Saturday, June 13, 2009

Making an artful diagnosis


Art and science are often considered opposites. Science islogical, systematic. Art is free-flowing, inexact. Even Frenchcubist Georges Braque believed that art was meant to disturb andscience to reassure. He may never have imagined a classroomwhere art would be used to teach science.
That's what is happening at a handful of universities around thecountry, including the University of North Texas Health ScienceCenter in Fort Worth.

First-year medical students are learningdiagnostic skills by observing the details in paintings andphotographs as a part of a newly required class, "An Eye forDetail: The Art of Observation, " being presented with the AmonCarter Museum in Fort Worth.

"There is an art to science and science to art, " explains NoraChristie, tour program manager at the museum. "One of the quotes Ilive by is 'Science gives us how to live and art gives us thereason to live.'"

The paintings, the photographs, the portraits become surrogatepatients. Students are given four minutes to observe the physicalclues within the artwork and then write their patient profiles.What is their socioeconomic level? How is their health? How old arethey? How are they emotionally?

"It teaches medical students how much information can be gatheredjust by observing, " says Dr. Bruce Dubin, associate dean of medicaleducation at the University of North Texas' College of OsteopathicMedicine. "The tendency for doctors is to look narrowly at thesymptoms rather than at the broader person. Art educators bring outthe ability to look at things more subtly."

A good physician needs to look for physical clues to diagnose apatient, says Dr. Dubin. For example, "the shape of fingers canpoint to lung problems. Rashes can be indications of gastricproblems. An asthma patient will tend to lean forward, raise hisshoulders and have dark circles. His speech patterns tend to beshort and episodic rather than flowing."

This program, which is based on a collaboration between the FrickCollection and the Weill-Cornell Medical College in New York, wasdeveloped in 2001 and offered to first- and second-year medical students on a volunteer basis. This year, UNT made it arequirement.

Ninety percent of the information a doctor needs to make adiagnosis comes from a patient's nonverbal and verbal cues, saysFred Puckett, a third-year medical student. "Having art as a patient is a creative way to teach, and it allows us to be able to bounce ideas off of each other. With a live person you can't openly discuss the patient without affecting the patient's emotions. The art allows you to explore and discuss topics you would otherwise avoid."

One of the paintings used in the class is John Singer Sargent's1888 painting of the 12- to 13-year-old Alice Vanderbilt Shepard, the great-granddaughter of Cornelius Vanderbilt. She's wearing aflowing white shirt and a military-style black jacket with ornateivory-colored buttons. She has a sad, far-off gaze. A pillow propsher up.

Ms. Christie says: "The pillow is an indication that her back maybe hurting her and, in fact, it is. This is a subject we know a lot about. Her mother allowed the portrait to be done if the artist could do it quickly. Her daughter had hurt her back falling out of a tree or off a ladder, and she couldn't sit for long in one place.The clues are in the painting."

In Eliot Porter's photograph Patrick, a young boy from the 1950s is in overalls holding a chicken. He's barefoot and has a stiffcollar.

"His eyes are puffy and he seems to be breathing through his mouth, which may indicate allergy problems." says Ms. Christie. "We don't know a lot about this boy. It's up to the students to figure it out."

Leslie Houston, a third-year medical student, opted to take the course even though it wasn't required for her. "It taught me to observe the details."

An applicable scenario, she says, might play out in real life something like this: A successful businessman walks into a doctor's office. Usually he's well put together. On this day he says he's fine, but his hair isn't combed and his shirt is wrinkled. "These are indications that something may be wrong, " says Ms. Houston.

"This class totally removed the stress of medical school and helped hone my observational skills in a playful way. It's an extra tool for a physician to use. It's a holistic approach - mind, body, spirit."

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