Published by
Stanford Medicine

Author

Medical Education, Medical Schools, Medicine and Society, Stanford News

Engaging with art to improve clinical skills

Engaging with art to improve clinical skills

med students looking at paintingThe scene: A group of medical students huddled around the iconic Robert Frank photograph Car Accident – U.S. 66, Between Winslow and Flagstaff, Arizona in the Cantor Center for the Visual Arts. They’re being led through an observation exercise by Sarah Naftalis, a doctoral student in art and art history at Stanford, as part of an innovative new medical school course supported by the Bioethics and Medical Humanities Scholarly Concentration.

Naftalis asks students what they see as she gestures to the photograph, which appears to have as its focal point four people standing out in a field, looking at something under a blanket on the ground. Several students note the people, the odd lumpiness of the blanket and the reduced horizon. Second year medical student Sam Cartmell says, “Well there may be more than four people,” and points to an odd contour at the shoulder of the lone female in the photograph. Cartmell’s observation sparks a lively debate, as his fellow students take turns looking closely at the work, seeking to discern what Cartmell has seen.

The concept behind this class is so important. If medical students can grasp these observation skills, it will really serve them well in their residencies and beyond.

That moment, explains Naftalis, illustrates the “productive ambiguities of art,” as well as the benefit of engaged close looking without “rushing to assign meaning to what we see.”

The practice of engaged close looking as a means to improve observational skills is a key goal of the course, which includes gallery sessions facilitated by doctoral students from the Department of Art and Art History at Stanford paired with a clinical correlate hour where School of Medicine faculty members applied the lessons of the art gallery portion to the clinical setting. Physicians from family medicine, orthopedics, dermatology, pathology and anesthesiology led discussions on a range of topics including narrative, body in motion, skin and tone, and death.

“The thematic organization was meant to inspire conversation across disciplines, by putting two takes on a similar theme in proximity to each other for two hours,” explains art history doctoral student Yinshi Lerman-Tan, who helped develop the course. “Bringing medicine into the space of the museum was a great aspect of the course – simply allowing different bodies of knowledge to exist under one roof. The medical students would sometimes use clinical vocabulary or concepts to describe works in the gallery, making for an interesting range of language in our discussions.”

Cartmell said one important take away for him from the course, which is called “The Art of Observation: Enhancing Clinical Skills Through Visual Analysis,” was learning to observe without jumping to interpretation. “I was surprised at how strong the impulse was to interpret the work, before I had actually observed the entire piece,” he says. The exercises the instructors led us through, describing what we saw objectively without commentary, really forced me to slow down and really see what was in front of me, without jumping to conclusions or interpretation.”

Continue Reading »

Medical Education, Medical Schools, Stanford News

Stanford Medicine Music Network brings together healers, musicians and music lovers

Stanford Medicine Music Network brings together healers, musicians and music lovers

sarahkenricMore than 100 physicians, students and members of the Stanford community gathered last week at the Li Ka Shing Center for Learning and Knowledge for the inaugural concert of the Stanford Medicine Music Network.

During the event, Lloyd Minor, MD, dean of the medical school, told the audience, “It is so gratifying to be here this evening, and to see that musicians in the medical community have a means to continue to play and perform.” Music was a big part of Minor’s life in medical school and he played the cello in a musical trio that played at various events during that time.

The network was launched last year after Minor and Steve Goodman, MD, PhD, associate dean for research and translational science, discovered they both attended a 1976 cello performance by Yo-Yo Ma, who was then a student at Harvard. The shared memory inspired them to establish a musical home for the medical community. They joined forces with Audrey Shafer, MD, professor of anesthesiology and director of the Medicine and Muse Program, and Ben Robison, a medical student and professional violinist, and created the Stanford Medicine Music Network (SMMN, pronounced “summon”).

Among the goals of the network are to connect musicians for group practices, organize chamber music and string quartet groups and stage performances at Stanford and in the surrounding community in an effort to contribute to healthy communities.

The concert featured classical and contemporary music as well as a special gift presentation by Charles Prober, MD, senior associate dean of medical education, thanking medical student Kenric Tam and his parents, Carol and Kingsang, for their generous donation of a grand piano. The piano, which will reside outside Paul Berg Hall, will be available for events and members of the Stanford Medicine community to play.

