Full transcript
0:00um we're very fortunate to have Dr s
0:03freedlander as our uh guest speaker I'll
0:06I'll tell you just a little bit about Dr
0:08freedlander and then um introduce the
0:11the topic um he received his
0:13undergraduate uh inmd degrees at the
0:16University of Michigan um he followed a
0:19residency in Michigan um by doing a
0:22fellowship at Mass General Hospital in
0:24muscular skeletal oncology um it's fair
0:28to say that I I I I think many of us
0:30consider him one of the founding fathers
0:33um of that specialty in
0:351976 after serving two years in the US
0:39uh Navy he joined the faculty at Yale
0:43and from 1986 to
0:462016 um he served as the first chair of
0:50the Department of Orthopedics and
0:52Rehabilitation as well as the uh chief
0:54of that service at Yale New Haven
0:56Hospital um he's been president of many
1:00uh of our national committees um
1:03including the American Association of
1:05tissue Banks the American Council of
1:07transplantation the OS uh the uh
1:11academic Orthopedic Society Association
1:14of Bone and Joint surgeons uh the AOA
1:17and has served in many um important
1:19roles for our Academy so I'm very
1:23grateful that uh he is uh virtually um
1:26joining us today and uh Dr Perle who is
1:31assisting him I think may have given him
1:33the most difficult topic I've I've uh
1:35perhaps ever seen for Grand rounds and
1:38it's carrying Beyond the Bones the
1:40intersection of medical Humanities and
1:43orthopedic surgery a challenging topic
1:46but something uh I'm really looking
1:48forward to hearing about and I think
1:50we'll all uh appreciate uh Dr freed
1:53Landers and Dr perl's perspectives so
1:56thank
1:58you thanks so much for having me let me
2:01see if I can get my screen share working
2:07here all right thank you so much again
2:10um my name is Sean perkl and I'm excited
2:12to talk a little bit today about the
2:14intersection of medical Humanities and
2:15orthopedic surgery and special thanks to
2:17Dr Fred ler for being here with
2:22us so I think it's best to start with a
2:25few clarifying terms that we all might
2:27be a little bit less familiar with uh
2:29the humanity more generally are defined
2:31as a group of disciplines that study
2:32expression to help us understand what it
2:34means to be human they can include the
2:37study of History Literature philosophy
2:40religion art Music Theater and more the
2:44medical Humanities aims to answer
2:45questions about health and illness
2:47including how social cultural and
2:49historical factors can impact a person's
2:52experience or of illness or access to
2:54Medical Care medical Humanities can also
2:57examine the ethics related to clinical
2:59care public health and scientific
3:03research there have been many Physicians
3:05throughout history who have been
3:06Advocates of the humanities whether in
3:08name or through action in Greece figures
3:11like hypocrates emphasize the importance
3:13of understanding the patient's
3:15experience he's known as the father of
3:17medicine largely because of his
3:18contributions to this idea that disease
3:20was spontaneous instead of attributed to
3:22Supernatural causes such as Divine
3:25punishment or demonic possession but it
3:28contributions to medicine also f fused
3:30on observation and understanding the
3:31patient as a whole and its emphasis on
3:34medical ethics led him to being the
3:35namesake for the Hippocratic Oath which
3:37continues to guide medical practice
3:39today similarly in ancient China and
3:42India medical Traditions also integrated
3:45philosophical and ethical
3:48perspectives during the medieval period
3:50and into the Renaissance medicine was
3:52closely tied to religion mamones and
3:55other medieval Physicians often combined
3:57medical practice with theological in
4:00harmonizing faith and reason this
4:03holistic approach emphasized the
4:04connection between the mind the body and
4:06the
4:07soul the enlightenment brought
4:09significant changes in medicine as well
4:11with an increased emphasis on the
4:13scientific method and leading into the
4:1519th century the formalization of
4:17medical schools increasingly focused on
4:20scientific training however the shift
4:22often came at the expense of the
4:24humanistic aspects of
4:26medicine despite this trend some medical
4:29educ ators and practitioners continued
4:31to advocate for a more integrated
4:32approach figures like William
4:35Osler figures like William Osler in the
4:3719th century advocated for the
4:39importance of the humanities and medical
4:41education emphasizing the role of the
4:43physician as a compassionate healer and
4:47Scholar the formal establishment of the
4:49medical Humanities as a field began in
4:51the 1970s and programs were developed at
4:53medical schools often incorporating
4:55literature philosophy history and the
4:58Arts these programs aim to Foster
5:00empathy reflection and a deeper
5:02understanding of the patient
5:04experience over time it has slowly
5:06become a global movement with increasing
5:08recognition of the importance of
5:10understanding the cultural social and
5:12emotional dimensions of Health the field
5:14now includes diverse disciplines like
5:15narrative medicine bioethics and medical
5:18anthropology and includes works from
5:20popular figures such as aul gue Oliver
5:23sax Rafael compo and derome
5:27grman so why does this matter and why
5:29are we talking about this today this is
