These are my most recent watercolors painted in Washington Heights. They feature the markets, bus stops, street people, and Orthodox Jews around Broadway, Fort Washington and St. Nicholas Avenues. Thanks to my teacher, the master Timothy Clark, I am finally beginning to see the light and gain the ability to paint it. But with a little thought these same lessons can be applied to improve medical skills.
Through watercolor I have discovered new ways to piece together my visual environment. In a recent class while doing a demonstration, Tim said, “I am not teaching you how to paint, I am teaching you how to see.” The ability to see is of course a prerequisite to making a painting, and this is the same thing I tell medical students and residents in training when they rotate through my wound clinic. The ability to see is a required skill in any therapeutic encounter, but especially when diagnosing and treating wounds.
When discussing a patient I often ask the resident, “What was the first thing you saw when you walked into the room?” Often my question is met with puzzled looks. The newly trained doctor, whose skills regarding observation either haven’t been taught or are perhaps yet undeveloped, may not appreciate the process of seeing. The reliance on laboratory tests and written reports from imaging procedures too often supersedes the simplest and most direct diagnostic tool – using the senses to collect critical information about the patient. For most doctors the time looking at patients is minute compared to the time looking at computer screens.
Just as the watercolor teacher can teach the art of seeing by demonstrating light, shadow, form, and color, medical students can indeed be taught to synthesize the vast amount of science and physiology they have memorized into visual skill at the bedside. Wound care, because it is so highly based on direct observation, lends itself to reliance on the process of seeing, but this is necessary for most situations when diagnosing illness.
When a patient presents with a medical problem, for example, it is important to observe their body movement, physical habitus, and skin color. Important clues appear with regard to emotional state, pain, anemia, hypoxia, and other pathologies. As the patient reveals their symptoms, the physician is already assembling the observations into a differential diagnosis, to be supplemented with hands-on physical examination and diagnostic tests. Too often, the process of observation is missed, the doctor is too distracted to hear the symptoms, and there is a rush to type the computerized orders for blood tests and imaging studies and enter the billing codes for insurance reimbursement. The critical steps of seeing and thinking become truncated, information is lost, and a therapeutic relationship becomes shallow.
And so I return to my sketch pad, looking at the world and trying to decipher tonal scales, color temperature, and form. I think about the lessons my art teachers have given me and struggle with my brushes and paints trying to get it right. When I am with my patients I am acutely aware that I employ the same skills to become a better doctor, and try to impart lessons on seeing to my students. Tim Clark’s goal might be to teach art, but his lessons can easily be translated to medicine.
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