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Adding a Dose of Fine Arts

More medical schools are offering courses in literature, painting and theater to improve doctors' ability to connect with patients.

May 24, 2003|Mike Anton | Times Staff Writer

When it comes to diagnosing what's wrong in a patient, medical schools are increasingly telling students to look for answers in some unexpected places: in novels, paintings, dance and theater.

Technical training remains the heart of medical education. But the number of future doctors taking literature, art interpretation and other humanities courses has surged over the past decade. They are trying to awaken their feelings and intuition as a way to connect with patients who often feel as though they've been reduced to a collection of symptoms.

Educators say the distilled emotions and insight in the arts offer students a crash course in the old-fashioned skill of the bedside manner. Art, they say, is a textbook on the human condition.

"What we are dealing with here is the art in the art of medicine," said Brownell Anderson, an executive with the Assn. of American Medical Colleges.

This year, more than three out of four medical schools offered humanities coursework alongside such staples as molecular biology and neuroscience. In the early 1990s, only about one out of three did.

Yale students study paintings at the university's Center for British art to enhance their observational skills. At New York's Columbia University, trainees read Tolstoy's "The Death of Ivan Ilych" as a primer on suffering -- and to sharpen their abilities to interview and listen. At UC Irvine, anatomy students write essays about their cadavers, imagining who they were in life, before taking them apart.

"The medical education system gives students the message that what's important is memorizing textbooks," said Johanna Shapiro, a psychologist who started the medical humanities program at UC Irvine five years ago. "To be a good doctor, they have to draw on every resource they have, including what's inside themselves. Science is simply not enough."

In the traditional boot-camp world of medical school -- where students spend countless hours digesting scientific facts -- the humanities were once seen as having nothing to do with treating the sick.

"We talk tongue-in-cheek that when a student moves from his pre-med to his medical school years, he is moving from the pre-cynical to the cynical years," said Dr. Abraham Verghese, an infectious-disease expert and best-selling author who last year began a medical humanities program at the University of Texas in San Antonio.

UC Irvine student David Santos, 26, found medical school left him no time to pursue his passion for painting. "It's been really hard to come back full circle and feel some of the creative juices I once had," he said. "Medical school dehumanizes people."

Time was, a doctor might taste a patient's urine for sweetness and confirm diabetes. But sophisticated diagnostic tests, tiny scopes and surgical tools and body scans have rendered such intimate techniques obsolete. Today, it's possible for a doctor to treat a patient without ever laying hands on him -- or even looking him in the eye.

Dr. Irwin Braverman, who leads the art class at Yale's medical school, recalls a patient with unexplained tumors on his legs. A resident, told in advance what the complaint was, walked in and "saw a person, a blob, and he immediately looked at the legs," Braverman said. The tumors provided no clue as to their cause; a biopsy would only narrow the possibilities.

Braverman saw something else. The patient had bulging eyes, which combined with the tumors, told him the man had thyroid disease.

"Doctors rely more on technical imaging devices than the eye," Braverman said. But a 2001 study published in the Journal of the American Medical Assn. found students who studied paintings in his class were 2 1/2 times more likely to notice subtle diagnostic details in patient photos than students who hadn't taken the class.

In a 2001 Gallup poll of more than 45,000 U.S. patients, respondents gave their doctors high marks for care and compassion, but significantly lower marks for communication skills.

"They said, 'How can you diagnose me if you didn't give me a chance to talk and you didn't listen? And if I do tell you something, you interrupt me?' " said Rick Blizzard, a health-care consultant who analyzed the data.

Doctors feel frustrated too.

"The traditional rewards for medical practitioners have diminished. They don't make as much money as they once did; they don't have the status in the public's eye as they once did; they're hounded by clerks from the insurance company," said Dr. Rita Charon, who teaches humanities at Columbia University's medical school. "Doctors are asking themselves, 'What are the real, fundamental rewards of taking care of sick people?' "

One answer, Charon said, is for medical schools to use the arts -- particularly literature -- to teach doctors how to engage sick people in a way that deepens their understanding of the patient, their illnesses and ultimately themselves.

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