Focusing on visual cues from our patients can help us to better understand them. Closely looking at art is one way that a clinician can improve their observation skills.
Art history methods can provide insights and skills you can transfer to your clinical work. Some of these methods are obvious, such as the development of a keen sense of observation, but there are other shared skills used in both art history and medical practice.
Both fields are bound by the need to observe and understand a given body or object in light of environment and context. Patients, like paintings, must be considered in relation to their context and this involves researching history and an understanding of cultural, social, and symbolic mores. Art historians and clinicians conduct research and collect data, but are also trained to find and identify visual clues that give critical information about your subject. The following is a short case study demonstrating how studying art history can provide transferable skills to enhance clinical judgement.
Case study: “The Doctor’s Visit,” by Jan Steen (1660-1665)
There is a doctor taking the pulse of a young woman inside a 17th century Dutch home. These two main characters are surrounded by other people, likely the young woman’s family and a servant inviting a young man to enter the room. The clothing and furnishings (painting, mirror, musical instrument, textiles, etc.) suggest a financially secure middle or upper-middle class family.
Some historical context
Jan Steen was a 17th century Dutch genre painter who lived near the University of Leiden, famous in Europe at that time for their medical faculty. While students came from all over to study medicine in Leiden, former butcher-surgeons or “quack doctors” took advantage of the proximity, setting up practices in the area and claiming to have university trained medical knowledge. Genre painters specialized in scenes of ordinary, everyday life, but also included some hidden messages, ranging from moralizing to humorous. These buffoonish quack doctors were a favorite target in Steen’s witty paintings.
Looking closely, there’s a world of hidden jokes and references in this painting that would have been immediately understood and enjoyed by the local community. The quack doctor’s formal clothing is a dead giveaway—he wears what would have been considered a pompous outfit in the hopes of being taken seriously in the home visit. The doctor’s facial expression shows concern in relation to the lethargic woman’s sudden increased pulse (as he misses the entrance of a young man entering the room behind him).
A series of objects in the foreground give important clues to the cause of the young woman’s physical distress. An open letter has fallen to the floor at the foot of the woman, a possible love letter from the gentleman entering the room. There’s a foot warmer in the lower left, an item that contains a range of symbolism relating to a woman’s marital status and overall availability in genre paintings of this era. A foot warmer with glowing coals hidden below a woman’s skirt identifies a married woman, whereas in this case, an empty footwarmer placed apart from a woman signifies she is single. The red brazier pot in the lower center contains the patient’s urine along with a ribbon or piece of fabric. This was a primitive (and medically unsound) form of a pregnancy test—the doctor burned the urine soaked ribbon and if the patient felt nauseous from the smell, she was deemed pregnant.
While the quack doctor keeps his eyes glued to the patient, he’s oblivious to the visual clues in the surrounding room. The others seem to know exactly what to diagnose and prescribe for the young woman’s condition. “Lovesickness,” pain or fever of the heart, was an actual condition discussed in medical essays of the time, and there was only one socially acceptable cure—intercourse via marriage. The older woman to the left plays music, a symbol of love, on the harpsichord while looking knowingly at the younger woman. The man on the right looks directly out at us, the viewer, with a bawdy laugh while holding a herring fish and two onions in his hands—a not so subtle reference to male genitalia. And finally, the maid ushers the young suiter into the room for the cure.
Studying art history provides transferable skills to enhance clinical judgement through observation/close looking, understanding your patient in context, i.e. their life history and cultural background. This will all allow you to identify and analyze all of the visual clues to better understand your patient in order to give better care.
This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.