5:31a quote from one of my medical school
5:32mentors when I was about to start my
5:34clinical rotations he told me obviously
5:37try to get honors in every ms3 rotation
5:39but if you get a high pass in your
5:40Psychiatry rotation or programs may see
5:43that as a positive a bit of tongue and
5:45cheek here and likewise in the memes
5:47pictured on the slide but in every joke
5:50there's a little or perhaps a lot of
5:52Truth what I'm trying to get at is that
5:55an Orthopedics we are extremely
5:57evidence-based arguably more so than
5:59other surgical Specialties in my opinion
6:02this is a good thing evidence-based
6:04medicine has improved outcomes for our
6:06patients it's the foundation for
6:08research in our field and we do this
6:10with such fervor that we can publish
6:12articles like this without even batting
6:14an
6:15eye at the same time we are
6:18stereotypically inhumane the bone is
6:20broken we must fix it any issue or
6:23complexity is admitted to
6:25Medicine I think it's an accurate
6:27characterization of evidence-based
6:29medicine and narrative medicine as
6:31opposites as yin and yang but I want to
6:33argue that finding an appropriate
6:35balance in our practices can make us
6:37better caretakers and make us better
6:40healers this is a study from 2018 in the
6:43Journal of surgical education on empathy
6:45and surgical
6:46training the authors report that a
6:49decline in empathy exists that begins
6:51during the clinical years of medical
6:52school which continues throughout
6:54residency
6:55training I would agree that practicing
6:57in a humanistic manner can be
6:59challenging in modern medicine financial
7:01and time pressures the use of technology
7:03and place of personal interaction and a
7:06decreased emphasis on the humanties and
7:08physician education are just some of the
7:10factors that might contribute to a sense
7:11of
7:12dehumanization empathy demonstrates the
7:14physician's understanding of and concern
7:17about the patient's thoughts and
7:18feelings in this study patient rated
7:20surgeon empathy was the strongest driver
7:22of patient
7:25satisfaction and while we may view
7:27ourselves as empathetic listeners and
7:29effective communicators and this study
7:31by tongue at all 75% of orthopedic
7:33surgeons felt that they communicated
7:35satisfactorily with their patients but
7:37only 21% of Orthopedic patients reported
7:40having adequate communication with their
7:42caretakers this has led Orthopedics to
7:44being described by patients and in the
7:47conclusion of the aaos as high tech and
7:50low
7:52touch numerous Studies have shown that
7:54increased provider empathy improves the
7:56health of the patients that we care for
8:01why else might this matter if appealing
8:03to improved patient experience and
8:05better outcomes did not do the trick or
8:07levels of empathy and communication are
8:09one of the leading causes of medical
8:10litigation in this study the doctor
8:13patient interaction was the second
8:15leading cause of lawsuits behind only
8:17the presence of medical
8:19complication here's another study which
8:22emphasizes this point the authors go on
8:24to say that despite the occurrence of
8:26harm to the patient the proper way in
8:28which Physicians have reled to their
8:29patients contributed to the patient's
8:31decision to not complain about a medical
8:35act I could go on all day with studies
8:37that reinforced this point the annals of
8:39surgery concluded that 34% of
8:41malpractice complaints were related to
8:43poor
8:46communication historically the most
8:48significant way in which Physicians have
8:49engaged in the humanities has been
8:51through writing and narrative medicine
8:53it seems only proper that a physician
8:55write an article about advances in our
8:57understanding of disease or give a l
8:59man's interpretation of the latest
9:01change in the US Healthcare System but
9:03these pieces only represent a fraction
9:05of the works from a larger community of
9:06Physicians for whom caregiving runs in
9:09loog step with writing Perry class is an
9:11American pediatrician and writer she's
9:13also the national medical director for
9:15reach out and read a literary
9:17organization which works through doctors
9:19and nurses toot parents reading aloud to
9:21their children she writes because it has
9:23shaped her as an observer and a
9:25Storyteller and therefore certainly
9:27affected her as a clinician writing has
9:29been a path to imagining and
9:31understanding lives that she has not
9:33lived Dr Danielle ofy is a primary care
9:36internist at bellw hospital clinical
9:39professor of medicine at NYU and
9:41editor-in chief of the bellw literary
9:43review she shares that we work fast we
9:46talk fast we eat fast and we walk fast
9:48often at the same time writing is an
9:51almost sacred experience because when
9:52you think on the page you forced to slow
9:55down and engage in
9:58Discovery and that's editorial by our
10:00very own Dr Leopold and core he shares
10:02that the concept of narrative medicine
10:04holds that by becoming a more insightful
10:06consumers of the stories we see and hear
10:08through the written word the stage
10:10visual art or other sources we become
10:13more empathetic listeners to the stories
10:15our patients tell and by extension more
10:17reflective trustworthy and effective
10:19practitioners of our
10:22profession this is an editorial by Dr
10:25Schaefer out of Johns Hopkins published
10:27in jbjs he co-runs the site kosler uh