As the program ended, Goodman noted in his concluding remarks that the word “summon” describes multiple aspects of what the network represents. “As musicians, we are summoned to perform, and this in turn summons those who care to listen,” he said. “As physicians and medical students, many of us are answering a summons we felt to care for others, and I think keeping music in our lives allows us to do a better job of that.”

Previously: Stanford’s Medicine and the Muse symposium features author of “The Kite Runner”“Deconstructed Pain:” Medicine meets fine artsStanford network launched to connect musicians, music lovers and What physicians can learn from musicians

Events, Medicine and Literature, Stanford News

"Deconstructed Pain:" Medicine meets fine arts

"Deconstructed Pain:" Medicine meets fine arts

Gernod_Weis_Oel_auf_Leinwand_150x200_1995Stanford’s medical school is just steps away from Stanford’s arts corridor, home to the Cantor Art Museum and the newly opened Anderson Collection at Stanford. This proximity results in a cathartic intersection between the arts and medicine, a connection captured by two recent events sponsored by Stanford’s Medicine & the Muse Program in Medical Humanities and the Arts.

The first event featured doctors and medical students reading poems they had written that were inspired by the paintings in the Anderson Collection at Stanford. The poetry reading included a performance by Stanford’s Musicians in Residence, the St. Lawrence String Quartet.

The second event, a gallery talk titled Honoring the Ghosts, celebrated Veteran’s Day by exploring the relationship between war trauma and art, through the paintings of the late Frank Lobdell, a World War II veteran and Stanford emeritus professor. The gallery talk, the first to take place in the Anderson Collection at Stanford, was an interdisciplinary event sponsored by Medicine & the Muse, the Stanford Arts Institute and the Anderson Collection. The event drew an overflow crowd, including World War II Veteran Genero Felice, Stanford student veteran Steven Barg and his wife, Shannon, also a veteran and Stanford physican John Scandling, MD, who majored in art history as an undergraduate.

The talk was introduced by Alexandar Nemerov of Stanford’s Art & Art History Department. Nemerov’s father, Howard Nemerov, was a World War II veteran who wrote about his war experiences, eventually winning a Pulitzer Prize for poetry. The audience listened intently as Sarah Naftalis, a doctoral student in Art & Art History, described Lobdell’s horrific World War II experiences: Part of a liberating party for the concentration camps in Germany, Lobdell’s unit came upon a burned barn full of concentration camp victims the Nazis did not want to be freed.

That experience influenced Lobdell’s work, and indeed, he stated that he worked out his war trauma “on the canvas.”

War trauma was also explored in the art, poetry and music event, when Hans Steiner, MD, used Jackson Pollack’s Lucifer as inspiration for his poem dedicated to his relatives killed in World War II.

Continue Reading »

Events, Medicine and Society, Stanford News

On death and dying: A discussion of "giving news that no family members want to hear"

On death and dying: A discussion of "giving news that no family members want to hear"

The standing room only crowd at the Stanford Humanities Center had come to hear physicians read their own writing about the most difficult of topics: “I Am Afraid I Have Bad News: Death and Dying in Medicine.” The enthusiastic response to the topic demonstrated the interest in and need for such a forum. “This is a topic we just don’t talk about enough, in medicine and in society,” said Ward Trueblood, MD, a member of Stanford’s Pegasus Physician Writer’s group who curated the event.

Trueblood’s own experiences as a trauma surgeon, particularly during the Vietnam War, affected him deeply. “When I went to medical school, they didn’t teach you about death and dying,” he explains. Trueblood has found writing to be a powerful way to process his experiences. His memoir, Blood of the Common Sky: A Young Surgeon in Vietnam, will be published this year, and his book of poetry To Bind Up Their Wounds is available on Amazon. Trueblood appreciated being able to give fellow physicians an opportunity to share their experiences with death and dying through personal poetry and essays.

Gregg Chesney, MD, a critical care fellow, read two poems, including “Lost in Translation”:

In trying to explain how “she hit the floor with a thud”

now means “she never woke up

and never will,” something was lost.

