The Art of Medicine

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Self-portrait from my last operation before retiring as a general surgeon nearly six years ago.

This week’s Discover Challenge at The Daily Post is all about identity so finally, after starting my blog almost three years ago and now with close to a thousand followers, this seems like just the right opportunity to introduce myself, somewhat belatedly I agree, with this self portrait, and through part of an address I gave on the Art of Medicine at a National meeting a few years ago.  If you have time to read it I hope you enjoy it and get to know me a little better than you do already.

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“When I was asked to speak to you on the Art of Medicine I questioned myself as to whether or not I had the necessary credentials to address such an expert audience of educators and scholars on the subject. My only qualification, it seemed to me, was that of someone who has spent the last forty years practicing medicine and surgery, committed to helping patients to the best of my ability and dedicated to teaching students and residents, and passing on to them the knowledge, skills and art that had been passed on to me by my teachers, and always encouraging them to have the arts and humanities in their lives. Hopefully these qualifications will prove to be sufficient for my task this morning.

The art of medicine has three factors said Hippocrates… “the disease, the patient, the physician..”. a relationship that is as true today as it was over two millennia ago. But I would also like to add a fourth factor, the student. For without the student there is no future to the art. We all start out as students. We all have role models and teachers, who have guided us. That is why I have always believed that second only to my patients, my students have been the most important people in my professional life. Remember, our responsibility to be teachers is embedded in the Hippocratic oath

“…and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art…” reads the oath.

The art that was being imparted by Hippocrates however was founded in the belief that health was based on a balance of the elements: earth, fire, air and water; the humours: black bile, yellow bile, phlegm and blood; and the qualities of hot and cold or wet and dry. How very different is our understanding of the art today, which is based on scientific truths and the rigors of research that are so integral to the practice of medicine in the twenty first century.

There is no time in this presentation to catalogue all the scientific and clinical landmark contributions that have been made throughout the ages: Vesalius’s revelations of human anatomy in the 16th century; Harvey’s description of the circulation of the blood in the 17th; in the 18th Laenec and his stethoscope that changed, forever, the art of diagnosis; and then a few years later Moreton’s anaesthetic that set Surgery on its way; and the molecular biology and genetics of today. The message that I give to my students at every opportunity is to enrich their lives by studying the history of medicine and see unfold not only the history of our profession, but also the history of humanity.

In 1892 Sir William Osler published his Principles and Practice of Medicine, the definitive textbook of Medicine for the age. It seems only fitting to be quoting Osler at a meeting dedicated to medical education and the humanities in medicine. I opened a copy that I own, certain I would be enlightened in some way, and I was not to be disappointed, for there on the very first page was his dedication: “To the memory of my teachers.” What a great message to every practitioner opening this book, to be reminded that it is our teachers who must always be thanked for guiding us on our individual journeys. Then on the second page Osler quotes from the First Aphorism of Hippocrates ‘Experience is fallacious and judgement difficult”. It is interesting that he chose not to include the famous words that begin this aphorism: Vita brevis, ars longa, “Life is short, the Art is Long”, words that have become ever more meaningful to me as the vita becomes ever more brevis.

And this from his address to the New York Academy of Medicine in 1903:

“For the junior student in medicine and surgery it is a safe rule to have no teaching without a patient for a text, and the best teaching is that taught by the patient himself.”

How true that is. One of my patients is someone who has been an inspiration to me, and from whom I have learnt so much over the years. She is a remarkable young woman who has had Crohn’s disease from a very young age, has been through numerous surgeries and spent countless months in hospital throughout her life. I spoke with her about my presentation to you today and asked her for her perspective on the art of medicine. This is what she wrote to me:

“The Art of Medicine is maintaining the optimal balance between the scientific expertise and treatment of injury and disease, and the humanity and humility of character necessary in the promotion of a patient’s overall health and well being…Doctors today have a need for adaptability that never was present before but that being said… I believe that more and more it is up to the patient to be an active participant in their own care and treatment.”

Another of my patients writes: “The Art of Medicine is projecting a quiet but strong confidence such that the patient never doubts a positive outcome”.

From an anaesthetist colleague: “The art of medicine is the balance of science, skill, passion and compassion”.

From a surgical trainee: “The art of medicine is the ability to convince your patient that you recognize their humanity and see them as a complete human being.”

And from a first year student: “Medicine is a demonstration of love: love for humankind, curiosity for cure and a hope for the future”. Remarkable insight from a someone just beginning their studies and so very close to the words of Hippocrates, written over two thousand years ago, ”Where there is love for humanity,” he wrote “there is love for the art of medicine.”

And so, we learn from our teachers, we learn from our patients, we learn from our colleagues and we learn from our students. I’m sure you will agree with me that our responsibility as teachers is to ensure that the passion, commitment, and remarkable humanistic and artistic spirits that reside in all of our students, as they begin their journeys, just as we did ours, are nurtured, celebrated and supported at every opportunity.

