{"id":1576,"date":"2015-08-28T09:28:25","date_gmt":"2015-08-28T13:28:25","guid":{"rendered":"http:\/\/blogs.nejm.org\/general-medicine\/?p=1576"},"modified":"2015-08-28T09:28:25","modified_gmt":"2015-08-28T13:28:25","slug":"how-do-you-teach-art","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/08\/how-do-you-teach-art\/","title":{"rendered":"How Do You Teach Art?"},"content":{"rendered":"
\"Andrew<\/a>

Andrew Ip, MD, is a 2015-16 Chief Resident in Internal Medicine at Emory University in Atlanta, Georgia.<\/p><\/div>\n

When I first applied for medical school, I beamed about exploring not just the science of medicine, but also the art<\/em>.\u00a0 But what is that art?\u00a0 Some would say it\u2019s clinical experience, combined with being cultured and\u00a0compassionate and communicating with clarity\/conviction.\u00a0 But how would one teach that art?<\/p>\n

Journal Watch\u2019s<\/em> Dr. Allan Brett\u00a0recently reviewed a multicenter US study\u00a0following ~300 metastatic cancer patients who had failed initial chemotherapy (NEJM JW Gen Med Aug 6 2015<\/a>).\u00a0 The study showed that additional chemotherapy for patients with poor life expectancy <6 months had no better quality of life or prolonged survival.\u00a0 In fact, patients who had the highest performance status had worse quality of life when given additional chemotherapy.<\/p>\n

Even with our remarkable scientific discovers in medicine, we still have a very tough job to deliver the science of medicine in a patient-centered format.\u00a0 Oftentimes, it is a judgment call to decide if a patient with end-stage liver disease or heart failure or COPD or cancer would benefit from any additional aggressive treatment.\u00a0 From my experience, many patients, and their families, are initially resistant to accept a terminal prognosis and want to pursue aggressive measures.\u00a0 What happens next involves a moment in which the physician can analyze the situation, with risks\/benefits in mind from a scientific point of view, and then deliver a message that keeps the patient\u2019s goals of care in mind while also informing the patient that you do not wish to harm them with interventions that may be not in their interest.\u00a0 This is one of the toughest things to do as a clinician, often leading to many of us tip-toeing a fine line.<\/p>\n

One story that has stuck with me from residency is the story of Mr. G, an Ethiopian patient.\u00a0\u00a0Mr. G had\u00a0end-stage cardiomyopathy and had been in the hospital for 3 months while\u00a0on inotropes.\u00a0 Unfortunately, he did not qualify for any advanced heart failure therapies. As our team was trying to explain the dire situation, he initially wanted all aggressive measures. He also said to me, \u201cplease, don\u2019t tell my wife and children.\u201d He squeezed my hand as he spoke to me, and I squeezed back.<\/p>\n

As a clinician who prides myself on my empathy and compassion, this was one instance where I had to go against honoring all of my patient’s wishes.\u00a0 Our team felt aggressive measures would not give any quality of life and would likely lead to more harm than good.\u00a0 We also contacted his wife and children to inform them their loved one was going to die soon.\u00a0 This was the most difficult part, as Mr. G was extremely upset from a cultural and personal standpoint that his family knew his prognosis.\u00a0\u00a0 It was a judgment call that, because I misunderstood the cultural implications, fractured my physician-patient relationship with Mr. G at the time.\u00a0 However, I did not give up on delivery of care, and I treated Mr. G and his family as my own family \u2014\u00a0and a remarkable turnaround occurred\u00a0in our relationship.\u00a0 His children delivered a card and flowers to me, thanking me for all the personal care I gave to their father, and Mr. G embraced me as his physician, holding my hand yet again.\u00a0 Mr. G died peacefully 2 days later, with his family at his bedside.<\/p>\n

 <\/p>\n

\"A<\/a>

A gift from Mr. G’s children<\/p><\/div>\n

 <\/p>\n

Maybe\u00a0the art of medicine is\u00a0not something you teach.\u00a0 Maybe it is an individual style you develop with experience with direct patient care or with role models and mentors.\u00a0 But what we often forget is the patient should be at the center of anything we deliver in medicine.\u00a0 That may be the art.<\/p>\n

I would love to hear thoughts from others about their experience developing their own art of medicine, or in scenarios where sometimes treating a patient may have caused more harm than good.<\/p>\n","protected":false},"excerpt":{"rendered":"

When I first applied for medical school, I beamed about exploring not just the science of medicine, but also the art.\u00a0 But what is that art?\u00a0 Some would say it\u2019s clinical experience, combined with being cultured and\u00a0compassionate and communicating with clarity\/conviction.\u00a0 But how would one teach that art? Journal Watch\u2019s Dr. Allan Brett\u00a0recently reviewed a […]<\/p>\n","protected":false},"author":1254,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,4],"tags":[49,25,31,34],"class_list":["post-1576","post","type-post","status-publish","format-standard","hentry","category-about-residency","category-clinical-implications-of-research","tag-art-of-medicine","tag-end-of-life-care","tag-patient-care","tag-residency"],"yoast_head":"\nHow Do You Teach Art?<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/08\/how-do-you-teach-art\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"How Do You Teach Art?\" \/>\n<meta property=\"og:description\" content=\"When I first applied for medical school, I beamed about exploring not just the science of medicine, but also the art.\u00a0 But what is that art?\u00a0 Some would say it\u2019s clinical experience, combined with being cultured and\u00a0compassionate and communicating with clarity\/conviction.\u00a0 But how would one teach that art? 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