10:31the site is a melting of the words
10:32closer to Osler a tribute to Dr William
10:34Osler who is most remembered for
10:36revolutionizing formal medical education
10:39by teaching at the bedside Dr Schaefer
10:41argues that one way to be a humanistic
10:43orthopedic surgeon is to address the
10:45most common procedure that we perform
10:47one that we might do 100,000 times
10:49during our career the patient interview
10:52he highlights an opportunity for what he
10:54calls the small talk before the Big Talk
10:57an attempt to connect with a patient
10:58with something El side of medicine if
11:00only for a few seconds before getting
11:02back to the history presenting illness
11:04it has been shown that we have we
11:06interrupt patients at an average of 18
11:08seconds after the patient starts talking
11:10which honestly seems like an
11:11overestimation to me this Behavior can
11:14be frustrating to the patient who may
11:16feel that their story is not being heard
11:18and that the orthopedic surgeon is
11:19uncaring Dr Schaefer encourages us to
11:22learn about patients and briefly
11:24document these details in the record for
11:26a recollection later a 37-year-old
11:28construction work an army veteran or
11:30likes to play guitar recalling this
11:32information can be an effective tool for
11:34relationship
11:37building so why do I write and who took
11:40this stock photo of me without my
11:41permission I suppose it could be broken
11:43down into two limbs of course Nothing in
11:46life is altruistic and there is some
11:48secondary gain writing for me is an
11:50opportunity for
11:52self-reflection this is a hard job and
11:54there are times when we will see things
11:55that no person should have to see or
11:57alternatively behave in a way way which
11:59is not productive writing helps me
12:02process these emotions and better
12:03understand another's
12:05perspective I write to get better to
12:07identify areas for self-improvement
12:09which will help me become a better
12:10physician if I happen to publish the
12:12piece there is some element of
12:15self-promotion but a lot of my
12:16motivation to write is to have a voice
12:18in something bigger and outside of my
12:20small circles the pen is mightier than
12:22the sword and by writing I've given
12:24myself an opportunity to raise awareness
12:26for issues that are important to me to
12:28propose Solutions in public forum and to
12:30advocate for
12:33change this is an article I wrote as a
12:35junior residents it's a self-reflection
12:37about the insecurities I was
12:38experiencing and to some degree continue
12:40to experience on a daily basis when we
12:43talk openly about impostor syndrome we
12:45can destigmatize feelings of self-doubt
12:48and if nothing else promotes
12:51self-compassion I've used writing to
12:53highlight areas for self-improvement and
12:55to help me process feelings of anger
12:57frustration and guilt
12:59I wrote this article in the middle of R2
13:01year on the walk home from a difficult
13:03call shift and I have read and reread it
13:06after many difficult call shifts as a
13:07way to stay centered and more
13:11calm I've used writing to find gratitude
13:14to reflect on my journey into medicine
13:15and the path becoming an orthopedic
13:17surgery resident this article is a
13:19reminder that this job is a privilege no
13:21matter how dark it can be at
13:25times this is an article I wrote with Dr
13:27freedlander published in jbj JS through
13:29their what's important series which uses
13:31narrative medicine to initiate a
13:33dialogue about medical mistakes and to
13:35provide advice to others going through
13:36similar experiences which no doubt will
13:39be all of us residents and Junior
13:41attendants Dr freed laner provides the
13:43following reflection on a young patient
13:45in his practice who sustained a near
13:46full amputation of his arm after being
13:48struck by a train after many rounds of
13:51Serial de breeds he reflects that he
13:54came to realize there are times when
13:55it's a mistake to proceed with a
13:56strategy when the likelihood of its
13:58success is nearly zero or certainly when
14:00that strategy is beyond his resources
14:02and
14:03talents Dr Antonia Chen shared a
14:05challenging case of hers with unexpected
14:08bone loss and a young primary total hip
14:10she shared that there are times when she
14:12doesn't have all the answers that she
14:14must follow her pride and ask for help
14:16and that asking for help was probably
14:18the most important thing for the patient
14:20outcome Dr Julie sore shared a difficult
14:23case in which a young patient had a poor
14:24outcome after a routine elective
14:27procedure she discusses second victim
14:29syndrome and how that she wished she had
14:31recognized her symptoms while she was
14:32struggling with them so she could havea
14:34counseling though she ultimately found
14:36support from her husband colleagues and
14:40family we can use writing to advocate
14:42for continued progress and to attempt to
14:45promote intergenerational understanding
14:47and conversation and a profession in the
14:49midst of a significant culture shift in
14:51this paper from earlier this year I
14:53discuss a podcast from the New England
14:55Journal arguing that a perceived fad for
14:57Resident work life balance is dangersous
14:59for patient safety I counter that by all
15:01historical measures efforts at ongoing