Yes, that is her heart tracing its beat across the monitor, but that swollen tangle

of blood, wrapped and knotted at the base of her brain

has pressed the leafless stalk of her medulla and left her

brain dead.  There is no one-more-test, no

chance-for-recovery, but at 2am, rendered in secondhand Mandarin,

that point might be missed, or left to dangle precariously,

soured and unplucked,

as he works out how to raise a 3 year-old on his own.

As Chesney finished the poem, his six-month old son cooed in his mother’s arms. The irony of the moment was not lost on the audience, as they contemplated the fate of the young father in Chesney’s poem.

Bruce Feldstein, MD, Stanford’s hospital chaplain, read “At My Father’s Bedside,” in which he shared what he had learned from his patients with his dying father:

The moment itself is peaceful, I’m told. No fear. Simply letting go. Smooth, like a hair being pulled from milk… You know, we human beings have been dying for a long time. Your body has a natural wisdom built right in for shutting itself down. The body knows just what to do. And there are medicines along the way to keep you comfortable.

During the Q&A session, an audience member asked Feldstein if there was anything he wished patients knew about their physicians. “Yes, how much doctors care,” Feldstein responded. “And that this effects them too. How difficult it can be to be the medical professional in that instance, giving news that no family members want to hear about their loved one.”

Continue Reading »

Medicine and Society, Stanford News

Man on a mission: Working to help veterans who have lost limbs

Man on a mission: Working to help veterans who have lost limbs

vet - smallerThe student riding the Segway stands out on the bicycle-laden Stanford campus. His short hair and erect bearing suggest he is a veteran. The prosthetic legs that extend from his torso to the Segway stand confirm it.

I had seen Dan Berschinski one day on campus and asked Tim Hsia, student president of the Military Connected Network, if he could introduce me. Berschinski, I learned, had just finished his first year at the Stanford Graduate School of Business – and he’s on a mission. As was highlighted in a CBS News story last fall, he’s at Stanford to learn how to grow his current business into a thriving enterprise, hopefully one that employs veterans with disabilities.

Ever since he woke up in Walter Reed National Military Medical Center after having his legs blown off by an improvised explosive device (IED) in Afghanistan, the West Point graduate has been thinking of ways to help veterans.

“Look, I was an officer,” he told me recently. “I couldn’t sit there feeling sorry for myself. My soldiers were still in Afghanistan, still getting killed. And the hospital was full of guys with injuries as bad or worse than mine.” Berschinski was sitting with me at a campus cafe, his Segway and cane propped against the door. The fact that he’s able to walk on his prosthetic legs is a miracle, although, he said with a small laugh, his doctors were hesitant to use that word. “Let’s just say that nobody with my injury has ever walked out of Walter Reed,” he said, hands firmly placed on his thighs.

Berschinski’s right prosthetic leg attaches to his hip – there was nothing left of his leg to salvage. On his left side, he must force the portion of his thigh that is left into a sleeve. He explained this all to me matter-of-factly. In fact, Berschinski is quick to point out that he feels lucky. Pointing to his left hand, which is missing a finger and is marked by a large portion of a skin graft, he said, “Hey, they were able to save this hand. If they hadn’t, I would be a triple amputee.” Shaking his head, Dan continued, “Those guys have it rough.”

The use of IEDs and the length of the wars in Iraq and Afghanistan mean that there are veteran amputees in numbers not seen since the Civil War. But in a society where only less than 1 percent of the population participated in those wars, these veterans are somewhat invisible. Berschinski is out to change that by raising the visibility of veterans who have lost limbs. In addition, he wants to shine light on civilian amputees, particularly children, who often cannot afford prosthetics. He serves on the board of the Amputee Coalition, using what he describes as this “new change in my life” to help others who he believes aren’t as fortunate as he. “I have the advantage of being cared for by the government. I have access to cutting edge prosthetic limbs and care. Most people don’t have that.”

Asked if he has advice for current medical students who might be treating patients who have lost limbs, he was quick to answer. “Yes. Your optimism, and your support are critical. Yes, the medical skills are important. But you have to understand that patients are looking to you for hope. And don’t ever underestimate the willpower of your patients. Certainly don’t give up on them.”

