The Art and Science of Medicine

HELEN: Welcome to Talking About Blood. I’m Helen Osborne, host of this podcast series and a member of the advisory board for The Blood Project. I also produce and host my own podcast series that’s about health communication and it’s called Health Literacy Out Loud. Today’s guest is Brenda Moore-McCann. Brenda is a medical doctor, an art historian, and a writer. She also is an adjunct assistant professor at Trinity College in Dublin, Ireland. In 2008, Brenda inaugurated a medical humanities module that uses art as a teaching tool for first-year medical students. She’s published a number of papers on art and medicine. Like me, Brenda is an advisory board member of The Blood Project. She’s a very active participant as she directs the art interpretation section of that website. Brenda, welcome to Talking About Blood.

BRENDA: Hello, Helen. It’s a really great pleasure to join you and I’m honored to be asked to join the long list of prestigious people that you’ve already interviewed on your podcast. So, thank you for inviting me.

HELEN: Brenda, when I think about you, I think of that phrase I’ve long heard about the art and science of medicine. You’re a doctor, you’re an art historian. You seem to have both sides of that. Tell us more about your experience of how you embody the art and science of medicine.

BRENDA: Yes, it’s been a fascinating journey for me because I’ve been lucky enough to have had the opportunity to have training in two fields. Interestingly, these are very often in the public’s mind perceived to be quite different fields. But I would argue that in fact they have a lot more in common than is often realized. And I think probably a good place to start would be to use a quotation from William Osler, a Canadian physician who has many, many quotable quotations on medicine. And I think one that I was attracted to in terms of this particular discussion is that he said, “Medicine is the science of uncertainty and an art of probability.” Now, I like that very much because I think it gets to the heart of things.

HELEN: You talked about medicine is the science of uncertainty and the art of…

BRENDA: And an art of probability.

HELEN: Of probability. Do explain more to all of us. What are both of those sides about?

BRENDA: Well, I think there is the idea, since if you like the 17th century, because behind our ideas about medicine is ultimately philosophy. And the philosophy of medicine is very, very influenced in the last couple of hundred years by the philosophy of Descartes, the French mathematician and philosopher. And it was he that privileged rationalism and the intelligence as a way of getting to know what the world is about. And that has been a major influence in terms of how medicine has become more and more scientific and tries to use what we call the scientific method, because it’s believed that by using the scientific method, one is more likely to reach the truth of the matter. Now, however, there have been, of course, as always, opposing viewpoints, which haven’t got as much attention, particularly in Western thinking over the last couple of hundred years. And one particular person I would mention would be Giambattista Vico who was also 17th century. Now, he believed that, of course, it is important to use intelligence and the rational mind in terms of trying to understand and to acquire knowledge about the world. But he felt it was not adequate for all of the experience that human beings go through. In other words, it doesn’t incorporate enough of intuition, imagination, and things like that.

HELEN: So, thank you for that. You’ve taken us back several centuries for that. You’re talking about the philosophers and the scientific method.

BRENDA: Yes.

HELEN: Let’s bring art into that conversation, whether your own experience or if you want to bring in other notables along the way. How does art fulfill that other part of it?

BRENDA: I think, actually, that when I moved more formally into the humanities, mainly through art history and a study of Greek and Roman civilization, I began to become aware that this was a very different way of learning. And it was much less based on trying to reach certainty, because life itself, in most cases, has uncertainty as a formidable part of one’s experience. And I began to realize that the imagination and intuition and all the things that were not necessarily privileged within medicine was actually probably more important in trying to understand the world and gain knowledge. Some people say that science delivers knowledge about the world, whereas art delivers knowledge of the world, which is a nice way of putting it.

HELEN: Oh, isn’t that interesting? It’s a beautiful way of putting it. Bring this to today’s world. Can you give some very everyday examples of that intersection and that commingling of art and medicine?

BRENDA: Yes, I can. If you look at it from one point of view, let’s say we want to look at the point of view of art informing science. I’ll give you two examples, and probably there could be more, but I’ll give you two. There was a Spanish artist called Santiago Ramón y Caguel. I don’t know if that’s how you pronounce it correctly. He died in 1934. Now, he was a practicing artist, but he was also a medical doctor and a scientist. We know more about how our central nervous system works through his drawings.