15:04change are seeking to address High rates
15:05of depression burnout suicide and
15:08substance abuse in our
15:10profession and for all the differences
15:12that exist between the Old Guard and the
15:14new guard of medicine there's always
15:15room for discussion of difficult topics
15:17and writing has given me a seat at the
15:19table to provide solutions to make the
15:21practice of medicine better and more
15:24enjoyable writing has been an Avenue for
15:26me to push for improvements in
15:27Orthopedics and to make the process of
15:29recruiting new trainees more Equitable
15:31as
15:32well it has been a way for me to
15:33challenge myself and my colleagues to
15:35become more compassionate
15:39positions I'm fully aware that the time
15:41that we spend with patients in the Ed in
15:43the clinic and in the operating room is
15:45a finite resource and we have to be able
15:47to triage this often means that being a
15:50compassionate physician and a competent
15:52orthopedic surgeon are different and
15:54competing goals not every day is like
15:57that though and most patient have the
15:59opportunity to connect with others I
16:01would argue that being a one-dimensional
16:03surgeon is worse for patient care and
16:05one important way that we can stretch
16:07our imaginations and better empathize
16:09with patients is to reflect on our own
16:11choices and to have a willingness to see
16:13another's perspective through engaging
16:14in the medical Humanities and with that
16:17I'll turn it over to Dr Fred
16:25ler boy that was fabulous uh thank you
16:28very much let me um make this
16:32happen we all okay
16:35good well again thank you thank you uh I
16:39apologize in advance for stuffing too
16:41much in the next uh few minutes uh Sean
16:44has stck this
16:47right he this a bit more effectively uh
16:51also um I must uh tell you how flattered
16:56I am to be uh at the University of
16:58Washington
16:59um good friends uh it's a
17:03program that is
17:06extraordinarily well entrenched in our
17:09history in in our uh teaching and
17:13clinical practice today and uh well into
17:17the
17:18future uh have to shout out uh uh Rick
17:23Matson good friend along with Seth
17:26Leopold Lisa tesman Paul Manor
17:29and I could use uh the rest of my 20
17:32minutes to go down the list of your
17:34extraordinary faculty but say how
17:39please um and uh uh to talk about this
17:45subject my disclosures uh are of a
17:48completely
17:49non-compensated U nature uh and mostly
17:52our relationships including uh Seth
17:55Leopold and my wife and I'll not spend
17:59any more time on that but what I hope to
18:01do um over the next 20 minutes or so is
18:05convince you that art is valuable not as
18:09a substitute for science but as a
18:12compliment to to the science where we
18:16much more familiar and I hope that in
18:18the next few minutes to really
18:21demonstrate that this is true uh in
18:24terms of enhancing our skills of
18:27communication and
18:29observation and observation is where I'm
18:31going to concentrate but it is also a uh
18:36interesting and I would say Fairly
18:39reliable uh source of history of
18:41medicine and certainly our quest to be
18:45more empathetic and understanding about
18:48our patient
18:52care John's already talked a bit about
18:56the hugely important topics of
18:59communication skills and I only bring it
19:01up to point out that skills are things
19:03we can learn uh we can learn how to
19:06communicate better and I would also uh
19:10for the notion we can also learn to see
19:15better if we can't in fact see it smell
19:18it taste it uh touch it we can't use it
19:22in our clinicals and that's a huge
19:25disadvantage to ourselves uh as well as
19:27to our patients so my personal Epiphany
19:31um was when my father's Barber noticed
19:34that he was junti and that led to uh his
19:38diagnosis of pancreatic cancer um as
19:42unfortunate as it was it was still
19:44important to know my wife Linda had a
19:49similar
19:50Epiphany if you will she was visiting a
19:53friend in the hospital her friend was
19:55anxious disheveled uh clearly
19:57uncomfortable when and the team walked
20:00into the room asked how she was doing as
20:03as we always uh uh like to um the
20:08patient said I'm fine and they walked
20:11out without ever leaving their hand hand
20:14from the handle of the door uh and my
20:17wife realized they had completely missed
20:21all of the clues that would have been
20:22very helpful to them and developed this
20:25course where she sat elel freshman
20:28Medical students in front of a narrative
20:30painting as you can see in the
20:32background asked them to put aside their
20:35initial reactions about what's going on
20:38but inventory in a painstakingly long
20:41period of time 15 minutes everything
20:44they could see before putting it
20:47together and coming up with
20:50conclusions uh if she were uh here or I
20:54was there with you I I would be tempted
20:58to put this um mid 1800s painting by
21:03Henry Wallace entitled uh Chatterton in
21:06fact it has a longer title and go
21:09through an exercise of inventorying all
21:13the things you see in this painting
21:15before you come to a conclusion uh I
21:18hope some of you are already coming to
21:21conclusions and kind of fighting uh that
21:25uh instinct to come up with an answer
21:28what's going on but rather than call on
21:31you which which is just inconvenient um
21:34despite the
21:36technology W uh my wife would ask you
