As a second-year medical student pursuing training within an academic health care system, I am learning that the intricacies of medicine go much beyond what initially meets the eye. A seemingly benign patient complaint, like a headache, can herald a life-threatening brain bleed. “Tired eyes” may be the only symptom reported by a patient with a raging autoimmune disorder.
Just as the complex physiology underlying a patient’s chief complaint may be covert, so too may be the patient’s underlying humanity. I remember a patient returning to our emergency room three times in a week with complaints of chest pain at night. His first visit appropriately involved an extensive diagnostic workup to exclude an underlying heart issue. His second visit repeated the workup, with no new findings. Each time, the patient left frustrated and scared. On the patient's third visit, I observed as a new doctor to the case, Dr. T, took the time to have a real conversation with the patient and his concerned wife. She uncovered that the man had just been fired, that he had struggled with anxiety for a long time, and that his chest pain was relieved with walking. Dr. T correctly diagnosed the man with panic disorder and connected him with the medication and psychiatric treatment he so desperately needed.
My most effective physician mentors, like Dr. T, navigate the complex landscape of medicine with utmost humanity. They avoid jumping to a particular diagnosis or judging a patient based on a first impression. Inspired by their approach, I painted Outer, Inner, which appears on the cover of this issue.
The figure in my piece is a patient. The work’s right side represents what initially meets the clinician’s eye. I used lighter tones and bright colors to emphasize the ‘outer’ aspects of the woman—her practiced way of presenting herself to the world, stated symptoms, and more obvious signs of her medical condition. Nevertheless, she is naked, exposed. The left side of the painting represents the ‘inner,’ deeper aspects of this woman. I used organic shapes to suggest the organs that make up the complex biology of her body, and darker abstracted areas to suggest her unseen soul.
While the woman’s outer side is evident, her inner side will only be discovered through her physician’s subtle observation, active listening, thoughtful questioning, and deliberate clinical decision making. My most inspiring mentors have demonstrated that through this understanding and persistent approach, both the disease process and the patient’s underlying humanity may be revealed.