Art Med Insight is an elective course offered several times a year to medical students and residents at MGH and elsewhere. It's meant to sharpen our powers of observation in medicine by practicing this skill with sculpture, paintings, and photographs. Some might call it hokey, but the approach has caught on with a large handful of medical schools and residency programs and there's growing evidence that courses in art observation and critique can improve the trainee's ability to articulate clinical observations and analyze complex information.
It's not a surprise that keen observation is critical to good clinical care—noticing a subtle change in a patient’s physical appearance may lead to an early diagnosis, or catch a medical error before it causes harm.
But as our discussions in the course quickly revealed, we feel the barriers to observation acutely while working on busy hospital floors. Time is a huge one: we have just a few minutes to “pre-round” on each of our patients before we discuss them with our team and we are liable to miss something or notice it and promptly forget. Perversely, limiting our observations can be a defensive mechanism against the sensory overload of intern year, particularly if noticing something generates more work.
Preconceived notions can be both an aid and a barrier to good observation. Back in medical school, we were encouraged to see a newly arrived patient without knowing much more about them than their vital signs in order to maximize learning (though it was tempting to cheat). As interns, we have to admit many more patients in a short period of (duty) hours, so this strategy would be disastrous. Instead, we dive into old medical records the second we hear that a patient might come to our floor. The admission note is nearly complete before we have laid eyes on him. This may make us more efficient, but there is the risk of our perceptions being influenced by what previous doctors have recorded, and of perpetuating errors and missing changes as a result.
So, more than a much-needed distraction, ArtMedInsight was an important reminder to keep an alert and open mind just as I learn to appreciate the challenges of applying this lesson to the hectic job of medicine.
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