21:39what you see you would uh jump to some
21:43conclusions and she would quickly tell
21:46you not to do that yes it is an
21:48individual line on a bed and yes there
21:53are some shredded papers uh next to uh
21:57they had an arm falling off the bed and
22:00yes there is a little vial on the floor
22:03near his hand of some
22:06unknown um substance or
22:11or some some reason that it might be
22:16important to this scene um but what you
22:20really uh will come to at some point is
22:24the need to make a decision is this in
22:28individual on the bed sleeping is this
22:31individual on the bed drunk or drugged
22:34is this individual on the table uh on
22:37the bed uh dead um for some reason and
22:42in inventorying everything there is a
22:44way to come to a logical conclusion but
22:48there is also an advantage to knowing
22:50the story behind this and I I will share
22:52it this is a young poet um the poet has
22:56committed suicide from uh
22:59cyanide that was
23:01involved in in that little bottle on the
23:05floor after shredding his
23:08poetry uh
23:10papers having been um uh accused of
23:16plagiarism uh which I think he would
23:18have disagreed with but this was his
23:20reaction and in the Romantic sense there
23:24are some other Clues here the open
23:25window for his escaping soul and things
23:28like that they really go far beyond
23:30medicine but but is part of the
23:33language we can use these same
23:37observation skills whether we're looking
23:40um at skin pigmentation patterns uh Cafe
23:44light spots uh the blue Scara of
23:47osteogenesis imperfecta skin folds and
23:51um uh uh developmental um hip
23:55dysplasia um or even looking um
23:58portraits of Richard III who was
24:02supposed to be an evil
24:04deformed uh King died in his
24:0820s uh and his skeleton was recently
24:12exhumed in a parking lot in England that
24:15that told that not the way Shakespeare
24:18presented him a hundred years later and
24:20having never known him um but he had
24:23scoliosis but he wasn't a hunchback and
24:26an and and evil because of a twisted
24:30skeleton um what I'd like to do next uh
24:33and thank you uh Seth Leopold is go
24:36through some of the opportunities my
24:39wife and I had to share uh in in um
24:43clinical Orthopedics and related
24:45research some uh Adventures we we took
24:49uh over uh about 15
24:52years there are some early observers to
24:57uh to uh
24:59um Health to medicine to
25:01anatomy and uh no better place to start
25:05than with Theus and this is a picture of
25:09his anatomical drawings uh from around
25:141543 and you can see that he was a very
25:17very keen Observer uh one of the first
25:20to put his anatomical Knowledge from
25:25dissection uh in in visual ual form and
25:29if you were to stare at this and I'm not
25:31going to let you do that for very long
25:33because I have to move ahead uh but
25:36these these uh um uh images diagrams are
25:41readily available you'll see they're
25:43incredibly accurate um it went on uh The
25:48Next Century to a more widespread use of
25:52anatomic dissections sometimes
25:54syruptitious
25:55sometimes not as we see here uh both by
25:59Rembrandt and vandermeir who um are
26:04shown in the midst of anatomy
26:08lessons this
26:10Anatomy quickly
26:12got um used by artists and George stubs
26:19here in the uh uh 18th century depicting
26:23animals as as he was fond of doing uh it
26:27it is very apparent that he understood
26:30the musculature the anatomy beneath the
26:33skin uh as many many artists were doing
26:37by this
26:38time uh this is another example of
26:43anatomic knowledge these are sculptors
26:46sculpting of um two of our former
26:51residents by my mentor Dr Wayne
26:54Southwick and they will live forever in
26:56bronze on the ground of our Medical
26:59Center but again uh a very very keen
27:04Observer and he took it full advantage
27:07of his knowledge and his skills to put
27:09these uh before
27:11us there's a lot of history uh uh
27:14captured in art as well and that that's
27:18extremely helpful and I'm going to tell
27:19you a couple of stories very briefly
27:22this being one of my all-time favorites
27:26um and
27:28is from uh the early 1500s it's um scene
27:33of saints cosmes and Daman the painton
27:35stes of medicine in the 4th Century ad
27:40performing one of their three
27:41prerequisite Miracles where they have
27:44already transplanted the limb the
27:47healthy limb of a Moore donor and we
27:49could talk about that in more detail um
27:52for the disease limb that's on the floor
27:55and uh while we are still doing some of
27:57that uh stuff with today um Howard and I
28:02uh there are some other things that are
28:04also preent and still in play uh today
28:10uh orthopedic surgeons clearly are known
28:12by their identified by their Halos you
28:15can see the Angelic help in the
28:17operating room uh the indirect and poor
28:20lighting and as always the
28:23anesthesiologist is out of the
28:26room here we see
28:29uh Tom Thomas Akin's rendition of the
28:32Gross
28:33Clinic a compendium of surgical care um
28:39this painted in 1875 for the first
28:42Centennial of the United States and uh
28:46Thomas Akens is actually here in the
28:48background in the uh
28:51stairwell and uh we see Dr Gross and All
28:55His glory standing there in his street
28:59clothes as they all did in front of the
29:02horrified mother of the patient with the
29:04bloody scalpel and no regard whatsoever
