When a patient comes to see a GP they tell a story, their narrative. Sometimes it is a quick story, sometimes it is long and complicated and sometimes they tell us their story in chapters over a number of weeks.
They may tell their story in words, however, sometimes they tell us by their actions or emotions. For some patients the story is easy to tell, but sometimes it is hard and they may tell it through pauses and silence.
The more we can understand a patient's story, the more we can help the patient in terms of reaching a diagnosis and negotiating an appropriate management plan.
Studying a book, film or picture allows a better understanding of the characters involved and their story. By developing our skills in analysing and interpreting the story in a picture or book we are increasing our chances of being able to analyse and interpret the story a patient is telling us. Better understanding of a character in a book or film that reminds us of a patient may also give us a different insight into that patient.
Literature
Dr John Salinsky is a GP in London and is the author of Medicine and Literature, a book about his favourite classics.1 Dr Salinsky writes that the wisdom and insight of the great writers helps him achieve a better understanding of human emotions and behaviour.
His book includes suggestions on how reading the classics can be incorporated into a teaching session, and sometimes suggests reading a chapter, the whole book or seeing the play.
Books that are partly about doctors can be chosen but it is important to remember that the doctor or medical aspect of the book is only part of the story and the story needs to also be considered as a whole to get more enjoyment and meaning from it.
He suggests it is also useful to better understand the author. Those of us who want to know about who created the story and characters are likely to be the doctors who want to know more about the patient and the symptoms and signs.
Art
Earlier this year, the BMJ's picture of the week was Vincent Van Gogh's Trees in front of the entrance to the asylum painted in 1889 when he was in a sanatorium.
Van Gogh wrote about this painting: 'This combination of red ochre, of green saddened with grey, of black lines that define the outlines, this gives rise a little to the feeling of anxiety from which some of my companions in misfortune often suffer, and which is called seeing red.'
Just as we listen to a patient's narrative, a work of art is telling a narrative in a different way.
Literature and art together
A combination of using books and visual art in medical education is to use comics.
In an interesting article earlier this year, authors Green and Myers talk of 'graphic pathographies' which are illness narratives in graphic (comic) form.2
Graphic pathographies are another tool to increase observational and interpretive skills and have an important role in education by conveying understanding in a different way to the conventional written word.
These can also be used to help patients understand what to expect from a certain disease.
Green and Myers state that 'to read a comic effectively you must understand not only what is overtly seen and said but also what is implied'.
I think the same advice would apply to any GP consultation.
Evidence?
Currently, there is no definitive evidence to prove that involvement in arts changes the way GPs practise medicine.
The GP curriculum is already very detailed and including the arts in the curriculum would add another pressure to training. Perhaps an involvement in arts is only appropriate for those who have an interest in it, find it a useful tool for learning and are prepared to do it in their own time.
Learning more about understanding the arts should be an option in GP training because medicine is an art. It is the art of interpreting words, actions and emotions to allow a story to unfold so its true meaning is understood and the story can continue.
- Dr Carter is a GP locum in West Yorkshire
References
1. Salinsky J, Heath I (foreword). Medicine and literature: The Doctor's Companion to the Classics. Oxfordshire, Radcliffe Publishing Ltd, 2002.
2. Green MJ, Myers KR. BMJ 2010; 340: c863.