HELEN: Through his drawings? Interesting.

BRENDA: Through his drawings, exactly, and not through his experimentation necessarily in the formal way. He’s now called the father of neuroscience, but he was an artist. He got the Nobel Prize in 1906. Then I could mention somebody probably more familiar to a lot of people is Louis Pasteur, who died in 1895. He was also an artist. I learned this only recently. He was an artist, and in fact it was his knowledge of particularly a type of printmaking called lithography. As most people would know, there are different ways of making prints, but basically you get a mirror image of the plate or the drawing that you are working on by application of various other colors and so on. But the image you get is a mirror image. It’s not exactly the same as the original. So it was his knowledge of lithography and the whole business of mirror images that led him to discover that certain molecules exist which actually can mirror each other. One molecule can mirror another, but he also noted, this is important, just like our hands look like mirror images of each other, but we cannot superimpose one on the other completely. It won’t work. But yet they look the same, but when we try and put one on top of another, they can’t, they don’t replicate. So he recognized that certain molecules are like that, and that led to his invention of pasteurization that was used initially in wine and beer and then subsequently in milk and then onto various vaccines and so on. So that’s an image of two artists contributing to science.

HELEN: That is fascinating. You and I have gotten to know each other a little bit on The Blood Project through our Zoom meetings.

BRENDA: Sure.

HELEN: I know a little bit about your background. As I introduced you, you’re both a medical doctor and an art historian. You bring both of those pieces together. What you may not or others may not know about me, there’s a part of me that very much wanted to be a doctor, but for lots of reasons I didn’t go in that direction. I also love the arts. So I went into a career in occupational therapy that brought the arts and science and medicine together. I am curious, just from your big picture, you’re talking about all these very famous people over the centuries. What do you think it is about some of us and maybe some of our listeners who have that humanities side to who they are and that science side? I mean, that’s even what The Blood Project is all about. It brings us a large component of information about humanities as well as the straight science. What characteristics do you think we have in common that we’re finding ways to bring in both in our world?

BRENDA: Well, I actually have come to believe that actually all of us have a creative side. All of us have imagination, intuition. But the thing is that some of us don’t realize it. Some of us realize it more than others, or it’s just a sort of innate sense of curiosity about more than just the subject at hand drives us to explore other avenues. There’s a very interesting–there was another Nobel laureate, I could quote Peter Medawar, who a lot of people would know of, and he once said that actually most scientific inquiry doesn’t end up the way it’s expected to. That in fact it requires a creative input to actually realize that what you thought you were looking for, you actually find something else. And we see examples of that. For example, the way penicillin was discovered. It was just serendipity that Fleming found the spores in a plate that had been left over the weekend, and this led to the discovery of penicillin. So sometimes chance–well, serendipity comes into things. But as Louis Pasteur says, “Chance favors the prepared mind.” So it’s back to that curiosity thing. If you’re on the lookout for something and you have an exploring mind, you’re more likely to find how fascinating that things are overlapping a lot more than you had originally thought.

HELEN: Thank you. And I want to ask you about some projects I know you’re very actively involved in as you teach medical students. And when I think of medical students, it’s probably someone who is a phenomenal student who got into medical school and knows the answers to a whole lot of questions. But you are working with them on using art as a tool and as a tool of teaching. And you’re also doing the same on The Blood Project, bringing in art as a tool of teaching. Bring this to closer times. For someone who is quite indebted in that scientific medical model, what does bringing the arts do for them? Is this comfortable? Is this uncomfortable? Does it work?