Jacqueline Genovese is assistant director of the Arts, Humanities, and Medicine Program within the Stanford Center for Biomedical Ethics.

Previously: Battling hearing loss on and off the battlefield and Stanford graduates partner with clinics in developing countries to test low-cost prosthetic
Photo courtesy of Dan Berschinski

Events, Mental Health, Stanford News

A campus-wide call to pause and reflect

A campus-wide call to pause and reflect

contemplation by designA friend once said to me in her warm Virginia drawl, “You know Jacqueline, there is a whole other world  on the other side of STOP.” I found out how correct she was when a severe back injury forced me to stop my hectic, stress-filled schedule. It was a tough way to learn a valuable lesson, but I wouldn’t change those pain-filled days given what they taught me about the importance of getting off the merry-go-round of activities that I thought I had to do.

On Friday, those in the Stanford community will be given a glimpse of that world on the other side of STOP without injury, by participating in the Carillon Concert and Quiet Contemplation. Everyone on campus is invited to gather at 11:30 AM for a Carillion Bell concert, a chance to relax, do some tai chai, win some raffle prizes, and most of all STOP and contemplate. Attendees are encouraged to bring a mat and a desire to “take a chill pill” as my children would say.

And for our far-away readers: You, too, are encouraged to, in the words of the event organizers, “pause, reflect and take time to unwind.”

Jacqueline Genovese is assistant director of the Arts, Humanities, and Medicine Program within the Stanford Center for Biomedical Ethics.

Medicine and Society, Stanford News

Stanford network launched to connect musicians, music lovers

Stanford network launched to connect musicians, music lovers

Minor playing celloThis week marks the launch of the Stanford Medicine Music Network, an online meeting place for musicians in the Stanford health-care community looking to share their love of music. An e-mail invitation went out yesterday from SMMN (pronounced “summon”) co-founders, asking for musicians and music lovers to join in to build community and provide opportunities for other musicians to play and perform with them.

The goal of the network is for musicians to eventually perform in the surrounding communities, particularly in schools and nursing homes where music has been cut back or is not available. There’s more about SMMN in this Inside Stanford Medicine story.

Jacqueline Genovese is assistant director of the Arts, Humanities, and Medicine Program within the Stanford Center for Biomedical Ethics.

Previously: Intersection of arts and medicine a benefit to both, report finds, What physicians can learn from musicians, More than medicine: Medical students embrace their artistic passions through unique program, The benefits of the arts to both patient and practitioner and Stanford neurologist rocks out for science
Photo of Lloyd Minor, MD, dean of the School of Medicine, by Mark Hanlon

Events, Medicine and Society, Stanford News

Medical students and author Khaled Hosseini share their muse with Stanford community

Medical students and author Khaled Hosseini share their muse with Stanford community

"Giving UP! "Say Something" by A Great Big World at An evening with Medicine and the Muse at Paul and Mildred Berg Hall, Li Ka Shing Center at Stanford School of Medicine on Wednesday, April 16, 2014   ( Norbert von der Groeben )When best-selling author Khaled Hosseini, MD, took the stage at Stanford’s recent Medicine and the Muse symposium, he smiled, shook his head and said, “Those student performances were amazing. I am not sure how I can follow that.” The performances Hosseini referred to were those of numerous medical students and included a soulful dance set to the song “Say Something” by Great Big World, an emotional spoken word poem, a performance of Chopin, a documentary film clip, an opera singer, and a playful dueling instrumental performance featuring an Indian drum and violin.

In addition to these performances, art and photography created by medical students was on exhibit in the lobby of the Li Ka Shing Center for Learning and Knowledge. One art piece was a tree adorned with thank-you notes written to patients by several fourth-year students. One note read:

It’s unfair that all I can say is “Thank you”
Because I learned and benefited from…
your pain
your illness
your despair
your secrets
your body and mind and spirit
I am honored to have had a chance to care for you, learn from you, and witness your resilience

Hosseini himself had a chance to see one of his former patients, who came to the event and brought his medical record for Hosseini to sign. “I guess I did all right for you,” Hosseini laughed, “You are here.”

