Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Do You See What Eyes See?

Doctors need to learn, or at least re-learn, how to look at a patient.

From different vantage points, we all at some time have bemoaned the lost art of the doctor-patient interaction: As caregivers, we experience that self-conscious, almost embarrassing moment, when we realize that we do not have the time—and maybe the insurance company reimbursement—to listen any longer to that patient sitting in our office. As patients, we experience that rushed feeling, and the regret that we just spent a $5 co-pay for an audience with someone who does not seem all that interested in what we have to say.

However, there is always room for more bemoaning: While it may not be so obvious to the lay public not educated in the respective physical examination techniques, many of us are not only not being listened to—we are also not being looked at.

The reasons for the lost art of the skillful physical examination are many: laboratory testing and X-ray imaging can expedite diagnoses after the most cursory physical examination of the patient; after all, doctors are being asked to see greater numbers of patients within the confines of typical office hours. Before you know it, patients and physicians begin to see the phlebotomist and the X-ray tech as the main members of the health care team. The lack of time and committed teachers of the dying art of the physical examination in our medical schools only propagates this proportionally heavy reliance on tests.

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As strange as it seems, and even more basic than learning the physical examination, doctors need to learn, or at least re-learn, how to look at a patient.

A fascinating approach to this problem is being taken by leaders in the medical education field, through collaborations with art museums. The thinking here, as described in a 2001 article in Medical Education, is that the importance of careful looking and description of what is observed is an explicit requirement in the visual arts field. Those in the field of medicine would do well to emulate those critical skills, and a study published in 2011 in Academic Medicine appears to confirm this.

Researchers created a course for medical school students that involved sessions of art observation exercises linked with lectures that integrated concepts of the fine arts with the basics of physical diagnosis. A visual skills examination was then utilized to evaluate descriptions of patient photographs and artworks made before and after the course.

Interestingly, those who had participated in the observation courses increased their number of observations by approximately 40 percent compared to those students who had not participated. In addition, there was an increased complexity in the nature of the descriptions of clinical and art images made by the participants.

It appears that students can successfully improve visual observation and interpretation skills by utilizing visual problem solving in art and medical imagery. Through repeatedly practicing observation and describing those observations, the subliminal becomes the obvious.

Hopefully, counselors and clinicians will use such strategies, approaching patients with the eye of the art critic: Look for eye contact, notice a tremor. Is there a new asymmetry in the face of that elderly gentleman that might be indicative of a silent stroke having been suffered since the last office visit? Is there hidden meaning in the presentation of the physical form—that patient—who stands before you?

And give that phlebotomist and X-ray tech a little time off.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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