BRENDA: Well, I think the way–I’m a bit more restricted now what I do on The Blood Project because I’m not physically interacting, whereas when I was teaching, I would be physically interacting with the students and questioning them, etc. But I think what you’re getting at is if you’re exposed to the arts and you don’t necessarily have to have knowledge, I think I was able to show the students that–and yes, you’re right, a lot of them come and they’re very–they have to compete very heavily to get into medical school. It’s the same here in Ireland. So they might have what we call a lot of points, but a lot of them wouldn’t have been exposed a lot to art. So I would put them in front of a painting in our National Gallery, and I would say to them, “Don’t worry about knowing or not knowing, what it means or doesn’t mean. You can work this out yourself. You can do it because we all have to start somewhere.” So just–I use actually a mixture of a thing called visual thinking strategies that was developed in the United States and is used a lot in museums now, and I use a mixture of that and some of my own additions to my course. But I put them in front of the painting and I’d say, “I want you to imagine that that is your patient. So this figure in a painting is your patient. So now, where do you start?” So I would encourage them to just say, “Well, you just tell me, what are you looking at? What do you see? Tell me, describe what you see.” And so that requires them to describe as accurately as possible everything they can see in the painting. It mightn’t be a painting. It could be something else, but I usually start with a painting. And then their colleagues would hear what– and they’re looking at the same thing– they would hear what the person maybe left out, that there was a tiny little dog in the left-hand corner of the painting in the shadow, so you mightn’t see it straight away, that kind of thing. And then when the next person is recounting, they may see something more than the other person has seen. And there’s an element of surprise. “Oh, I thought I saw everything that was there.” And of course I would use that then to relate back to a patient, that when a patient comes in, you’re just looking at the exterior. You don’t know what’s going on in their mind. You know what I mean? You have to make observations and deductions purely on the evidence of what you’re looking at. I’m not expecting them to tell me who the artist is or what kind of art it is or anything. I said, “I’m not really interested in that. I’m more interested in what you see.” And a lot of them are really animated that they can see a lot more about a painting than they thought they could, and they can derive their own little stories about what it could mean. That’s how it works.

HELEN: Brenda, you are such an affirming person, and I know that. For first-year medical students who work so hard to get there, who are so book smart, is it hard for them to approach an exercise where there is no right or wrong answer?

BRENDA: We get over that very quickly.

HELEN: Oh, you do? Okay.

BRENDA: Yes, because in the very first class, I’d say, “We’re going to do this in a sort of like a conversation like you and I are having now.” There is no right answer. You’re not going to impress me if you tell me, “Oh, this is by Claude Monet” or something. I’m not interested in that. I’m only interested in what you can see. But I would build in other exercises that I can’t do on The Blood Project, unfortunately. And we would discuss how difficult– A thing that we take so much for granted about looking and seeing, but when you look, how much are you seeing? What’s the difference between a stare and a glance and how much are you taking in? Because our eyes have quite a wide range of vision, so you might see something in the corner of your eye, but you’re not registering it because you’re not paying attention to it. You’re only vaguely aware there’s something there. So it’s all about paying attention as well. And about your cultural background, that’s an interesting thing because I’d have multi-ethnic people in my class, and sometimes–for instance, I’ll give you one concrete example. We might talk about color and what color might mean in different cultures. And in our Western culture, black is for mourning when somebody dies. But in Chinese culture, it’s white. So if you’re looking at a painting that may have a certain subject matter and if people are dressed a certain way, you might interpret it that this is a mourning scene if it’s a Chinese painting. You see what I mean? So there are cultural differences. But what I’m really trying to get the students to learn is to trust their own eyes as much as possible, learning how fragile looking is and being aware of how fragile it is because the way we see things is coded by what we know. You don’t see what you don’t know. You don’t look at something that doesn’t interest you. So there’s all of that sort of thing. So you have to learn to describe accurately to your colleague, as you will when you become a doctor. You must learn how to describe accurately what you’re looking at.

HELEN: Thank you. That really intrigues me. I want to get back to the scientific medical part, which is evidence-based. What are you hearing for evidence or feedback from these medical students who did something somewhat unfamiliar and are having their “aha” moment? What is it like in their career or their practice, these lessons learned? Do any of them ever come back to you and talk about that?

BRENDA: Well, I know anecdotally that many of them would attend art classes because I would bring them to live model classes if they were an art student, and they’d have to draw the human body, the living human body, at the same time as they’re dissecting cadavers in their medical training. And I would bring them to a live body and get them to look acutely at how the body changes in movement, etc. So they’re looking at it very, very intensely. A lot of them would go on and continue with art classes afterwards, and a lot of them I would do a questionnaire after my course. The things I would note– Now, it wasn’t statistically significantly carried out, but anecdotally, because it’s a hard thing to do. I ideally would love to have had the university support a prospective kind of trial where I could have a group of people who did my course and a group of people who didn’t, and then follow them as they became doctors and went out into the world and their practice. How much did they retain of this more humanistic approach to a patient rather than thinking of a patient with a disease? They’d rather think of a human being with a disease, you know? But anecdotally, a lot of them said they wish they had more of this kind of thing in their medical training. They found it very, very helpful.

