RAB 2016-2017

Themes:

a) The patient examines the doctor

b) Medically unexplained symptoms

The Patient Examines the Doctor - Freya Elliott

  • This painting is entitled ‘The patient examines the doctor’, which is also the title of a chapter in Intoxicated by my illness by Anatole Broyard (1). It is a moving and witty personal exploration of illness and mortality. In that chapter Broyard explores what he looks for in a doctor.

    I have depicted the patient auscultating the doctor’s head as a metaphor for the patient wondering ‘what is the doctor thinking?’ ‘Who is this person?’ ‘Does he know what he is looking for?’ ‘if there is something to find, will he find it?’ And, as Broyard crucially adds, “How good is this man?”1

    Patients share the intimacy of their body and mind with their doctor, possibly exposing thoughts and details that they wouldn’t even reveal to their own partner. Broyard’s book reminded me how important it is for doctors to make patients feel that they are respectful of the immense trust that is bestowed on them. There is a vulnerability in the basic act of taking your clothes off and letting someone examine you.

    The two figures are squeezed into the composition to represent the intimacy of the interaction. I depicted the figures as the same person, to represent the idea that the doctor could easily be the patient, as we are all a patient at some point in our lives. I muted the colours, and faded out the outer part of the painting so that the viewer’s eye is drawn to the two central arms, which are almost entwined. I allowed drip marks towards the bottom, a metaphor for the impermanence of human life, and how our lives unravel in the face of illness. The patient is coming to the doctor because he is ill; once the doctor diagnoses what is wrong this resets the parameters of the patient’s life.

    References:

    1. Broyard, A. 1992. Intoxicated by my illness. New York: Ballantine Books. (pages 33-58)

Oyster Shells - William Hirst

  • Doctors have a choice to make about the extent to which they connect with their patients. They can be open and compassionate and give part of themselves to a patient, or they can choose not to engage with a patient’s story. Broyard describes this dichotomy (Broyard, 1993). On the one hand doctors can be ‘professional’ and ‘scientific’, which he suggests is at the detriment to the doctor-patient relationship. On the other hand, doctors can open themselves up to patients and become part of the patient’s story (Broyard, 1993).

    To represent these paths for medical practice, I sculpted two oyster shells, one showing the closed side of the shell and the other showing the open side. The oyster that is open has a pearl inside, representing the rewards that ensue from being open to patients. For the doctor, this is the reward of learning from the patient’s story, and for the patient this is the reward of shared decision making and understanding. The negative effect of being open is the emotion experienced by patient’s that gets loaded onto you as the doctor. This emotion must be managed, which can be exhausting for the doctor. Perhaps this is the price that must be paid for giving away part of oneself.

    Oysters also have a hard outer shell, which signifies the resilience needed in medical practice to be able to be supportive to patients. This resilience is needed to face pain and suffering that cannot be healed. Oyster’s shells and pearls are made up from many layers, symbolising the layers of trust in a relationship between a patient and a doctor. These also symbolise the choice of how many layers of engagement to peel away.

The Doctors Office - Christine Carter

  • ….This picture illustrates Georgina’s* story. It shows her on one of her various trips to the GP after he’s made a number of referrals and the investigations are all negative. The GP is at a loss. When he gets a nice clear result from a patient its easy; he can file that patient into one of the neat boxes on his shelves. A positive result for strep throat; excellent, that patient can be filed into infectious diseases and be given penicillin. Skip lesions and transmural inflammation found on histology after colonoscopy; a clear-cut case of Crohn’s. That patient can neatly be filed into gastroenterology. Chest pain, a STEMI and a blocked coronary artery; straightforward and treatable. A broken bone; easy.

    But Georgina doesn’t fit into any one of these boxes. Defeated she slumps back in her chair and starts to slip through the crack that has opened up on the floor. Tired, unsupported and heavy. The GP, desperate to help puts his hands in the air, also defeated. Racing against the clock he thinks, “Why are so many patients I see like this?…this isn’t what I was taught in medical school.”

    The rays of light in the picture edging towards the crack are symbolic of hope. In the past, after extensive fruitless investigation there was little more the doctor felt they could do. After the investigations for Georgina’s abdominal pain ... had come back clear, she had left the doctors office with no particular plan. Although she had been a frequent visitor up until that point she felt too embarrassed to go back. She felt like she wasn’t a ‘real’ patient. She learned to live with the ups and down of the pain.

    This picture is made in mosaic style from cut out pieces of magazine, to illustrate that this is a ‘messy’ subject to deal with.

    name and details changed