Before the book-signing, the overflow crowd was silent and attentive as Hosseini answered questions about his writing and Afghanistan posed by Paul Costello, chief communications officer for the School of Medicine. Hosseini shared that as a 15-year old coming to America from Afghanistan, he struggled. “To be a 15-year old in an American high school, not knowing how to speak English. That was tough. I was invisible.” When Costello asked Hosseini about his hope for Afghanistan, particularly after the April 5 elections, he said, “I hope there is a new future for Afghanistan. A future of peace, not war. Did you know that 64 percent of the Afghan population is under the age of 24? And their heroes are people like Steve Jobs… There is so much more to the country of Afghanistan than what is portrayed on television.”

Several students and spouses in attendance were also veterans of the U.S. War in Afghanistan. Shannon Barg, who served in the U.S. Army as a Blackhawk helicopter pilot and is participating in a writing workshop for student veterans sponsored by the Arts, Medicine and Humanities program, brought the copy of The Kite Runner she had read “over and over” in Afghanistan for Hosseini to sign. “That book was so important to me over there,” she said. “I can’t believe I had this chance to meet him.”

A conversation with Khaled Hosseine  and Paul Costello meets during an evening with Medicine and the Muse at Paul and Mildred Berg Hall, Li Ka Shing Center at Stanford School of Medicine on Wednesday, April 16, 2014   ( Norbert von der Groeben )Hosseini also shared his writing routine. “I write every day. Writing is very blue collar. You have to show up every day, and you have to put the work in.”

When asked about his days as a physician, Hosseini joked that his patients would spend more time talking to him about his books than about their ailments. “So I had to step down, for the sake of their health.” Although he derived satisfaction from helping patients as a medical doctor, Hosseini believes he can perhaps have a further reach with the humanitarian work his writing allows him to pursue. He has established the Khaled Hosseini Foundation to bring humanitarian assistance to the people of Afghanistan, building shelters for refugee families and providing economic opportunities, education, and health care for women and children of Afghanistan, and he recently wrote about his work with Syrian refuges in a New York Times op-ed.

“We are all part of humanity,” Hosseini said, “And we should try to help one another.”

Jacqueline Genovese is assistant director of the Arts, Humanities, and Medicine Program within the Stanford Center for Biomedical Ethics. Medicine and the Muse 2014 was made possible by the generous support of Stanford School of Medicine, the Medicine & the Muse Medical Humanities Program, Stanford Center for Biomedical Ethics, the Biomedical Ethics and Medical Humanities Scholarly Concentration, the Drs. Ben and A. Jess Shenson Funds, and a Stanford Arts Institute SPARK Grant.

Previously: Intersection of arts and medicine a benefit to both, report finds and Stanford’s Medicine and the Muse symposium features author of “The Kite Runner”
Photos by Norbert von der Groeben

Events, Medical Education, Medicine and Society, Neuroscience, Stanford News

The brain whisperer: Stanford neurologist talks about his work, shares tips with aspiring doctors

The brain whisperer: Stanford neurologist talks about his work, shares tips with aspiring doctors

Parvizi at MS 101 - smallJosef Parvizi, MD, PhD, knows firsthand how art can influence medicine. While at a concert featuring music created by digitizing space sounds, he was inspired: “Why can’t we make music by digitzing brain waves?”

Parvizi, a neurologist who specializes in epilepsy, told local high-school students attending Stanford’s Med School 101 recently that the beauty of being a physician-researcher at Stanford is that you’re “surrounded by brilliant people in all areas.” So he took his literal brainstorm to Chris Chafe, PhD, in Stanford’s music department, and the result is a newly patented “brain stethoscope” that can translate brainwaves into music. Parvizi demonstrated the difference between normal brainwave music and the music produced by a brain experiencing a seizure in this YouTube video about the research.