29:09whatsoever uh for
29:12germs uh here his assistance are
29:14decompressing an
29:17osteomyelitis uh of the
29:20thigh it pays no attention whatsoever to
29:24the fact that 25 years before this scene
29:27Lou pastor had already developed and
29:31presented proof of The Germ Theory uh
29:34and Joseph liser uh um had already
29:37demonstrated that there were ways to
29:40create sterility the use of carbolic
29:43acid and uh eventually
29:46Listerine um all well known on the other
29:51side of the Atlantic and completely
29:54ignored by some
29:56egotistical albe attemp talented
29:58surgeons here in the US and because of
30:02this when President James Garfield was
30:05shot in the back uh in
30:111881 he died
30:14not uh of of the bullet even though it
30:17um it got stuck in the
30:19spine he died of the Myriad of Dirty
30:23Fingers probing his wound trying to find
30:26the bullet thinking that that was the
30:28key to success and he succumbed about um
30:32four to six weeks later uh of the
30:35infection that resulted from this and
30:37from ignoring uh the principles that
30:40were already well described across the
30:43uh the
30:45Atlantic um so uh you can ascribe
30:49Garfield's death in large measure uh to
30:52folks like Dr Gross
30:55indirectly his colleague Dr Ed knew 10
30:58years later after the death of Garfield
31:03still he put on he put on a
31:06clean uh robe but did nothing uh beyond
31:10that to respect
31:14bacteriology we then um are treated to a
31:18variety of paintings that
31:21emphasize the
31:25empathetic
31:26and high value uh the public patients
31:30placed upon the health profession and
31:33here Luke vials uh the doctor is
31:37emblematic of that uh here all the good
31:41doctor could do um was look watch Wait
31:47had very little to offer uh other than
31:51his empathy but for that um and despite
31:55the lack of Curative
31:58approaches healthc Care Professionals
32:00were held in very high regard uh and
32:03welld
32:05deserved even artists uh and here uh
32:10Francesco Goya is paying tribute to his
32:13doctor Goya in the foreground and uh Dr
32:17aretta um has his back literally and
32:23figuratively another fascinating story
32:27uh in in the art world is that of
32:31fredao uh and
32:33um here um we see evidence uh of of the
32:39beginning of her story when she was
32:42injured in a motor vehicle accident as a
32:45teenager returning from college where
32:48she was
32:49Premed and parts of her injury included
32:53uh a fracture of her Lumber spine kept
32:57her in bed for a year and it was in bed
33:00uh with her
33:02father's art supplies that she learned
33:05how to
33:07paint and she used that skill to share
33:11with us some of her most serious
33:15illnesses um this is her actual x-ray
33:19which is published so I I don't think
33:21I'm violating her uh personal history uh
33:25showing her spine fusion which she
33:28depicts here in in her painting um
33:341946 here she is uh and and her palet is
33:38her heart uh painting a tribute to uh
33:41one of her primary doctors Dr frell who
33:45was responsible for a great deal of her
33:48care and uh the target of her affection
33:51uh because of that uh Sean already
33:55talked about narrative medicine the
33:57ability to relate to patients on a much
34:01more personal level something that Rita
34:04shiron has written about um for for more
34:08than uh 20 years and something that we
34:10should aspire to but there are clearly
34:14is evidence as we learn to look at our
34:17patients um of the emotional impact of
34:21their their um clinical State um here
34:25Vincent Van go uh this this souring
34:30souring Old Gentleman clearly is um um
34:37emotionally uh distressed distraught uh
34:40and that's the an important part of his
34:43Persona and his illness Edvard mon
34:46probably U found one of the most
34:49impressive ways to canote emotion in his
34:54paintings hear the scream this is one of
34:57four vers
34:58that that he did uh over over the years
35:02and is Haunting in its uh
35:06intensity I want to um and I'm getting
35:09close to the end here uh show you a
35:12photograph another piece of
35:16art uh because I think it's a call uh to
35:20action on on on our part here rente a
35:24Taylor um a slave in South Carolina on a
35:29cotton P Plantation was photographed at
35:32the request of a Harvard Professor Dr uh
35:37Lewis ausus and
35:41you just have to look at this to
35:46understand there's an important story
35:49and much to learn uh
35:52by really uh
35:55inventorying uh this face this body uh
35:59this
36:00context um the professor used this
36:04Photograph and those of his family and
36:07others to promote white supremacy to
36:12indicate the what he he thought were
36:17flaws um of people of color uh and at
36:21this time his family his descendants
36:26have uh there's a great movie about this
36:29have asked for custody of these uh
36:33photographs from Harvard uh and were
36:36denied uh but at some point in time I
36:39hope you look at these photographs more
36:42carefully and come to your own
36:44conclusions about the dignity um of this
36:47gentleman and how it's being uh violated
36:51by the context I'm going to try to do
36:53this myself and share it with you when I
36:56when I get a chance
36:58um I'm not going to spend U more time uh
37:02defining narrative medicine uh other
37:05people have done this very well
37:07including Sean's introduction including
37:10authors uh including this this book uh