HELEN: Oh, Brenda, I hear that. I feel that. I hope that our listeners do too, and maybe some of them will be inspired to actually do that research in there. That would be absolutely fascinating.

BRENDA: I know you want to think of the listeners and what they take away from this. My suggestion is, in as much as you can, try and immerse yourself in any of the arts. I’m not saying it has to be visual arts. It can be literature. It can be music. It can be something. Not only will it help your own development as a human being, but it also may sustain you through difficult periods in your medical career. There’s a professor in Harvard Medical School who was being interviewed, and he was asked, “What advice would you have for medical students?” And he said–and I agree with him– he said, “I would advise them to read James Joyce.” He said, “I learned more from reading James Joyce than I did from medicine.” And I think the reason he gave was very, very important for people to understand. To be a good doctor, you really have to have as much life experience as possible and be as well-rounded a person as possible because you’re meeting people with diverse backgrounds, different ethnic backgrounds, cultural backgrounds, different educational backgrounds. So if you want to become as well-rounded, you will learn more about life experience that you won’t be actually able to experience yourself in reality, but you can vicariously–in other words, by reading or looking at something– you can have the experience of what it might be like to be in another person’s shoes. And that is extraordinarily helpful as a doctor that you develop that kind of compassion or even insight as to what another person might be experiencing. You can do that through the humanities. If you immerse yourself in and read–we can all read books no matter how busy we are or go and look at pieces of art. So you are broadening your experience by using the humanities. That’s the real message, I suppose.

HELEN: So, Brenda, you’ve been talking a lot and wonderfully about how the arts can influence medicine and science. What about the other side of that? How can medicine and science influence the arts?

BRENDA: A very good question. I think, actually, the arts have been tremendously influenced by science, by developments in science, from mathematical perspective, going way back to the Renaissance, when you could give the illusion of a three-dimensional space on a two-dimensional surface, right up to then the development of theories of color that came along and influenced people like the Impressionists in their day. And then something as simple as the artist not having to grind the powders, the pigment, in their studios. Once paint went into tubes, the artist was able to leave the studio and go out into nature and paint directly from nature. And, of course, the big one, of course, is photography in the late 19th century. Completely had a massive influence on how painters had to react to this machine, which was beginning to do some of the things they would take days and weeks to do. They could do it in an instant. So, they’re just some of the answers. And I would say also even more recent developments in science, from information technology and so on, has influenced how artists think in the way they use their art. And sometimes they take on science to challenge it through their art. So, they have a knowledge of it, etc., etc. So, there’s some of the ways. I’d just like to finish up by saying there was a historian of science, very, very well known. He’s written many books. His name is called Martin Kemp. And he says, “I believe that we surrender our human wholes to our specialist parts at our peril.”

HELEN: Okay.

BRENDA: So, I think that’s very appropriate for The Blood Project.

HELEN: You’re talking about that whole, that both sides, that art and science of medicine and humanity.

BRENDA: Exactly.

HELEN: Brenda, thank you for sharing this with all of us. You’re wonderful, and I’m so glad I know you through our many meetings. And even more, I’ve learned so much by your explaining how these two, with seemingly disparate sides, come together. And it’s all about who we are. Thank you for being a guest and talking about blood.

BRENDA: Thank you so much, Helen. It’s been a pleasure. Thank you.

HELEN: As we just heard from Brenda Moore McCann, it’s important to consider the art and science of medicine. Together, they seem to make us more complete understanding. To learn more about The Blood Project and explore its many resources for professionals and trainees and patients, go to thebloodproject.com. I invite you to also listen to my other podcast series that’s about health communication at healthliteracyoutloud.com. Please help spread the word about this podcast series and The Blood Project. Thank you for listening. Until next time, I’m Helen Osborne.