Lisa Brandt knew she was seriously ill when she could barely drag herself from the couch to her bed. Brandt, then at the age of 48, felt chilled to the bone and suffered from an unquenchable thirst.
But her illness struck at the height of influenza season, in January, 2011. Brandt says a doctor at a walk-in clinic in London, Ont., refused to examine her, telling her to go home and rest. Even after she started urinating blood and called 911, she says, an ambulance paramedic scolded her for wasting his time with a case of the flu.
It turned out that Brandt had sepsis, a life-threatening complication of an infection that had stealthily spread after dental work. Brandt received intravenous antibiotics in the nick of time. But until she was rushed to the ER, health-care professionals dismissed her concerns and acted “like an assembly line,” she said.
We like to think of physicians as attentive listeners who are doggedly determined to uncover what ails us, like the brilliant diagnostician on the hit TV series House.
But in real life, doctors can only cover so much ground in a 10- to 15-minute appointment. Physicians increasingly rely on time-saving tools such as symptoms checklists, blood tests, magnetic resonance imaging (MRI) and ultrasound to diagnose their patients.
As medicine embraces technology like never before, bedside teaching has declined and fewer doctors are being trained to pick up on subtle physiological clues, Sherlock Holmes-style. Instead, medical centres in the United States are warming up to devices such as “Dr. Watson” – IBM’s artificially intelligent supercomputer, which boasts a success rate at diagnosing lung cancer of 90 per cent, compared with 50 per cent for human doctors. (In Canada, the BC Cancer Agency is currently involved in research with Watson.)
Nevertheless, there is opposition to medicine’s current efficiency-driven approach. A small but growing number of medical professors insist that medicine is not just a science – it’s an art. They argue that education in the humanities and the arts is the best antidote to the kind of tunnel vision that can lead to misdiagnosis and the lack of empathy that is eroding the doctor-patient relationship.
To be a good doctor, they say, every medical student should aim to be something of a Renaissance man or woman.
Courses in arts observation can help doctors hone their clinical skills, said Dr. Caroline Wellbery, co-author of a research paper on the role of arts education in medicine, published last month in the journal Academic Research.
In learning to study the play of light and shadow in a painting, for example, medical students can gain awareness of different ways of seeing, wrote Wellbery, an associate professor of family medicine at Georgetown University who teaches students about the parallels between medicine and the arts.
Skills in arts observation can be put to use at the clinic, she said. If a patient has digestive problems, for instance, the root cause may be clearer if a doctor notices facial expressions linked to chronic anxiety and stress.
Wellbery acknowledged that the benefits of arts observation are difficult to measure. Nevertheless, a 2008 study found that medical students who took an eight-week arts-appreciation course had more sophisticated clinical observations of slides showing patients with a range of disorders, compared with classmates who had not taken the museum-based course.
Similarly, exposure to the precision of language in the literary arts can help sharpen critical thinking and communication skills, while an appreciation for narrative may encourage doctors to “engage in the patient’s story,” Wellbery said.
That’s not just a touchy-feely idea. Studies of the placebo effect suggest that attentive care from a physician can trigger the body’s healing response, improving a patient’s condition without any other medical intervention.
Wellbery goes so far as to say that arts-based courses should be mandatory in medical schools: “It creates buy-in.”
At Yale School of Medicine, first-year medical students are required to take an arts-observation workshop at a museum filled with 18th- and 19th-century British paintings. In general, however, medical schools that offer courses in the arts and humanities, including Harvard and Columbia, offer them as electives.
In Canada, Dalhousie University in Halifax has had a medical humanities program since 1992. The program encourages medical students to participate in extracurricular activities such as weaving, choir and visual arts, with an aim to “developing empathy and creativity.” Similar options are available to medical students at the University of Alberta and University of Toronto.
But are courses such as these the answer to patient dissatisfaction with doctors?
The lack of quality time with doctors is “very much a systemic problem,” Dr. Eugene Bereza, director of the Centre for Applied Ethics at McGill University, said.
More often than not, doctors become brusque with patients because spending extra time with them would mean turning away others in need, he said. “It’s not because doctors have lost their humanity.”
He added that physicians often order MRIs and other tests not because of overreliance on technology, but because medical-practice guidelines require them. “There are certain standards that have to be met.”
In 2012, physician services accounted for about 15 per cent of overall health-care spending, according to the Canadian Institute for Health Information.
Should Canada reduce spending in other areas, such as medical technologies, “and just have more family doctors who are sensitive?” Bereza said. “I’m not sure that’s the answer.”
Nevertheless, doctors including Bereza agree that something has got to give. In the United States, growing recognition that the bottom-line approach to health care is making patients sicker has given rise to “slow medicine.” This nascent movement dovetails with the medical humanities in its emphasis on reclaiming traditional examination skills and patient-centred care.
Teaching doctors how to connect with patients and build relationships based on trust should not be regarded as optional, Wellbery said. “It is an essential part of medicine, the human part of medicine.”Report Typo/Error