The arts improve medical care through learned observation

The visual and narrative arts can help physicians hone their observational skills—a critical expertise increasingly needed in today's medicine, contends a Georgetown University Medical Center family medicine professor.

Published online "ahead-of-print" July 8 in Academic Medicine, Caroline Wellbery, MD, PhD, explains how "arts observation" can have positive impacts on physicians and patients, and should be incorporated in both medical school training and clinical practice.

A medical school program that emphasizes "intense and mindful observation" can work to correct efficiencies in clinical practice that "paradoxically decrease face-to-face interactions with patients," says Wellbery, who teaches Georgetown medical students the value of viewing art and reading narrative texts.

For example, she says, a 2012 study shows that medical interns and residents spend only 12 percent of their training in direct contact with patients, due in part to an increasing reliance on electronic devices for care guidance that can take time while at the same time depersonalizes patients.

Reduced focus on the bedside exam can potentially result in delayed or missed diagnoses, Wellbery says. "Keen observational skills could help a physician, for example, notice lesions on fingers that suggest rheumatoid arthritis, facial expressions that could be linked to depression—observation is aimed at simply understanding the gestalt of the patient, how to put into context what is perceived in the patient encounter."

Because arts-based teaching tools and visual thinking strategies enhance needed clinical observation skills, many medical schools and residency programs have developed formal offerings in this area, Wellbery says, often in collaboration with local art museums.

But many only emphasize one aspect of the arts, such as reading, while ignoring others, such as the viewing of art pieces, she says. "This article helps theorize how the arts in general can hone the art of observation," Wellbery says.

"Close observation is an accepted, even essential, scientific habit that is easily understood within the medical culture, and engaging in the arts specifically as a means of honing skills delivers these humanistic offerings," she says.

Examples of the relationship between medical care and the arts, according to the analysis:

• Nature writing: "A natural setting which, to the uninitiated, may first appear to be an inert scene will, on closer examination, reveal an overwhelming flurry of activity involving a host of miniscule players."
• Poetry: "Poetic precision provides an educational bridge to recognizing the importance of detail in the clinical realm, where exactness is critical to providing safe, high-quality medical care."
• Short narratives: "For teaching purposes, short writings lend themselves to fruitful analysis, an interpretive process often described as analogous to interpreting patients' experiences."
• The built environment: "Architectural and interior design offer opportunities for noticing, opportunities that also promote awareness of a host of environmental and cultural disturbances; for hospitalized patients, these disturbances include the nighttime interruptions, the ubiquitous alarms, the repeated blood draws, the repetitive questions, the standard-issue gowns, and the rounding teams towering over their beds."