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Diving into color, texture, shape // “diagnosing” a Pollock, a Turner, a Zoffany // boosting clinical observation // becoming better doctors.

Pictures at an Examination

By Meera Lee Sethi // Fall 2009
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zoffany, pictures at an examination


Before a physician even shakes a patient’s hand,” says Amy Ship, assistant professor of medicine at Harvard Medical School, “the opportunity for physical diagnosis begins.” An unsteady gait could signal ataxia; unusually pale skin, anemia. Even with blood and urine tests, CT and MRI scans, and myriad other diagnostic tools available, a physical examination remains crucial. In a recent study, it was clinical judgment, more often than testing, that led to a diagnosis.

Yet there are signs physical diagnosis skills may be fading. A study of top-tier first-year residents found that many had trouble performing 13 abdominal examination maneuvers.

If clinical observation is becoming a lost art, perhaps art could help reclaim it. More than a decade ago, Irwin Braverman, professor of dermatology at Yale School of Medicine, and Linda Friedlaender, curator of education at the Yale Center for British Art, created the Observational Skills Workshop, in which students amass visual clues to “diagnose” paintings, then apply the same process to patients. After two controlled studies demonstrated that the workshop significantly improved physical diagnosis skills, the class became a requirement for every first-year Yale medical student.

At Harvard Medical School, one of more than 20 schools that followed Yale’s lead, an elective—Training the Eye: Improving the Art of Physical Diagnosis—relies on a curriculum designed to help museum visitors and public school students become adept at seeing paintings and sculptures. The medical students learn to employ the same concepts to analyze visual clues associated with clinical ailments. The artworks that follow are a few of the dozens that are helping a generation of physicians look at patients first, test results second.

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