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Bub, Barry MD

Medicine and the Arts

Dr. Bub is president, Advanced Physician Awareness Training, and resides in Philadelphia, Pennsylvania.

Art is about freedom, and control—you need both. Sometimes doing art is like making love—yet it’s also like doing surgery.

— September Heart, artist, personal communication from 2005.

The seemingly innocuous phrase “art and science of medicine” contains within it a deep fissure that divides what should be a seamless whole of medical practice into two disparate elements—evidence-based “science” and relationship-centered “art.” There is little evidence to substantiate such a division, since beautifully executed science is aesthetically pleasing and great art requires technical mastery.

The artist David Lenz demonstrates such skill in his work titled Sam and the Perfect World. The piece is not only aesthetically compelling, but it challenges societal values related to the issue of perfection.

The viewer cannot help but focus on the gigantic circle in the sky, but only momentarily, since the little boy with his puzzled expression captivates the eye as well. One’s attention then shifts to the vanishing point in the center of the horizon, equidistant from both the circle and the boy.

This is not accidental. The artist has carefully positioned his subjects using the artist’s rule of thirds to the composition; both the circle and the boy are located approximately one third from the edge of the painting. The boy’s head almost intersects the point of the one third horizontal and vertical axes, with a slight compensation to the right for balance. The boy leans forward and the fence leans backwards, making the scene appear distorted as if seen through the fish eye of a wide-angled lens. His direct gaze is disconcerting. Why is he alone? What is he thinking? His stance is puzzling, too. Is he the subject or the host?

More questions follow. Is the sphere a halo? Is the shape intended to evoke an image, perhaps an expanding sun or an ovum? It is interesting to note that both sun and ovum yield life.

Against the backdrop of this gigantic, powerful orb, stands this little boy, his forehead barely rising above the horizon. This painting is in fact a portrait of Sam, the artist’s son. Sam has Down syndrome.

Sam and the Perfect World won the first prize in the National Portrait Gallery’s 2006 Outwin Boochever Portrait Competition. The artist’s written statement from the Outwin Boochever Portrait Competition illuminates the painting’s narrative:

My wife Rosemarie had just given birth to our son Sam, and although he appeared perfectly healthy, something, nevertheless, didn’t seem right. There was an awkward silence in the room, no words of congratulation or comments about how cute he was—even though he was cute. Five minutes later the diagnosis was given: Sam has Down syndrome. “Are you going to keep him?” a nurse asked. Later that evening someone else came by to “console” us. “It’s every mother’s worst nightmare,” she said.

Welcome to the world, Sam.1

So this is a painting of a son and a sun. The son is inviting us into his world, one dominated by the sun. There is an unmistakable relationship between the two. What might it be?

To many ancient civilizations, such as the Mayans and the Egyptians, human destiny is tightly intertwined with the sun. The sun’s shape is circular and as Michael Schneider in his book A Beginner’s Guide to Constructing the Universe 2 points out: “… the circle has been a universal symbol of an ideal perfection and divine state that always exists around and within us.” So, Lenz not surprisingly uses the symbol of the circle to represent divine perfection:

In America today, perfection is highly valued. We dump loads of chemicals on our lawns to try and get rid of every weed, every dandelion. Models and supermodels are tall, impossibly fit, their clothes stylish and wrinkle-free. Images like this tend to change our perceptions, our ideals, until finally they leave us looking around at the peeling paint on our own houses, and our less than fit bodies, and it leaves us wanting.

Perfection, I would submit, is overrated. and besides, I like dandelions.1

In Lenz’s piece, weeds hug the fencepost that look out on his perfect world of rolling hills and quiet farmland, a Garden of Eden dominated by a divine light. Lenz explains, “In the painting, Sam assumes the role of presenter, host, even tutor, of this most revealing examination of the civilization man has made for himself.” Sam, the imperfect, introduces us to the world of perfection. Lenz continues, “Sam is not society’s accepted definition of perfection. In spite of that, or perhaps because of that, he really does have an important message for everyone to hear.”

For physicians, one take-home message relates to holism. The artist has integrated emotion and intellect, talent and technique to create a piece of work that is not Sam-focused, orb-focused, nor landscape-focused; rather, each exists in relationship to the others with the whole being greater than the sum of its parts. Likewise, the practice of medicine, which has, among other things, been described as disease-, patient-, or physician-centered, can in reality only be relationship-centered. Holism embraces perfection and imperfection, health and pathology.

The method in which facts are instilled in medical students and physicians allows Sam to become disposable, an “it” and a “nightmare” (imperfection); while we, as physicians, hide our flaws and vulnerabilities behind crisp, white coats—the very models of perfection. Holistic practice requires that we embrace our imperfection and acknowledge our humanity.

Barry Bub, MD

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1 Lenz D. Artist’s Statement, from the National Portrait Gallery’s 2006 Outwin Boochever Portrait Competition. Available at: ( Accessed October 20, 2006.
2 Schneider M. A Beginner’s Guide to Constructing the Universe: The Mathematical Archetypes of Nature, Art, and Science. New York, NY: Harper Perennial; 1994.
© 2007 Association of American Medical Colleges