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Artist’s Statement: Clinical Vision

Madanes, Sharon Brenda MFA, MD

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doi: 10.1097/ACM.0000000000003363
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As a medical student on a surgery rotation, I was asked to review imaging for both consults and scheduled patients during morning rounds. Scanning up and down through different levels of a computerized tomography scan, I felt pulled to look in two ways: one was searching, actively and diligently, for pathology, and the other was watching, passively and with admiration, as anatomical structures shifted into mesmerizing, abstract shapes. As a painter, I toggled between these two modes, relishing in the complexity of images and their reception.

Aesthetics, according to the philosopher Immanuel Kant, is free play of the imagination, or one could say, imagination unfettered by the concrete or objective. Radiology is akin to aesthetics in that one must activate the imagination to draw on the multiple bodies of knowledge required to investigate an image. But unlike an aesthetics-based field, a radiograph is grounded in objective findings, even if these findings are subtle or exist on a spectrum. The image is an index of a body and is created by a concrete physical interaction.

Looking at patients as an artist and as a physician are often at odds: searching for pathology is a kind of looking that requires filtering out visual information that might not provide clues in a directed search. The other type of looking is receptive, open to aesthetic moments, to information that is outside of utility.

In medical school, students are trained to compare what is in front of them to an internalized idea of “normal.” This requires immense skill and knowledge—holding a catalogue of images in one’s mind to understand how disease or injury can influence anatomy and grasping how material interacts with a particular imaging modality. It is also problematic, especially when cultural constructs of normativity inform our ideas of pathology.

Having a second way of looking, the kind that is taught in art school, has provided me with the perspective to recognize medicine as a lens through which the body is seen, a lens that is not fixed, a lens that is fallible and must constantly be refocusing. Both lenses, the lens of art and the lens of medicine, are tools that I have used to try to bridge the divide between patient and care provider, medicine and culture. The artist in me tries to see and address what medicine fails to in a clinical encounter.

In my painting Clinical Vision, on the cover of this issue, I explored how we can honor both types of looking, particularly in an educational setting. The light (blue glow of the room and pink of the projected image) is a stand in for sight. The light of the projector is not contained to the screen itself. It reflects onto the world around it, the everyday objects, the bodies of the physicians and students examining an abstracted cross section of a body. The intersection and melding of these two kinds of light reflects how medical sight might interface with other ways of seeing. How can I hone my clinical vision and simultaneously foster a more expansive type of looking, a kind of looking that sees patient’s stories, finds interest in “nonessential” information, thinks about how culture changes vision, and finds color where there might be none?

Clinical Vision
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