37:14which was literally uh and figuratively
37:17breathtaking uh when breath becomes air
37:21uh and I hope that in this rather quick
37:24overview I have been able to convince
37:27you you that art is of importance and
37:32beyond that of value in a number of ways
37:35as we approach the care of our patients
37:38and I contend uh that paying more
37:43attention um to our observational and
37:46communication skills our understanding
37:49of the history of where we've been and
37:51where we're going uh and the use of
37:54empathy uh will improve our clinical
37:57practice and our patients I think it
38:00makes a difference and I wish it on
38:03you um as a closing gesture of
38:08observation look at this you've seen it
38:10three or four times already and look at
38:13it more carefully um some of you will
38:16already have noticed this is not a
38:18picture of a bird uh this is a picture
38:21of a person masquerading as a bird uh so
38:25things are not always what they
38:28SE and with that um again my gratitude
38:32for your attention and hope um this
38:36stimulates some discussion in your own
38:38mind with yourself and with your
38:40colleagues and uh take from it what you
38:44will thank thanks guys yeah thank you
38:47very much that that was wonderful and I
38:50was wondering how you were going to pull
38:52this off and and uh now I now I get it
38:55and it was really a great talk and and
38:57also thank you Sean um we have uh quite
39:01a bit of time for comments or questions
39:04you can um just write something in the
39:07chat box you can text me or you can just
39:11uh I see Dr Henley raised his virtual H
39:14you can do that or just chime in uh
39:17Brad yeah hi Gary Brad and Lisa I have a
39:20cold nice to see you um you've done an
39:23excellent review of classical art and
39:25medicine I wondering if you could uh
39:28spend a few minutes trying to
39:30prognosticate into the future of what
39:33you think the intersection between
39:35Orthopedics and Humanities and art will
39:38be especially with the
39:41contributions of the computers and AI in
39:44art because I well I'll leave it at
39:47that well uh first of all it's a nice to
39:51hear from you Brad and uh sorry I can't
39:54give you a hug um
39:57uh uh thank thank you for for that uh
40:02question I think I would like to
40:06reemphasize that that I'm not trying to
40:09convince you that that art is a
40:12substitute or humanism is a substitute
40:16for science uh but they're colleagues
40:18they're they're partners and that we
40:21have to find ways uh to bring these
40:24aspects of our character together
40:28uh as we we treat patients and there
40:32used to be a time when I looked at my
40:35clinic list just like a lot of you
40:38do and realized I was already 45 minutes
40:42behind and I was destined to get a
40:47barrage of
40:49um not so welcome comments as I walked
40:52in the room uh late and and um
40:58uh portraying some uh disrespect if you
41:02will for for for the patient in their
41:06minds and then I took this
41:09communication skills program uh from the
41:13academy and um 20 something years ago in
41:17fact I I was on the the committee uh for
41:21the Academy um with uh John Tong and um
41:28[Music]
41:29um uh one one Jim hearnden uh as we
41:33tried to conceptualize this and how to
41:35spend the million dollars that um The
41:38Academy was going to put into teaching
41:41communication
41:43skills
41:46and you know I got I got to tell you I
41:49it turned things around for me so
41:51instead of walking into the room
41:53defensive and saying you know my time's
41:55valuable too and why are you crabbing
41:58I'm here to help uh I I learned to walk
42:01in the room and say hi I'm Gary
42:03Freelander I'm sorry I'm late and I do
42:05that even when I'm not late um and it it
42:10it just allows me
42:14to to interact with
42:17people um as individuals and and not as
42:20items uh and patience and have a
42:24conversation and I think the our few
42:27future um as we
42:30use the humanities if you will to put
42:33some humanism in our attitude our
42:37conversation uh slow down
42:41look and put things together that that
42:46you're I I'm enjoying and I think you're
42:48going to enjoy uh healthc care a lot
42:51better in this time
42:53of great stress um you know from so many
42:58different directions um both
43:00economically and electronically if you
43:04will I I was in I'm I'm sorry to be so
43:08long-winded about this but I was in a I
43:10was a patient yesterday at a healthc
43:12Care Checkup and I pointed to the there
43:17was a cell phone on the counter um as my
43:21doctor was about to leave and I didn't
43:22want him to forget his phone and I said
43:24is that is that yours and he said yeah
43:27and the phone was
43:30was um recording our
43:33conversation with an AI app that was
43:37then going to write his
43:39note and I asked him how he liked it and
43:43he said he actually doesn't it saves him
43:46time but but unless
43:50he creates a dialogue in a certain
43:54construct the note the note really isn't
43:57um as valuable as he would like so I you
44:01know I think we have to learn to be
44:04human we have to learn to take advantage
44:07of technology in the future and we have
44:10to remember to do it in a Humane
44:13humanistic uh way and to blend all of
44:15that together is our challenge far far
44:18too long an answer and probably didn't
44:20really get to the core of what you
44:23want um but uh I'm optimistic about the
