There was a time when doctors relied mostly on their own observations to figure out what was ailing their patients. But as technology improved, doctors began ordering more high-tech tests to back up the findings they make with stethoscopes and tongue depressors. Now a prominent medical group says doctors should actually cut back on expensive tests and procedures to save money. One prestigious medical school is trying an unusual way to teach young doctors to be more observant.
The artist's eye
At the Isabella Stewart Gardner Museum in Boston, a group of 20- and 30-somethings crowd around an oil painting of a Spanish dancer.
It could be any art appreciation class from one of Boston's many colleges and universities. But these are Harvard medical students. They're spending one afternoon a week at art museums, taking a course called, "Training the Eye" — a course that co-creator Alexa Miller hopes will help them become better doctors.
"There are some things that looking at art teaches us to do that apply very directly to taking care of patients," Miller says.
One of the things Miller says students learn is how to freely and without hesitation describe what's in front of them.
"Classes are pretty intense," says Miller. "We meet for about two and a half hours each Friday afternoon and spend the first hour, hour and 15 minutes looking at art and just talking about what we see."
Diagnosis and art
As the med students stare at John Singer Sargent's "El Jaleo," a wall-length tableau of Spanish-style dancers and musicians, they take turns imagining what's going on in the scene before them. One of the figures in the painting has his head tilted up to the ceiling with his throat exposed.
One student says, "I think it looks like he's snoring," and her classmates giggle. But she continues: "I think he has his head back up against the wall, I think he's had a really long day and he's sleeping."
In between student observations, Miller encourages them to probe deeper. When one student suggests the "sleeping" man could be singing instead, Miller says, "OK, great, so connecting these two themes that seem to be opposing … what do you see that makes you say you can hear the music?"
The idea is that by making all kinds of observations and being asked to think about why they're seeing what they're seeing, these Harvard med students will become more flexible thinkers who can hold different possibilities in their heads before making a diagnosis.
The value of flexible thinking
Fluidity of thought and getting comfortable with ambiguity are crucial in health care, says Sharon Levine. She's a professor of medicine at Boston University.
"If you don't deal with ambiguity, you will make mistakes," Levine says. "If you become fixated on one thing and don't think about other possibilities based on your physical exam, then you do yourself and your patients a disservice."
Levine sits on the American Board of Internal Medicine , one of the groups that's critical of the overuse of diagnostic tests and procedures. She says too often, doctors are using tests like CAT scans, MRI's or other hi-tech measures without first considering factors like the patient's medical history, their general health, or how they live their lives.
And Levine believes this can lead to inefficient health care.
"Technology is crucial in doing medicine now," she says. "But if it replaces thought and people do it reflexively, it can be a waste. And you wind up shooting a flea with a cannon instead of going after the flea in a more directed way."
By some estimates, about one-third of medical spending in the United States goes toward unnecessary testing and treatments.
A 2008 Harvard study found that students who take "Training the Eye" are able to make nearly 40 percent more clinical observations than those who haven't taken the course. That can mean fewer tests.
And Joel Katz says the training seems to last. Katz is an internist and a co-creator of the Harvard course.
"Our anecdotal observation is that students who do this course have come back to us years later and said, 'Oh, I feel much more prepared and much more confident in my ability to do physical exam,'" he says.
That confidence in observation, Katz says, comes from students learning to listen to each other and from working together to try out different interpretations of what's in front of them: "What one person sees in a painting may be very different than what another person sees in a painting and by talking and dialoguing together, they can maybe get to a third answer or see other truths that the painter intended or didn’t intend. And that’s our goal. That’s what we want to see them do."
Harvard isn't the first or only medical school to have its students take art appreciation classes; there's a class at Yale, for instance. But being scientists, Katz and his colleagues say they still want more evidence that art can make doctors better and more efficient at what they do.