{"id":45621,"date":"2019-09-13T14:17:31","date_gmt":"2019-09-13T13:17:31","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=45621"},"modified":"2019-09-23T13:19:55","modified_gmt":"2019-09-23T12:19:55","slug":"its-not-all-black-and-white-can-art-help-doctors-navigate-medical-uncertainty","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/09\/13\/its-not-all-black-and-white-can-art-help-doctors-navigate-medical-uncertainty\/","title":{"rendered":"Rose Olson: It\u2019s not all black and white\u2013\u2013can art help doctors navigate medical uncertainty?"},"content":{"rendered":"

The practice of art appreciation may help doctors’ decision making by alleviating the demonisation of uncertainty, says Rose Olson
\n<\/span><\/p>\n

\"\"<\/a>I remember crawling in paint until I was coated from elbow to shin. My father\u2019s massive shoulders would be bowed over stretched canvas, paintbrush curled into his left hand. With each strike, colour would flood the fabric while I\u2019d watch in awe to see what image would appear. Art runs in the family\u2014<\/span>my mother worked at the local art museum, where on lucky summer days, I\u2019d be set free in its endless marble hallways. I\u2019d march alongside ancient Japanese suits of armor, tiptoe past Francis Bacon\u2019s sinister papal shadows, and swing in Vincent Van Gogh\u2019s twisted olive tree branches. Growing up in a home where art was a profession meant the unpredictable artistic process was profoundly valuable. That bare stretch of canvas may look insignificant to some, but to me it teemed with vivid possibilities.<\/span><\/p>\n

I carried that passion for art with me into medical school. During my white coat ceremony, the speaker introduced me to the \u201cart of medicine\u201d as the physician\u2019s highest achievement, a mastery of the craft exemplified by the fathers of medicine who stood before us. Yet soon after receiving my first white coat, medical school\u2019s creeping demands and anxieties overtook me. Success was now measured in quantifiable, predetermined forms: honours on clinical rotations, high USMLE Step scores, and research publications. Eventually, my youthful enchantment of art was rebranded as a diversion or, in medical student speak, \u201clow yield.\u201d\u00a0<\/span><\/p>\n

Does art have any place in medicine? In the age of evidence based medicine, abstract creative processes like art may seem irrelevant. Yet a careful look into medicine\u2019s \u201cobjective data\u201d reveals its often nauseating number of presumptions and limitations. So when a patient\u2019s signs and symptoms fail to follow the textbooks, and all clinical algorithms have been exhausted, how is the doctor to proceed? This is exactly where art can lend great value<\/span>\u2014<\/span>by teaching us comfort with ambiguity. While artists may have a specific message in mind when crafting their work, similar to medicine, each viewer is affected in a distinct and often unpredictable way. Interpreting art is a meditation in seeing things from multiple points of view and growing to respect that others may not agree with your interpretation. Physicians have a lot to gain from learning to navigate these grey areas.<\/span><\/p>\n

Tolerance for medicine\u2019s ambiguity is rarely included<\/a> in medical education<\/a> and training<\/span>. Medical students and trainees are placed in high pressure contexts where clinical prowess is often judged by the number of correct answers marked on multiple choice exams or uttered in response to pimping questions on rounds. Such an environment can programme students and trainees to view ambiguity as failure and creativity as frivolous. Residents and early career physicians are often made anxious by uncertainty and feel pressured to minimise it, whether as <\/span>a way to reduce frustration<\/span><\/a> in unclear patient cases or appear confident when consulted by colleagues. Patient expectations may also contribute to the physician\u2019s drive to give a precise diagnosis and treatment. We want to give our patients an unequivocal answer<\/span>, <\/span>even when there is none.\u00a0<\/span><\/p>\n

This culture comes with its risks: when ambiguity is intolerable, the associated frustration and stress may only be relieved by attempting to piece together certainty where it doesn\u2019t exist. This may result in the overordering of diagnostic tests and empiric treatments in <\/span>attempts to find \u201cthe one solution.\u201d<\/span><\/a> Or it may lead to rigidity in clinical problem solving, even in the face of data discrepancies. Patients may shoulder these harmful consequences when they experience delayed and missed diagnoses or the side effects of unnecessary medications, tests, and procedures. Healthcare workers who struggle with ambiguity<\/a> are less likely to engage their patients in shared decision making, avoiding candid discussions of the uncertainties, caveats, and risks of their diagnoses and treatment options.<\/span><\/p>\n

A growing <\/span>body of research<\/span><\/a> suggests that early exposure to art interpretation in medical education may in fact increase students\u2019 ability to tolerate ambiguity. <\/span>The educational approach known as Visual Thinking Strategies (VTS)<\/a> involves group discussion of art images where learners are encouraged to carefully observe pieces, verbalise their personal interpretations, and interact with their peers\u2019 viewpoints while affirming the co-existence of multiple possible meanings<\/a>. Research suggests that tolerance for ambiguity is a \u201cstate\u201d not a \u201ctrait.\u201d This means that our ability to admit uncertainty\u2014whether in art or in medicine\u2014can be taught<\/a>, and that programmes such as VTS may help us to hone these skills.<\/span><\/p>\n

Can art grant doctors all the wisdom they\u2019ll need to navigate medicine\u2019s infinite uncertainties? Probably not. But <\/span>appreciating art may help doctors<\/span><\/a> to react to medicine\u2019s ambiguities with more comfort, intrigue, and motivation than frustration, disillusionment, and burnout. In turn, physicians may develop a more flexible process of problem solving, an honest understanding of medicine\u2019s limits, and an ability to openly share these realities with colleagues and patients.\u00a0<\/span><\/p>\n

If our teaching and training embraced ambiguity, it would help to challenge medicine\u2019s pursuit for absolute certainty, and make doctors more comfortable in admitting when we are unsure. Giving art legitimacy in the medical world will require reframing what trainees have been taught is \u201chigh yield\u201d and imagining new success measures beyond the multiple choice test. But <\/span>maybe then more doctors will realise what artists have known all along: there are many more colours to choose from than black and white.<\/span><\/p>\n

Rose Olson<\/i><\/b> is an internal medicine resident physician at Brigham and Women’s Hospital in Boston. She also works as a research consultant on gender based violence for the World Health Organization. She is passionate about social medicine, gender equity, and all forms of art. Twitter @rose_m_olson<\/a>
\n<\/span><\/i><\/b><\/p>\n

Competing interests: <\/b>None declared.\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

The practice of art appreciation may help doctors’ decision making by alleviating the demonisation of uncertainty, says Rose Olson […]<\/p>\n

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