My belief is that the art of medicine is about hearing as well as listening, about seeing as well as looking, about caring as well as treating and about feeling as well as touching. Perhaps, in no greater way is trust between a doctor and a patient expressed than in the laying on of hands  Touching is one of the most intimate acts that we perform as physicians. It is sacred, a defining moment, for in its action our patients know how much we care. They permit us to palpate, to percuss, to incise. My earliest memories as a medical student were watching the manner in which my teachers would touch their patients. The gentle holding of the hand, the taking of the pulse, the steady palpation to reveal the site of pain, the handshake of greeting that, with its strength, tells the patient, I am here and this moment is yours. This universal image of a student and a teacher communicating with their patient is one that I believe captures the essence of the art of medicine and one that I expressed to the students at the end of a graduation address I gave some years ago:

Listen and you will hear.
Look and you will see.
Touch and you will feel.
Treat and you will care.
Practice your art with compassion
And live your lives with passion.
Be a student always
And a teacher ever,
And your lives will be as fulfilled
And meaningful as any who have gone before
And any who are yet to come.”

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So dear followers and fellow bloggers if you made it to the end, thanks for reading all the way and learning more about this truly blest husband, father, grandfather, surgeon, teacher and artist.  As you know art is an important part of my life and has been since I was a young boy. Now that I am retired, although I do still teach and assist in surgery, I am able to spend more time in my studio and hope to continue to improve in the years to come.

Last week the subject I chose, not surprisingly, for the Weekly Photo Challenge: Future was my beautiful granddaughter who I hope one day will read today’s post and learn something about her besotted grandpa who loves her more than she could ever know.

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36 comments

  1. First: this was an exquisite self portrait, very special Andrew, I loved it. Next: this was an incredible post, thank you for sharing so much of your life and thoughts, it was uplifting and inspiring. Third: it is heartening to know people like you – are physicians caring for others and teaching the next generation to care! It would be a lovely thing, if all physicians would.
    What a marvelous post!! 🙂

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  2. Wow Andrew! I am beyond impressed! Not only are you an amazingly talented artist but you also served as a surgeon!!!! Wow. You truly are inspiring Andrew. 😊 Thank you so much for sharing more about your life. As someone who gets dizzy with the sight of blood and can’t imagine the years of training and hard work, you truly are admirable. And to have two talents! Beautiful speech.

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  3. The self portrait is really amazing – and the things you write about the art of medicine were quite inspiring as well… I am a first year student currently and can definitely relate to that 😉
    Thanks for this amazing post…

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  4. I truly loved this post Andrew. It says so much about you beyond the words you chose to include. You are a man of many talents my friend, and continue to amaze. You know I love your artistry and your medical painting is amazing–again saying so much more about you than a quick glance would indicate. And your note about your granddaughter actually brought a quick tear to my eye. Beautifully done Andrew, beautifully done

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  6. This portrait is my favourite of all the work I’ve seen from you so far. Beautiful “introduction”. 🙂 Also, I loved what the surgical trainee had to say. “The art of medicine is the ability to convince your patient that you recognize their humanity and see them as a complete human being.” There’s not enough of that in medicine. Come to think of it, there isn’t enough of that in any occupation.

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  8. Your self-portrait is wonderful – warm and intimate, cool and sterile at the same time. It reminds me of my own training, and your address brings back fond memories of your mentoring of my medical school class. Thank you for this.

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    1. Thanks Martina for your lovely comments, which are so very much appreciated. Those were some of the most rewarding years of my professional life having the privilege of getting to know you and all of your classmates. Hope all is going well for you. Warmest wishes as always.

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  10. As someone living with chronic pain and illness, I appreciate every word you have written in this post.
    I have come to learn and discern which of the many doctors and other medical professionals I encounter approaches their work as if it is an art; and how important each patient is to them by the way they touch, listen and speak to me, and the compassion they bring to each of our meetings.
    Your words tell me that your patients and students have been very fortunate to have you.
    Thanks so much for sharing this about yourself 🙂

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    1. Thanks for your moving comments, which are very much appreciated. Thank you also for visiting and your many other comments today. I wish you good health and send you my best wishes 🙂

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  15. I must say i stumble upon your page and am so happy, Love ur body of work. I personally come from a big artist family… Louise, Mike, Susan & (mom) Neith Nevelson… all different mediums of art sculpture, paintings and textiles….. I am just a pice of work, but Art is all to me. I have my own site here, its not painting but it is my own inspiration of art and magic. I truly love ur hand and how you have evolved from being a surgeon to artist. “Life is short, the Art is Long” truer words could not have been said, and the laying of hands from doctor to patient is so important, it is trust. I who nursed the elderly for many years know this and this job brought me to Le Marche Italy where I reside now. I loved what you wrote above, we are all teachers, students from the time we are born to the time we transcend. I say this because as also a mother of now a 27 yr old, she taught me things as a baby without even knowing and thankfully I am open minded enough to have learned and am still learning from all who i encounter everyday.
    “Life is the greatest game we will ever play, we win by getting through it learning as much as we can along the way”
    Thank you Andrew for having this place here, I am glad i stumbled upon it.
    Issa

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    1. Thank you Issa for all your lovely comments and welcome to thechangingpalette 🙂 As you can see we are Italophiles and would happily live in your beautiful country. We have happy memories of visiting Le Marche which is one of the jewels of Italy. Sending you warmest good wishes…Andrew

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  16. I visited one of our universities open days with my daughter who is about to become a student. I could feel her excitement as the different lecturers did their best to attract the best students to the best course being theirs.. I will ask her to read this.

    Just a remark; I am glad I was not the patient when you did the self-portrait. Didn’t you get confused with the scalpels am brushes 🙂

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  17. I needed to read this as a patient for I am reading Gabor Mate’s book on The realm of a hungry ghost. It takes so much as a person never mind as a physician to heal. As for art on painting, I thorough enjoy paintings since my brother is one and we will be visiting Art Vancouver in April.

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