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Medicine and the Arts

Commentary on Beggar Seated on a Bank

McGlynn, Danielle MD; Gunderman, Richard B. MD, PhD

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doi: 10.1097/01.ACM.0000483998.21869.92
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Educating the eye of the physician represents one of the most important objectives in medical education. We must learn to see—not merely to seek out signs of disease through microscopes and CT scanners, but also to recognize the humanity of our patients. Fortunately, some of the most appropriate educational resources, the masterpieces of great artists, lie at our fingertips. By looking at human life through their eyes, physicians can learn to see more deeply.

The work of renowned artist Rembrandt van Rijn (1606–1669) represents a prime example. He was born in Leiden and spent most of his life in Amsterdam. Though he was born into a privileged family and later became quite successful as an artist, he also knew great suffering. He and his beloved wife, Saskia, lost three of their four children. Soon thereafter Saskia died, and Rembrandt eventually outlived even their surviving child. He also experienced great financial distress, in part due to his habit of buying art beyond his means. He eventually declared bankruptcy and was buried in an unmarked grave.1

Rembrandt produced no fewer than 300 paintings, a similar number of etchings, and some 2,000 drawings.2 Appraising his work, historian Kenneth Clark3 wrote that “the truth of his paintings goes beyond that of any other artist who has ever lived.” No less an artist than Vincent Van Gogh wrote that Rembrandt’s work “is so deeply mysterious that he says things for which there are no words in any language.”4 Some of Rembrandt’s most notable works were self-portraits, including more than 40 paintings and 30 etchings.2 By looking into himself, Rembrandt was able to reveal powerful human insights.

Consider the 1630 self-portrait entitled Beggar Seated on a Bank. Though beggars had often appeared in European art, they were usually portrayed in a disdainful or even satirical way.5 In Rembrandt’s version, however, the artist does not merely see himself in the beggar, but literally becomes the beggar. To make the beggar an object of derision would be to do the same to the artist. Conversely, it is only in discovering the beggar’s dignity that the artist truly realizes his own. Much the same might be said of the relationships between patients and physicians.

Light falls on the frowning face of the beggar, highlighting his tongue. A single button secures his tattered clothing. Sitting alone hunched over on a bare rock, the beggar creates an impression of desolation. He stretches forth his hand, in hopes of receiving something from the viewer at whom he directs his expectant gaze. The artist summons us to respond. A response might take the form of a handout, a coin placed in the empty hand, but it might also be a hand up, some means of helping the beggar lift himself to a better place.

Medical students have a tendency to see themselves as different from their patients, who are usually older, less economically advantaged and less educated, and above all sicker than their young and hale caregivers.6 By inviting viewers to see themselves in the beggar, Rembrandt challenges us to see the humanity we share with our patients.7 Even physicians eventually fall sick and die, and white coats and stethoscopes need not be obstacles to compassion.

Rembrandt suggests that we need to acknowledge and even cherish our shared vulnerability. Acknowledging our mutual humanity—nothing else—is the bedrock of compassion. Accidents of dress, wealth, and education should not create barriers between human beings who, at our core, are made of the same alloy. No policy and procedure manual, code of ethics, or moral injunction can substitute for the basic fellow feeling to which Rembrandt appeals. Only when we draw from a genuine sense of compassion can we provide our patients with the care they truly deserve.

How can we draw such masterpieces into the education of physicians? Fortunately, electronic versions of such works are universally available to medical educators, who can use them for illustrating lectures or even as a lecture’s centerpiece. Another possibility is to visit a museum with students and let them encounter great works of art directly. Learners should be challenged: Are they engaging the work? Do they feel their eyes opening to something new? Will they see patients, themselves, and the art of medicine differently as a result?

Great art educates not only the eye but also the heart. It draws us out of ourselves, to see life anew, with eyes opened to new realities and new possibilities. In order to care as well as we can for our patients, we need to become as human as we can. Living our humanity is exactly the opportunity offered to us by the great artists, and especially by Rembrandt. He captured the essence of the human as clearly and beautifully as anyone. By looking again at life through his eyes, we see medicine—the care of fellow humans—in all its richness.

Danielle McGlynn, MD, and Richard B. Gunderman, MD, PhD

D. McGlynn is a resident in anesthesiology, Yale University School of Medicine, New Haven, Connecticut.

R.B. Gunderman is Chancellor’s Professor of Radiology, Pediatrics, Medical Education, Philosophy, Liberal Arts, Philanthropy, and Medical Humanities and Health Studies, Indiana University School of Medicine, Indianapolis, Indiana; telephone: (317) 948-6302; e-mail: [email protected]

References

1. Westermann M. Rembrandt. 2000.London, UK: Phaidon Press.
2. Van de Wetering E. Rembrandt: The Painter at Work. 2000.Amsterdam, the Netherlands: Amsterdam University Press.
3. Clark K. An Introduction to Rembrandt. 1978.London, UK: Murray.
4. Roskill MW. The Letters of Vincent Van Gogh. 2008.New York, NY: Touchstone.
5. Higginson P. Fashioning the poor in sixteenth-century Europe. Art History. 2010;33:724727.
6. de la Croix A, Rose C, Wildig E, Willson S. Arts-based learning in medical education: The students’ perspective. Med Educ. 2011;45:10901100.
7. Podro M. London and the Hague: Rembrandt’s self-portraits. Burlington Magazine. 1999;141:553556.
Copyright © 2016 by the Association of American Medical Colleges