Stage, Screen, and Story

Art Shifts Perspective

Evidence suggests that the arts can improve clinical observation skills, attention to detail, empathy and understanding patients’ complete stories. Dr. Susan Meyer, associate dean for education, University of Pittsburgh School of Pharmacy, was one of several faculty members who helped develop a humanities elective course that would bring together an interprofessional group to share different perspectives about engaging with patients and families. The course, “Literature and Film to Understand Patient-Provider Experiences,” allowed students to “step out of the technical content and really focus on patient and provider experiences in a more holistic way,” Meyer said. “There were lots of conversations about stereotypes and the importance of really listening to the patient. We explored the use of words, particularly through some poetry, and what people might be thinking. There was a lot of reflection.”

The idea for the course originated last year, when the provost selected the theme “humanities in the university” for the year and made small grants available to advance the concept. Meyer said that a working group that thinks strategically about interprofessional education on campus—drawn from members of the six schools of health sciences and the school of social work—brainstormed different ways to engage students across professional boundaries and envisioned this course. Faculty members representing the various schools led the class, offered for the first time this semester.

“We narrowed down our ideas to five books and three films, and with the grant money we purchased copies of those resources to provide to the students,” Meyer noted. “The grant supported development of instructor guides that would support the use of those eight learning resources.” However, once it was determined that the course would only be one credit, they shortened the syllabus to two movies and one book, along with some poetry. “We used Being Mortal, by Atul Gawande,” she said. “One of the films was a documentary about the use of music in treating patients with dementia called ‘Alive Inside.’ The other was a feature film called ‘The Doctor’ from 1991 starring William Hurt about a physician who has a terrible bedside manner but then becomes a patient and it changes his perspective. It’s a really terrific teaching tool.”

Meyer found teaching these materials to be a refreshing change and appreciated the thoughtful conversations that the films and writing sparked among students and faculty. “Being Mortal, which is about getting old and end-of-life planning, really challenged students to think about their own mortality and how hard it is to have these conversations,” she said. “Or even to project how you might feel about these choices at certain points in life when you might not be ready to think about it. The students said they really learned a lot about themselves and they said it would change in a positive way their interactions with patients. Some had experience with underserved patient communities and were able to bring that to the conversation. Others said they would be much more aware of thinking about patients as the humans they are as opposed to just a disease state.”

Faculty members intend to offer the course again with different resources so students who like it can re-take it. Another book they initially considered was The Spirit Catches You and You Fall Down, which many institutions use with interprofessional students to explore the conflict between Eastern and Western medicine. The Diving Bell and the Butterfly, Wonder and The Running Dream are possible future texts, in addition to the film “Patch Adams.”

Meyer is also researching some visual arts-based education initiatives. Pittsburgh’s medical school has worked with the Carnegie Museum of Art on a project to increase students’ observation skills; Meyer and a former P4 student wanted to pursue a similar opportunity with the Carnegie museums. “We thought that using the visual arts might be a place to connect students from different health professions using visual arts to trigger conversations,” she explained. “For example, looking at art by patients—what might the patient be communicating? Or what do different health professionals see in that art? It’s based on some literature about how visual arts can have an impact on observation skills, empathy and problem solving.”

She sees signs that incorporating the humanities into pharmacy instruction could be gaining traction, noting that there is now an organization in medicine for the use of visual arts and there is a group of like-minded institutions talking about this. “Some of these students miss being able to read books and watch movies because the nature of health programs [doesn’t really allow time for that],” Meyer commented. She said the arts offer a good starting point for conversations in interprofessional academic settings. “When you have students talk together you can start to address some of the teamwork conversations by how you set up the class around visual art or reading to prompt them to talk about things from their perspective. It triggers this interaction among the students that they usually don’t have an opportunity to talk about. It’s a non-clinical way to start the conversation about the patient-provider relationship.”

Immersion in Visual Experiences

For Dr. Paul Ranelli, a professor at the University of Minnesota College of Pharmacy, the arts can elicit visceral reactions that make it an ideal conduit for telling stories about medication and illness that will get audiences to see patients and patient-provider relationships in a new light. “Whenever you’re working with human beings, I think looking at the arts and things that touch the soul—and how it’s related to patient care and being attuned to empathy and patient stories—will help you be a better pharmacist by giving you an understanding that there are things inside that human that you won’t know about,” Ranelli explained. “It’s about drawing upon all those senses we have and not just being a science automaton. You can use these reactions you get from art to say, I never thought of it that way. For example, I never thought of drug therapy affecting the family, or how complicated it can be to get titrated on a mental illness drug.”

