I stand with 10 classmates before a Bellini painting at the Frick Collection—St. Francis in the desert. I know nothing about this painting, not even the title or the artist. In fact, I know practically nothing about most paintings, having never learned much art history despite my long study of dance and music. The Frick class is required for my second-year medical school curriculum at Columbia; this is the first session. So far, we have been asked to stand for five minutes and look. I do not particularly like the chosen painting. It is not interesting to me. Gorgeous portraits surround us, including two by Titian (even I have heard of him); I wish we were looking at them instead. But this is the one we are asked to examine. I look.
A man stands in the lower center foreground, facing left. He is surrounded by nature—strange rock formations, plants, animals—with a trellis behind him. An odd light shines on him and on the rocks; his arms are outstretched in a welcoming gesture, but he wears a stricken expression, and his eyes roll upward as if in pain. In the distance is a city on a hill, fields, a river. There is a small drainpipe in the lower left corner; my eye keeps returning to it, bright against dark. I do not understand the painting; it makes no sense. Five minutes pass, and no one speaks.
Now the teacher invites us to comment on what we see. Tentatively, students offer their observations. “I wonder about the bell in the upper right,” someone says. I hadn't noticed the bell! “He must have had help constructing that entryway,” observes another. I see this now too—the cave is not a natural rock formation, but a human construction. Someone else remarks on the drainpipe, and I realize I was not the only one who found it peculiar.
Our teacher does not provide much explanation. She accepts each observation, repeating what each student says, sometimes offering a piece of background information. We continue to discuss the painting, and the longer I look, the more I see. She asks us to move to a different place in the room; I am surprised by what I notice from this new perspective. Eventually, we begin to venture guesses at the meaning of the painting, but we reach no consensus. An hour has passed, and I feel I could spend another. I am now not just interested in this painting; I actually care about it. I would like to return to it. I find myself thinking about it at home. St. Francis appears in my dreams.
The lessons of this museum experience readily apply to the practice of medicine—the necessity of “slow looking,” as our teacher termed it, the length of time necessary to notice details and begin to form a coherent impression of a patient; the importance of changing one's perspective, of discussion with colleagues, of restraining the initial impulse to talk or interrupt, instead reserving judgment and carefully observing for a few minutes.
But my experience at the Frick went beyond sharpening my observational skills. I found myself caring for this painting, this strange work of art that I had initially found not even interesting, let alone attractive. Something about that group experience brought me from a mild dislike—at best, a neutral boredom—to a deep level of attachment to the work. While I still don't love the painting, I feel connected to it. It is part of me now.
What about the experience brought me to this level of attachment? It was not only the time I spent with it, although this was certainly essential (what medicine terms “necessary but not sufficient”). What changed me from impartial—or negatively biased—observer to profoundly engaged participant in this work of art? The transformative experience was our group dialogue, facilitated as it was, in a nonjudgmental, accepting way, by a leader who reflected our statements and occasionally offered new information.
This is not how medicine is generally taught. As medical students, whether preclinical or on the wards, we live in fear, afraid to make a mistake, to forget a fact, to appear stupid in front of peers or superiors, or even to cause harm to patients through our ignorance. This fear can silence us during case discussions in the classroom or on rounds. It does not end with graduation; the rigid hierarchy of medical training means that the underlying fear persists, albeit at a more subtle level, as the physician-in-training advances up the ranks. Even outside the confines of academia, the fear of malpractice suits haunts every physician, and is essentially the same—fear of being wrong.
Maybe medicine cannot be taught the way our sessions at the Frick were conducted. After all, a patient is not a painting; we students cannot stand around poking and prodding for an hour while an attending preceptor benignly reflects our observations. But I wonder if some elements of “slow looking” and creative discussion could be brought to the wards, supplementing traditional Socratic-style methods that may degenerate to the infamous “pimping” of students by attendings. Would we lose that crushing fear of our own ignorance? Would we engage more deeply with each new case?
My reason points out that time constraints in medical training make this kind of learning far too inefficient. My heart argues that we cannot afford to ignore the lessons learned at the museum. If we neglect our creative learning process, we retreat, both from our patients and our own humanity.
The benefits of the “museum approach” might reach far. Each patient, however boring, unattractive, or confusing, deserves the concentrated attention I gave to the Bellini painting. But no physician, let alone medical student, can achieve this level of humanistic patient care without exposing some human fallibility. Only when we are free to reveal our ignorance can we truly begin to care for our patients.
The Arnold P. Gold Foundation Humanism in Medicine Essay Contest
The Arnold P. Gold Foundation is a not-for-profit organization founded in 1988 to nurture and sustain the time-honored tradition of the compassionate physician. Today, students, residents, and faculty participate in at least one Gold Foundation program at over 93% of our nation's medical schools and at schools abroad. Its programs and projects are derived from the beliefs that compassion and respect are essential to the practice of medicine and enhance the healing process; the habits of humanistic care can and should be taught; and medical role-model and mentor practitioners who embody humanistic values deserve support and recognition.
In 1999, the Gold Foundation instituted the annual Humanism in Medicine Essay Contest as a way to encourage medical students to reflect on their experiences in writing. Since the contest's beginning, the foundation has received close to 2,000 essays from students at more than 125 schools of allopathic and osteopathic medicine.
Contestants for the 2010 Humanism in Medicine Essay Contest were asked to address the following prompt: “Describe a barrier a physician might face to practicing humanistic patient care. How might this be overcome and what can be learned in the process?” Winning essays and honorable mentions were selected by a distinguished panel of judges. For the ninth year in a row, Academic Medicine is pleased to publish the winning essays from the contest.
Winning essays are also published on the Gold Foundation's Web site: www.humanism-in-medicine.org, and in the foundation's DOC newsletter. For further information, please call The Arnold P. Gold Foundation at (201) 567-7999 or e-mail: [email protected].