At Some Medical Schools, Humanities Join the Curriculum
By RANDY KENNEDY
Published: April 17, 2006
Art and medicine have worked hand in hand for a long time. To improve his
art, Leonardo dissected bodies. To improve his anatomy treatise, Andreas
Vesalius relied on the artistry of Titian's workshop.
But the other day, in the European paintings wing of the Metropolitan Museum
of Art, a group of seven would-be doctors had a different kind of reason to
appreciate the 17th-century Dutch biblical scene before them: course credit.
Three years ago, the Mount Sinai School of Medicine began an
art-appreciation course for medical students, joining a growing number of
medical schools that are adding humanities to the usual forced march of
physiology, pathology and microbiology.
This year, for the first time, the course is required for third-year
students, providing them not only with a blinking-into-the-sun break from
medical rotations but also, said Dr. David Muller, the school's chairman of
medical education, a lesson about how important, and underrated, the art of
looking is to the practice of medicine.
"To make a better doctor means to me — and I can't speak for everyone — one
who sees the person and not just the patient," he said, "not just an organ
system that is screwed up."
The course is similar to ones established in the last few years at Yale,
Stanford, Cornell and a few other medical schools, but traditionalists at
Mount Sinai have not always looked favorably on it.
When asked why, Dr. Muller said, "I think if I answered that question
strategically, I would say that in any big medical center there is always a
very broad spectrum of opinions."
But at least one study, published in The Journal of the American Medical
Association in 2001, has found that looking at painting and sculpture can
improve medical students' observational abilities.
It could also, wrote Dr. Irwin Braverman, a Yale medical professor and an
author of the study, eventually help apply some salve to that long
suppurating wound, health-care costs. "With heightened observational
skills," he wrote, "physicians can often ask the questions necessary to make
correct diagnoses without relying too much on costly blood tests and
Such utopian hopes seemed a distant concern for the seven students who
gathered in the Met's lobby on a sunny afternoon. They had other things on
their minds: all had survived a grueling surgical rotation but were
approaching the time when they would have to pick a specialty.
"Not only do we have to learn what we're learning but we have to remember
how to write a C.V. again and basically decide what we're going to do with
the rest of our lives," explained Risa Small, 24, one of the students,
summing up the year.
So a few minutes later, standing in front of Nicolaes Maes's "Abraham
Dismissing Hagar and Ishmael" (1653), a dark scene of high Baroque drama,
they seemed happy to lose themselves in the painting and to wonder aloud
what was happening in it. Shirley Delaleu, 25, pointed out the brooding
late-evening sky in the background and how Ishmael's body awkwardly twisted
as he descended a set of stairs away from Abraham, his father.
"It just looks like there's this great big world that he has to go out into,
and it looks ominous," she said.
With the typical ardor of medical students, others pointed out that all
three figures wore some red clothing, that they didn't make eye contact with
one another, that their figures formed a triangle, that Hagar looked
alternately angry and ashamed, that she was the only one who went barefoot
and that her hands were rough and manly, making it hard to tell whether she
was a man or woman.
Rebecca Hirschwerk, an art educator who is the course's instructor and one
of its creators along with Dr. Muller, explained that the idea for the
course developed while her husband was a resident at Mount Sinai. She began
to think about how, in listening and poring over charts, doctors sometimes
had little time actually to look at their patients, especially under the
pressures of today's managed medical care.
"I can't think of many places outside art where you can be in a moment, and
just look, for as long as you can take it," she said. "Think about what it
would be like if you were with a patient and could freeze the moment to
really pay attention to everything that patient was trying to tell you. It's
hard to do when you have only 15 minutes with patients, 20 times a day."
Partly intended to make better doctors by making better-rounded human
beings, such art courses are being joined by other, mostly elective
humanities courses — and in some medical schools, like the one at the State
University at Stony Brook on Long Island, whole humanities departments —
that bring playwrights, poets, actors, philosophers and other imports from
the liberal arts into the world of medicine.
Ms. Hirschwerk said that in choosing the eight works that the students see
in two visits to the Met, she tried to stay away from blockbuster paintings
that might be too well known. Works like the one by Maes, she said, had
enough ambiguity, body language and detail to reward long observation. On
that particular visit, she next led the students to another Dutch Baroque
work, by Gerard ter Borch, of a preening young woman and her maid, and then
to Giacometti's spectral "Three Men Walking II" from 1949, before ending at
"The Proposal," a light-infused genre painting of a man and woman by Adolphe-William
Bouguereau, a 19th-century French painter.
Ms. Hirschwerk asked the students to study "The Proposal" for several
minutes and then to turn away from it and recall the painting's details,
which they did in great detail, from the cat sitting at the woman's feet to
the almost invisible strand of thread stretched between her fingers.
Dr. Muller said that students were not graded in the class, in part to give
them a break from their academic grind, and so it was hard to tell whether
their art-appreciation was improving their diagnostic skills. But in
anonymous journal entries from previous classes, the students — who take the
course during their geriatric rotation, making home visits to elderly
patients — seem to pay closer, and more empathetic, attention to their
"It was clearly taking a toll on her, and she was close to tears several
times during the interview," one student wrote, of seeing a patient with
Alzheimer's disease, and talking to the man's wife. "Her husband sat next to
her apparently oblivious to her distress. He was distracted, quietly picking
a piece of tape with his name off his cane."
For the most part, the students seem relieved to have a chance to leave any
thoughts about medicine and disease outside the door of the Met. "It sort of
reminds me of life before medical school, back when you were still a regular
person," said Komal Kapoor-Katari, 27.
But their profession was never far away.
In front of the Maes painting of Abraham, Ms. Hirschwerk explained that she
had chosen it because it showed a moment of decision, one that — according
to the biblical story — would be fateful for world history. Then she steered
that weighty theme back to the students themselves.
"There's a chain of reaction for every decision that you make, and you're
part of that chain yourself," she said.
The observation was met with a long silence, one possibly filled with
thoughts of malpractice.
"Well, on that happy note," she said, finally breaking in, "let's go look at
the next painting."