita, PhD
Initiated the Saving Faces Exhibition in Omaha
Secured Funding to provide Mark Gilbert with a
residency
Headed the advisory board
Directed qualitative research efforts
Lessons Learned from
Saving Faces and Portraits of
Care
Art and medicine are linked intellectually and emotionally
Viewers react to the art in a variety of ways
Shared viewing and reflecting elicits compassion, leads
to appreciation of paradoxical nature of vulnerability,
strength, dignity
Mark taught the importance of
observation to the high school
alliance class
High School Alliance Facts
196 students graduated from 22 high schools in 11
school districts
35.1% Free and Reduced Lunch
96% of graduates are attending college and 78% are in
STEM related fields
Anna on MG
During the activity, I would say I felt a plethora of
emotions. Mr. Gilbert mentioned feeling vulnerable
while working on his drawings, and I could definitely
relate in that sense. I think I felt vulnerable because the
drawing's ultimate appearance was out of my control,
especially when I was instructed not to lift the charcoal
from the page. … I also experienced feelings of
excitement because of my lack of control and the
surprises in the drawings that surfaced.
Other Avenues?
Pictorial Art
Surgical Training
Literature
Poetry
Teaching observational skills
Sculpture
Ellie’s Choice
“Jungle Fish” by Stuart Moskowitz
Ellie on Visual Art Project
I feel hopeful because it is placed in a place where
health professionals such as doctors and nurses are
doing their best to make sad, sick kids well again. Even
though there is quite a bit of sadness on this floor there
is also a large amount of hope and trust, which is
shown by this artwork.
Mark Gilbert’s Rendition of
Mandibular Resection
Literature
Death of Ivan Illyich Leo Tolstoy
Complications Atul Gawande
Ward #6
Ted Kooser
Winner of more than 24
prizes for poetry and writing
11 full length poetry
collections
2 nonfiction works
Pulitzer Prize for Delights
and Shadows
13th Poet Laureate of the
United States
Melissa on TK
One of the most interesting things I learned was that he
said that once we read the poems and we interpret
them a certain way that poem is no longer his it is ours.
Hearing that surprised me because I thought he would
tell us exactly what he meant in each poem.
Observational Skills
Study Overview
Bill Lydiatt, M.D.
Virginia Aita, Ph.D.
William Roccafort, M.D.
Mark Gilbert
Ted Kooser
Special Agents Dan Clegg and Jonathan Robitaille
Teaching: Providing Future
Providers
Resident Education
Surgical Techs Training
Nursing
Medical Students
Dental Residents
Why Is Observation
Important?
Physical diagnosis is dependent upon it
Not limited to one sense for example head and
neck cancer may cause abnormalities in:
How the head is held - vision
Odor of the breath - smell
Pattern of articulation - hearing
Consistency of a mass – touch
OK, usually not taste since the days when urine was
tested for diabetes
Often patients will not volunteer information and
the ability to see visual clues can lead to an
opening in the conversation
Arthur Conan Doyle, M.D.
Watson “When I hear you give your reasons, the
thing always appears to me to be so ridiculously
simple that I could easily do it myself, though at
each successive instance of your reasoning I am
baffled until you explain your process. And yet I
believe that my eyes are as good as yours..”
Holmes “You see, but you do not observe. The
distinction is clear. For example, you have
frequently seen the steps which lead up from the
hall to this room…”
A Scandal in Bohemia, The Adventures of Sherlock Holmes
Can Observational Skills
Be Taught?
Experiential evidence suggests that senior clinicians
may be better observers
Balance between looking to confirm what is expected
and what is actually there
Dolev, et al reported using art as a means of improving
observational skills in first year students JAMA 2001,
186: 1020-1.
How Many Horses Do You See?
Teaching Observational Skills
Gallery discussions of Mr. Gilbert’s ability to observe
Speculated student’s might benefit from his techniques
Knew Mr. Kooser was a keen observer and also a
Professor of English
Developed a pilot series of seminars in consultation
with Mr. Kooser and Mr. Gilbert
Methods
3 seminars with lecture and participation plus keep a journal
of observations and thoughts on how observation is used in
practice
Session 1
Introduction to drawing and observation by Mark Gilbert
Defuse fear of being a poor artist
Teach a few techniques
Session 2
Introduction to observation by Ted Kooser
Describe a pepper
Spoke of his experiences reading medical reports
Session 3
Drawing a patient simulator
First Drawing
Left handed and standing up
Not looking at paper
Final drawing
Journal entry
Results- Subjects
10 M3 students
10 Otolaryngology-Head and Neck Surgery residents
Results
Evaluations
Generally felt helpful and enjoyed the class
Participants most surprised that observation not as keen
as they thought-best demonstrated by inability to draw
from looking
Journals
Kept the concept of observation at the forefront of the
students’ mind
How Many Faces Can You See?
Kirk Vaughn-Robinson
THANK YOU