Out of the hospital and into the museum

In late October, a group of medical residents gathered at the McMaster Museum of Art in Hamilton to scrutinize slides of paintings by Goya and ancient Egyptian statues as they might have examined, earlier that day, X-rays or CT scans. Halfway through the class, an unsettling mess of gray, black and white cubes popped up on the projection screen. “This is a famous work of art,” said instructor Karen Scott Booth, who can rattle off her encyclopedic knowledge at the pace of an auctioneer. “It’s probably one of the most famous works in the history of art. Does anyone know this work?” Silence. “Has anyone seen this before?” Silence. Booth gave her class a hint: “It’s Spanish, by one of the most notable painters of the 20th century.” Still nothing. She continued to prod, urging the doctors to look for clues. Finally, one student ventured: “Picasso?” In the nearly black room, Booth sounded pleased. “Yes, it’s Picasso.”

It was, in fact, Guernica, the artist’s renowned depiction of the horrors of the Spanish Civil War. None of the young minds in “The Art of Seeing,” a new visual literacy course for family medicine residents at McMaster, knew it. Until now, many have focused on chemistry and biology, toiling in labs and hospitals. But here they’re asked to look for signs, symbols and stories hidden in pieces of art—which will, the theory goes, enable them to better see signs and symptoms in their patients.

The class was introduced at McMaster because a number of studies have shown that careful and intensive observation of art improves doctors’ diagnostic and observational skills. In 2008, a study in the Journal of General Internal Medicine showed that medical students at Harvard who completed an art appreciation course were 38 per cent more accurate in making medical diagnoses than before they took the class. (Observations by a control group did not change.) At Yale, a study found that nursing students in an art program had more objective clinical findings when viewing patient photographs than their non-museum-going peers.

Dr. David Price, chair of family medicine at McMaster, believes art may be the key to improving how doctors observe their patients—a skill that’s been in decline with increasing dependence on technology in medicine. Price tells about a student who successfully completed an examination of a newborn baby, but who didn’t realize that the mother, sitting in the same room, was ill. She was admitted to hospital later that day. “We want doctors to see the whole picture,” says Price.

Other universities—Dalhousie, the University of Alberta, Harvard, Cornell, the University of California at Irvine—offer similar courses, and right now there’s a groundswell across Canada to further incorporate the arts into medicine. Canada is home to ARS Medica, one of the few journals in the world about the interface of art and medicine, and next May, the University of Toronto will host the first national conference on the topic.

Dr. Brian Goldman, author of The Night Shift and an ER doctor at Mount Sinai Hospital in Toronto, explains that art and medicine didn’t always inhabit separate spheres. “There was a time when a well-rounded physician had a good grounding in the humanities as well, and we lost that as more teaching time focused on understanding medical science and technology.” Goldman thinks it’s time to get rid of the dichotomy. “The whole process of art appreciation is getting to notice things that you otherwise wouldn’t. When I walk into emerg, before the patient and I have exchanged a word, I see the neck muscles are contracting every time they take a breath, and very subtly, that the nostrils are flaring. It’s telling me the patient is in respiratory distress, and I might have to make a split-second decision. You need the powers of observation to detect that.”

Dr. Joel Katz, who initiated the class at Harvard in 2004, is a pioneer in the trend of training doctors in the arts. Katz explains that he believes “the classes help doctors trust their own senses and rely on the physical, rather than expensive testing and radiology, which, unfortunately, has become the norm in modern medicine.” His own career as a doctor blossomed out of a job as a medical illustrator, and he still views the paths of artist and doctor as entwined. “St. Luke, patron saint of arts and medicine, was an artist and a physician. Both are detectives, using their eyes and other senses to figure out what’s going on in front of them.”

At McMaster, class participants say looking at art has been a welcome reprieve. A resident, Dr. Puneet Seth, explains, “When we were first looking at art, what came to mind were medical descriptions. ‘This person looks malnourished, or needs their blood sugar checked.’ ” With time, though, he says, “This is teaching us to look at people as humans, not just as medical subjects.”

For Dr. Joyce Zazulak, an associate professor and co-director of the new program, art is the vehicle to “train these doctors to look deeper, understand the patient’s experience of illness,” which will lead them to be better doctors. At the end of the class, she takes out an enlarged photo and asks the students to analyze it. The man in the picture is holding a cigarette and a drink, with a red face and distended tummy. “I see several risk behaviours,” one doctor quips, half-jokingly. To that, Zazulak reminds the class: “You’re going to make a lot of assumptions as doctors, but what’s important is to challenge those assumptions. Look harder.”