44:26future
44:28sure do we have any other any other
44:31questions I I would follow up on a
44:34comment uh on on what Dr frander said as
44:38as um you and Sean were speaking one of
44:40the things that I was thinking is you
44:42know Clinic can be tough uh as you said
44:45you look at your schedule for the day
44:47and you're like wow how am I going to
44:48get through that but if at the end of a
44:51clinic I I feel that I've had some just
44:55nice conversations narrative
44:57conversations with my patients if we've
44:59got to tell each other a couple of jokes
45:01or had a little bit of a lightharted
45:04conversation at at the end of that day
45:06from a very selfish perspective not only
45:08helping the patients I I feel much
45:12better about the day that I had about
45:14going home and and seeing my my wife or
45:17my kids or my dog and so even from a
45:20selfish perspective I think these things
45:22can be very very helpful for for us
45:25personally yeah Howard I really relate
45:29to that and I applaud you for um getting
45:31to a
45:33similar uh state of of mind I often put
45:37in my clinic notes that their dog died
45:40you know and six months later when I'm
45:43walking in or um for their their
45:47followup uh visit uh I asked them how
45:50things are going um um following the
45:54passing of the dog following that trip
45:56to to Someplace Special
45:59following uh that new relationship that
46:02they shared with me I don't remember it
46:05but they think I do I remember it it's
46:07in in my note and I know their PCP is
46:11scratching his or her head why the hell
46:13did I he did that find its way in the
46:16note which it won't with
46:18AI um because it'll it'll be uh
46:22considered irrelevant but boy does that
46:24make a connection and does that that
46:27make the rest of the
46:29conversation um far far more
46:35productive any any um any other
46:38questions or comments I know there's a
46:41lot I'm sure people are are have a lot
46:43to to think about it was really a a
46:46stimulating Grand rounds one question
46:49yeah go ahead Dr G Albert yeah this is
46:52Albert um a question for Sean actually
46:55um
46:57uh Sean you sent that you had a
46:59challenging day of call or something and
47:02then you wrote uh one of your articles
47:05on your way home how did you do that was
47:08that something you typed on your iPhone
47:10as you
47:12were you know like I because I think you
47:14know the journaling piece is
47:16real um and I was going to ask you I
47:19guess two questions first how you do
47:21that and then B do you find that writing
47:25or journaling uh in an electronic sense
47:28is the same as writing like with pen to
47:32paper um yeah thanks for the question uh
47:35I typically I do a lot of my writing
47:37sort of in uh I don't want to say like
47:40the darkest moments because I think
47:42that's a little extreme but I I do find
47:43myself very inspired after you know
47:46difficult patient encounters a
47:47challenging call shift uh a difficult
47:50conversation uh in this particular
47:52instance what I what I typically do is
47:54I'll record myself on my phone just
47:56talking out loud uh on the walk home uh
47:59big picture ideas large brush strokes
48:02and then with the idea that I'll go home
48:04and fill in the details later uh on my
48:06computer uh so that's what I did in this
48:08case I end up doing that a decent amount
48:10of times um I my experience with writing
48:15has always been on the computer I don't
48:17uh I don't really enjoy the process
48:18putting physical pen to paper because my
48:20handwriting is terrible and it's hard to
48:21read it and then I have to go back and
48:23transcribe it later um but I do enjoy
48:25the process of typing things out and
48:27reflecting I think that's made me uh a
48:30more compassionate person um and it has
48:34certainly affected the way that I
48:36approach Encounters in the future
48:37especially faced in a similar
48:41situation shot that's good to know I
48:45scrible things on napkins I've got
48:47enormous numbers of scraps of napkins
48:49around with just uh the beginning of a
48:52thought and look forward to getting back
48:55to them I do see in theat
48:57um Doug hanel has uh a very very
49:01important uh observation uh to make it's
49:04not uh what you look it's not what you
49:08look at that matters it's what you see
49:12um absolutely uh correct there's a
49:15corollary though and that is it's not
49:19what you say to the patient it's what
49:22that patient hears you uh say and there
49:26is so often a
49:29discrepancy uh the humanities offer us a
49:34more expansive and I think helpful
49:37language uh for our conversations rather
49:40than our technical jargon but you still
49:43need to understand it's what they heard
49:46you say not what you think thought you
49:49told them um uh and you have to you have
49:53to keep that in mind just want to
49:55underscore that the very good comment
49:57Doug thank
49:59you well thank you Dr friedlander and
50:02and Dr perkle that was uh really
50:05wonderful a nice way to wrap up our 2024
50:09series of of grand rounds I know
50:12everybody has to um get to work so I
50:15hope everybody has a great day and I
50:18look forward to seeing you all Saturday
50:19evening and and Dr freedlander um um
50:23happy holidays and and thank you again
50:26thank you wish I could join you sounds
50:28great we'll have to figure that out for
50:30a future date absolutely okay