That mindset is what prompted Ranelli to think about new ways to connect the humanities to pharmacy instruction. While art does sometimes explore disease, physician relationships and other healthcare topics, he realized that we rarely see art focused on medication experiences. Two years ago he reached out to the Mixed Blood Theatre in Minneapolis and collaborated with its artistic director to create “Go Ask Alice,” a play, written by playwright Syl Jones, featuring a series of vignettes based on true stories about patients, pharmacists and providers navigating the healthcare system’s medication environments. “I wanted to focus on drawing a strong connection of stories related to that social object that so many of us take,” he said. “I thought a play would be a good way to tell stories about patients in a way that is entertaining and serious and fun. This play covered all those emotions.”

About 100 people attended each of the play’s two performances, including students and faculty, and participated in a discussion led by Ranelli after the show. “The reaction was interesting,” he observed. “They said, wow, I never thought of that, or some people said, you know, that doesn’t put pharmacists in the best light. These scenes were based on stories from real patients. We were very truthful about the situations. Generally the qualitative statements [from surveys conducted on site] were very positive. It was all in the learning direction about understanding this better after they saw the play than before.”

Ranelli hopes to incorporate the play into the curriculum or find a way to fund more performances. Given that the total production cost for one live performance is about $18,000, and the estimated cost to make a professional film that could be distributed to other institutions for educational use is around $50,000, he is searching for a “friendly wallet” to make one or both scenarios a reality.

In addition to devoting time to “Go Ask Alice,” Ranelli helped bring to life an art exhibit that aims to encourage frank dialogue about the role of medication in our lives. He originally had an idea for a photography exhibit that explored what medicine meant to the artists. Then, at the Minnesota Public Health Association annual conference in 2016, he met Jes Reyes, the program coordinator at Avivo (formerly Spectrum) ArtWorks, which supports artists who are suffering from mental illness. “I described this idea to her, and she suggested focusing on all forms of art,” Ranelli said. They opened a traveling exhibit within 18 months called “To Really See: Exploring the Medication Taking Experience.”

Another recent project examined how design ties into cultural sensitivity in medical environments such as hospitals and clinics. “What are the comfort factors for someone who’s in a very vulnerable position?” he wondered. “How does an environment contribute to decreasing stress? Pharmacies are set up for merchandise but I don’t know if the environment is really that comforting to people. Students should be interested in how their pharmacy is perceived by patients.” With that in mind, he embarked on an interdisciplinary effort with the university’s interior design department and Phalen Family Pharmacy in St. Paul to design a pharmacy to be more culturally sensitive and more inviting to the clientele rather than looking like another big box store. “It’s about getting patients to want to come to see you and be comforted by the environment,” he noted.

Studying medication use behavior and exploring the social side of public health (human interaction with medication) is something that Ranelli believes is overlooked. “Social pharmacy looks at where pharmacy fits in within the big picture of healthcare,” he said. “Maybe [incorporating the arts into the curriculum] is superfluous to some, but anytime you’re working with human beings—and pharmacy is tied at the hip to patients—having a full breadth of experience in education and being able to carry that to your community is what builds relationships.”

A Lighter Look at a Heavy Topic

At the University of South Florida College of Pharmacy, Dr. Heather Petrelli, associate dean for student affairs, teaches a “Death and Dying for Healthcare Practitioners” cou are. “My favorite assignment is the death arrangements assignment,” she said. Students are randomly  assigned a cause and age of death. Then, “students fill in a worksheet to plan their own funeral. As part of the assignment they have to determine the cost. It helps them really empathize with caregivers of patients whe n they understand how arduous the process is. The last assignment is a paper exploring death in the media.  Students have to choose from 50 movies to synthesize all the materials in the course and use a movie with personal relevance as a backdrop for sharing the impact of the course—understanding historical impacts and how it will affect their future patients and their own perspectives.” 

One of the movies she shows students is “Wit,” based on the p lay about an English professor who is diagnosed with terminal cancer and reflects on the importance of human compassion as she interacts with various caregivers. “Storytelling is an amazing teacher, as is re    flection,” Petrelli said. “Any time you connect students to material through active means and can provide a sense of relevance, I think it’s an effective way to learn about the patient experience. “Historically, healthcare was focused on the biomedical model. Today, there has been a shift to continue to focus on the transactional or biopsychosocial model in which the patient and empathy is at the center.” She added that there are several other pharmacy faculty members who are incorporating the arts into coursework, some using Disney or Star Wars themes to engage students.

Petrelli believes the humanities tap into something that society desperately needs: creativity and critical thinking. “If we lose creativity, we lose the ability to be innovative. A lot of students we have today have lost the ability to cope and lost the art of critical thinking. Their lives have been so managed. We need to use that side of our brain.” Through student feedback she discovered that people want to talk about death and dying but are often uncomfortable or afraid. “This course gives voice to that and allows an opportunity for people to share their emotions,” she continued. “As healthcare providers we must teach our students that mental health and our emotions are equally a part of the human experience. It’s part of the holistic aspect of patient care.”

Jane E. Rooney is a freelance writer based in Oakton, Virginia.