In addition to the brain stethoscope, Parvizi has developed a procedure utilizing electrodes to detect the exact area of the brain that is causing the seizure, and then working with brain surgeons to operate on the affected area. At last week’s event he told the story of a patient who for 20 years had seizures that caused her leg to flail out to the side, greatly limiting her ability to do the things we take for granted every day, like driving or taking a shower. Showing a picture of the happy patient in her car holding up her driver’s license, Parvizi said, “This patient has been seizure-free for six years, driving and enjoying life like never before.”

Parvizi described being a physician-researcher this way: “Like riding two horses standing up with one foot on each horse, you have to keep your balance and it takes some skill.” But, he says, being a physician-researcher allows you to help thousands of patients with your research, and one patient at a time with the application of that research.

He advised the students to “do work you are excited about,” and in looking for a mentor, “be persistent, not pushy.” Parvizi told the story of how as a medical student he contacted the pioneering cognitive neuroscientist Antonio Damasio, MD, PhD, after reading his ground-breaking book, Descartes’ Error. “This was before the Internet, so I wrote to him and sent him faxes. I finally called him and told him I would be coming to the States and would like to meet with him. He told me he would give me 15 minutes. I told him, ‘I am coming all the way from Norway,’ and he said, ‘I will give you 15 minutes.’” That meeting set the course for Parvizi’s career, a career he clearly relishes.

“It took me 22 years of school and training, and that sounds like a lot, but it went by fast because everything is so interesting and exciting,” Parvizi told the group. Snapping his fingers and smiling, he said, “It went by just like that.”

Jacqueline Genovese is assistant director of the Arts, Humanities, and Medicine Program within the Stanford Center for Biomedical Ethics. Parvizi and Chafe will be demonstrating their brain stethoscope on April 29 from 5:30-7 PM at the Center for Computer Research in Music and Acoustics, as part of  the program’s Recombinations series.

Previously: At Med School 101, teens learn that it’s “so cool to be a doctor”, How epilepsy patients are teaching Stanford scientists more about the brainImplanting electrodes to treat epilepsy, better understand the brain and Ask Stanford Med: Neurologist answers your questions on drug-resistant epilepsy
Photo by Norbert von der Groeben

Medicine and Society, Mental Health

Examining House of Cards' Frank Underwood, "a textbook case of antisocial personality disorder"

Examining House of Cards' Frank Underwood, "a textbook case of antisocial personality disorder"

Shaili Jain, MD, is a Stanford/Veterans Affairs Palo Alto Health Care System psychiatrist and a fan of the television show “House of Cards.” These two worlds come together in a recent blog entry she wrote on Kevin Spacey’s sociopathic character and the psychiatric diagnosis of antisocial personality disorder. Jain, an affiliated faculty member of Stanford’s Program on Arts, Humanities, and Medicine commented to me that the show represents a compelling example of the intersection of entertainment and medicine.

Noting in her Mind the Brain blog post that she always likes to “explain misunderstood psychiatric concepts or diagnoses, and to clarify when a psychiatric term is used incorrectly or prone to misinterpretation,” Jain writes:

While enjoying the second season of House of Cards, I could not help but notice how Kevin Spacey’s character, Frank Underwood, meets a textbook definition of Antisocial Personality Disorder (ASPD). Inspired by Spacey’s tremendous performance, I thought I would venture forth and use this example of a central character in a drama to illustrate this misunderstood and, often, underestimated psychiatric disorder. Individuals with antisocial personality disorder (or sociopaths) are difficult and dangerous; they deny, lie, and contribute to all manner of mayhem in our communities and societies. They know full well what is going on around them and know the difference between right and wrong (and hence are fully responsible for their own behaviors) yet are simply unconcerned about such moral dilemmas.

When Frank wants something or needs to manipulate someone, he is able to “switch on” the charm in an instant.  He conveys to others that he cares deeply about them by flashing an infectious smile and being gracious and attentive.

And, as season 2 showed, there were many who fell prey to his deceit…not least of all the President of the free world. Perhaps nowhere is his charisma more evident that in the perverse loyalty of those in his inner circle; all turn a blind eye to what he is capable of and appear to be utterly captivated by his personality and presence.

Jacqueline Genovese is assistant director of the Arts, Humanities and Medicine Program within the Stanford Center for Biomedical Ethics.

Stanford Medicine Resources: