The Art of Medicine with Irwin Braverman, MD '55

June 24, 2021

Information

The Art of Medicine is an observational skills workshop for first year Yale medical students, a requirement since 2002. This workshop, created to enhance and jumpstart the observational skills of medical students to allow them to reach the skills of the diagnostician earlier, stems from the theses of two Yale medical students (Dolev ’01 & Mahony ’05). This workshop has been adopted in part or in whole by more than 100 medical and nursing schools in the United States and abroad.

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00:00OK. Well, welcome to this
00:03workshop and observation.
00:05ULL skills I'm ruined.
00:07Braverman class of 55 and marriage
00:09professor dermatology and so I'm
00:12inviting you to participate in an
00:15educational activity that's been
00:17required for first year medical students
00:20here at yelled for the last 22 years.
00:24And basically in medical education
00:27we want all of our students to
00:31become doctors with the skills of.
00:35Of Sherlock Holmes and in in since
00:38resting that we have never taught
00:41medical students how to use observation
00:44ull skills to figure out what's going
00:48on when they're looking at a patient.
00:53In my day we used to call it inspection.
00:57And nowadays being called
00:59observation or observation,
01:00ull skills and it's interesting
01:02what we've we have been taught.
01:05True beginning of time is that
01:08you carefully look at the patient.
01:11And then we would say,
01:13and we would then tell you what to look
01:16for the specific signs to look for
01:19both in general and in specific diseases.
01:23And then you were supposed to remember
01:26those things the next time you saw them.
01:29Then you would recognize and act on them.
01:32Well,
01:32we have never taught anyone,
01:35apparently,
01:35is how you actually go about
01:37looking at something you've not seen
01:40before and visually analyze it.
01:42They come up with the correct
01:44conclusion or diagnosis,
01:45and so that's how this whole program
01:48got started. As a matter of fact.
01:52And for years I've been teaching
01:54dermatology and I've been telling
01:56students how you go about evaluating
01:58a skin rash and the steps you take.
02:01And after all these years,
02:03maybe they've been a half a dozen
02:06have figured out how to do it.
02:08Everyone else has ended up just
02:11memorizing what I would show them.
02:13So if I show them interesting cases
02:15and show them subtle features,
02:17they would memorize those features.
02:19But no one ever sat down to figure out.
02:23How does he do that?
02:25Well,
02:25I think this exercise that we've been
02:28doing for the last 22 years is the
02:31way to instruct students and how to do it.
02:34And So what we've done is we've
02:37gone to the old Center for British
02:39art and we have been using a 17th
02:43to 19th century paintings.
02:44These are narrative paintings
02:46that tell a story,
02:47but the story they tell has a lot
02:51of contradictions within it and so.
02:53They behave like patients.
02:54They are surrogate for patients.
02:56So what I'm going to do is we're
02:58going to try to go through two
03:01paintings and I'm going to put
03:03up the painting as a whole and
03:05give you a minute to look at it.
03:08And then I will show you portions of
03:12that painting afterwards, magnified.
03:15Each for a minute and at the end
03:18of this five or six minutes,
03:20I'm going to ask you guys to tell me
03:23what you see and and the idea is,
03:26you're answering the questions of who,
03:28what, when, where, and why.
03:30That's basically what you're asking.
03:32Who is in it?
03:33What are they doing geographically?
03:35Location wise? Where is it?
03:37What time of day or season is it?
03:40And what do you think is
03:42really going on here?
03:43So the first thing is to tell me.
03:46What you actually see and I
03:50will use my my mouse too.
03:54Point out certain things on these
03:57paintings to help you as we go along.
04:00Although this exercise was originally
04:02conceived to help with observation,
04:04ull skills,
04:05it turned out that a major benefit
04:08of this that we had not anticipated
04:11nor had planned for was the students
04:14told us that what they really will
04:16learning was how they made decisions,
04:19how they came to decisions.
04:21Then they realized that they were
04:23coming to decisions based on inadequate
04:25information or incomplete information,
04:27and what they really had to do.
04:30Let's look at it.
04:32Come to a tentative decision,
04:34then go back and look more For more
04:37information to help support or deny it,
04:40and eventually reiteration in this way,
04:42they finally came to the right conclusion.
04:45So that's that was really,
04:47that's really the bit of
04:49the benefit of this program,
04:50OK?
04:53Sounds like you have an echo.
04:57OK, so we'll get started.
05:01Anne. This is the first.
05:07Painting, so I'll give you a
05:09minute to look at this carefully.
05:12Who, when, where and why?
07:57That means they want.
09:49OK. So who would like to come?
09:55Tell me what they see.
10:00Harold. Have done we unmute yourself OK.
10:05Well, what I'm saying is what I
10:07think is a wealthy individual just
10:10judging from the shirt and the and
10:13the stockings and the waistcoat.
10:16He's in an attic. With overlooking and,
10:20I get that from the dormer
10:22in the in the arch ceiling.
10:24He's overlooking a city,
10:25which I would I'm gonna guess his London
10:29with Saint Paul's in the background.
10:31He's dead, my guess is he tore
10:34up a letter from someone.
10:37There's a vial on the floor so
10:39it would suggest an overdose,
10:40but I don't know what's in his right hand.
10:43Whether that's a syringe or a dagger,
10:45you I know it's you, there's a.
10:48Blemish on his chest,
10:49but it's not blood stain so I'm not sure
10:52what that is and there's a funny dimple.
10:55But just to the left,
10:57there to the center of his
10:59left sternocleidomastoid.
10:59But I don't know what that is.
11:04You pointed out the wilting
11:05petals on the Rose. Does that
11:07mean that it needs to be watered?
11:10He's been in devil long time.
11:14OK, so So what you've done
11:16is you describe some things,
11:18but you have already come to a
11:22conclusion that he's dead so.
11:24What basis for your thinking
11:26that he's dead his color?
11:30OK, there's a color anything else.
11:38So when you look at him, he's lying on a bed.
11:43OK, but what about this posture on the bed?
11:48It doesn't look comfortable
11:50out OK, why is it not
11:52comfortable just the way the
11:53arm and hand are hanging? I don't
11:56think when we sleep that way, OK,
11:58but what else?
12:05You're on the right track,
12:06but what is there about his posture
12:09that really makes it uncomfortable?
12:11Is this a normal posture in any
12:14way though? So once this guy he's
12:17I mean he's hanging over the edge.
12:20I mean, I suppose if one
12:22were deeply intoxicated,
12:23posture wouldn't matter.
12:26The only thing that would go
12:29against being dead is the left
12:31hand seems to be holding his shirt.
12:34Which is sort of interesting.
12:39But I don't know it. It just looks
12:41like it just I was going by this
12:44color more than anything else.
12:46OK but but so alright.
12:47So there are several things here will
12:51come back to the party in a second.
12:54But you said this is he's in the attic.
12:59Right, OK, and the reason you
13:01said he's in the attic 'cause?
13:05There there are dormers, looks like
13:07a a pitched roof and then you're
13:10looking out high over the rooftops in
13:12the city right? OK so. That's right so.
13:16But we when we do this now,
13:19we have first year medical students
13:22who don't know anything about medicine.
13:25Zilch, clinical medicine.
13:26One of the things we can teach them,
13:29though, is something about what is.
13:33The concept of differential diagnosis.
13:35So the question here.
13:37So the question here is,
13:39could this possibly be in any
13:41other room in this House? Is that?
13:45Is it possible that it is the attic?
13:47The only place would give you this view.
13:52Penthouse anyone, how could you
13:57get this view of the window?
14:00If you weren't on the in the attic.
14:05Anybody?
14:09Maybe it could be on a lower floor,
14:12but if the house was up on
14:14a hill and it's looking out
14:17in distance X absolutely right.
14:18OK, we now have a differential
14:21diagnosis for the medical students.
14:23If this is on a hill looking out,
14:26you could be in the bottom of the
14:28house and see this same view.
14:30So now what tests do we apply
14:33to make to decide which it is?
14:36We have a differential diagnosis on
14:38a hill in the lower room or it's in
14:41the addict looking out what is there
14:44in this painting that what's the test
14:46that tells you which is the correct answer?
14:49Which is a correct conclusion?
14:53Well, it's a dormer Witchblade,
14:56yes, right exactly.
14:59Exactly, so it's this coming down the
15:02walls coming down tells you you're
15:04in the dormer or in the attic and
15:07that's that's to try to give you.
15:10Give a student a concrete example
15:12of what a differential diagnosis is,
15:15'cause both are possible and what
15:17test are you going to obtain that will
15:21help you distinguish between the two?
15:24And it's a simple.
15:25This is a simple, you know,
15:28in a kind of example,
15:30but it's a concrete example that I
15:32think helps some students understand
15:34what a differential diagnosis is,
15:36because they really haven't
15:38had that concept yet.
15:40OK, So what are the things so
15:42anyone else want to comment on?
15:45The way this fellow is lying on the bed?
15:50The shoulders and hips are 90 degrees apart.
15:54So the shoulders have a flat on the bed.
16:03How how is he actually resting?
16:04How would you describe the
16:06way he's resting on the bed?
16:10The fact that he's lying on his side,
16:14yeah. He's alive, but unconscious
16:19or asleep or intoxicated. OK,
16:23he's lying on his hips, right?
16:27Yes. But his back is almost
16:30flying flat on his back.
16:32His upper back is almost flat on the bed,
16:35isn't it? Right, so this is a
16:38terrible twist that you would have.
16:40Your body would have to make.
16:43And so you wouldn't sleep that way.
16:46You could only end up this way,
16:48I suppose if you were
16:51really comatose or dead.
16:53So I mean is this you have normal posture
16:55that tells you that he's not asleep.
16:58It's something more than asleep,
17:00so you now wondering,
17:01is he dead or comatose or what have you?
17:04So now you're going to look for other
17:07things in this painting to help you.
17:09And what else do you see here?
17:13The signal suggests what's going on.
17:18And there's the vial on the floor.
17:20And then I'm assuming is OK. Well,
17:24I don't know what's in his right hand.
17:27I think it is hard to tell, maybe paper.
17:30Actually, so there's a vial here,
17:33but there's no.
17:34I don't think there's a stopper or
17:37anything or cook any that I can see,
17:39but there's a vial that I think may be empty.
17:43What else is it?
17:44What else do you see in this in
17:47this painting that helps you
17:49with the status of this guy?
17:53It's a very uncomfortable position.
17:55Part of his head is overhanging
17:57the edge of the bed. Yeah.
18:02OK, an and he and the color of his face is
18:06really great as you see here.
18:08So I certainly look cyanotic,
18:10but what else is there in this
18:12picture that the artist is put in?
18:15To tell you that this guy
18:18is dead or about to die.
18:21What is the blemish on his
18:23chest and his neck? Well, if
18:25you look over here, oh this is
18:29just the. Hollow space of the.
18:35I think it's meant to
18:36be super sternal notch.
18:39Yes, 2% loss is a three linear
18:41red lines that he scratches
18:43that he has here in his chest.
18:46But what do you see over here?
18:52Rose losing its petals? Yeah,
18:53it is a rose that is drooping and you
18:57can see one of the petals falling.
19:01OK, and then what do you see over here?
19:05So the candle is burnt
19:07out at the candle is burned out
19:10and and what's above the candle.
19:16Smoke smoke.
19:17OK, so the candle is burnt out
19:21and there's smoke just burnt out.
19:24So this residual smoke so.
19:28So the window whoops.
19:31The window is open, right?
19:35So did a breeze come in
19:36and blow out the candle?
19:42No, the breeze is going the
19:44wrong direction. Had that
19:45it's going in the wrong direction, right?
19:48So. So that doesn't make sense that the
19:52window that the wind would come in a
19:54breeze would come in and blow it out.
19:58OK. One more thing, there's a chest over
20:02here, and there's a lot of torn paper.
20:07So we can, when you look at the
20:10room in general, would you say this
20:14is Model 6 or the Waldorf Astoria?
20:32You think this is a fancy
20:34hotel or just a grubby attic?
20:39It's just extremely early. Yeah, OK.
20:44I mean there are no sheets,
20:47although he's dressed seems to be
20:49dressed well. OK, so.
20:52So the watch thing. What is it?
20:58When you look at this
21:00picture painting as a whole,
21:02is there anything that strikes
21:04you as being either out of
21:06place or something that just
21:08strikes you as you didn't expect
21:10to see in this painting?
21:16Is there anything that
21:17strikes you about it that's?
21:21Then when you look at this
21:23first thing you notice.
21:25Well, he looks better.
21:27Off that is surrounded.
21:30It was my impression.
21:32Just in terms of his clothes versus.
21:35OK, so when you look
21:37at his clothes and look at
21:39the rest of the painting,
21:41is there anything that strikes you?
21:49When you look at the color here. And here.
21:58And then you see this.
22:08In general, you know this is a painting.
22:11That sort of muted.
22:12It's sort of brown colors, etc.
22:14But there's only one color,
22:16and that's his pants.
22:20What color are his trousers?
22:27Purple. OK, so if everything else
22:31The thing is sort of this dull
22:34brown color in the only bright
22:37color is a purple pair of pants.
22:40There must be a reason
22:41why the artist did that.
22:46Or get a red coat red jacket.
22:49He has a red jacket but but
22:52but the emphasis is here.
22:54The purple pants. I'm. OK.
23:02So the smoke going out the window.
23:05Kim is symbolic of someone who's dying,
23:08that's their soul going out the window.
23:12And the and the Rose is always
23:15been a symbol for life.
23:16So if the roses drooping
23:18affect was a falling off,
23:20this guy is not doing well.
23:23And then there is this scratching
23:25when he opens up his chest.
23:29The violin, the floor.
23:35Anne Anne Anne.
23:37He's in a Garret and there's full.
23:41You know a poor place to live
23:43and he has all this torn paper.
23:47An on the on the table there was a letter,
23:50the paper and a pen. OK,
23:53so this is called the death of Chatterton.
23:59Anne is a true story,
24:01and so Chatterton was a young boy who,
24:04at the age of 30, well,
24:07he lived in a village in
24:10England and his father.
24:12Was the sextant at a nearby church?
24:16And this church dated
24:17back to the 15th century.
24:21The church was now moving to
24:23a new place in the village,
24:26and the folks in the church had taken
24:29all the valuables out and moved it
24:33to the new location and they told.
24:36Everyone in the town that they could
24:39come in and take whatever was left,
24:42and his father recognized that something
24:45that was very valuable was parchment.
24:49And so he brought the kid home.
24:52This is Chester Patrin,
24:53which is very valuable.
24:55The young boy wrote poetry
24:57and he began writing poetry.
24:59And he at the age of like 15 or 16
25:03decides that he's going to sell his
25:06poetry because it's on parchment.
25:09From the 15th century he's going to
25:12sell it as poetry written by a priest
25:15who lived who worked in that church.
25:19At that time, years ago, and so he went to.
25:24Big editor in in London who threw him out
25:27of the office but he got to Robert Walpole,
25:31I mean rather.
25:32Horace Walpole,
25:33who was the son of Robert Walpole,
25:35the Prime Minister of England
25:37at the time in Horace Walpole,
25:39was going to give him money
25:41for these for this poetry.
25:43But a friend of hers told him,
25:46I think there's something
25:47suspicious going on.
25:49Don't do it,
25:50and eventually he gave the all
25:52the poetry back to this kid.
25:55At the age of 16 this kid was
25:58apprenticed to be a lawyer.
26:00Didn't like that and he got out
26:02of that and he went to London
26:04and he wrote as a freelancer for
26:07some magazines and newspapers.
26:09But at the age of 17 1/2 so
26:11this is the late 1700s.
26:14He wasn't really doing well
26:15and he committed suicide.
26:21In the early 1800s, like 1830 or so,
26:25the romantic poets.
26:28Shelley and those other guys found
26:31his poetry and loved it because
26:34he was writing it in in the style
26:37of the feelings that that Shelly
26:39and the others wrote their poetry.
26:42And So what they did was they puffed him
26:46up and essentially said he was a genius,
26:50a poet, and the public,
26:52and they didn't recognize him
26:54an he decided and he died.
26:57A poetic modders death essentially.
27:00So at that time this artist,
27:02Wallace was commissioned to make
27:05a painting of this whole event,
27:07because this guy was now a big figure
27:11and this was going to celebrate his life.
27:15That was appreciated by no one and so.
27:22This position that he's lying in.
27:24If you then tilt the move tilt this.
27:30180 degree, 90 degrees or 45 degrees.
27:34This now looks like what?
27:43Crucifixion, yeah,
27:44so that's why the purple pants,
27:47the purple is signified.
27:49This is a very important figure.
27:52That has been sacrificed by the public.
27:54So so if you tilt it this way,
27:57it looks like crucifixion.
27:58Now if he his hand was stuck out this way,
28:01it would be a dead giveaway and
28:03that's no fun in a painting.
28:05And in this way it looks like the PA TA.
28:08So when you look at this position here.
28:12Wallace, it really looks like this.
28:14Peeta and the Michelangelo, Peeta,
28:16and this was like a crucifixion.
28:20So that that was the purpose of the painting.
28:24To celebrate this guy who nobody recognized.
28:27Now the story doesn't end there
28:29because two things happened.
28:31Nobody knows what Thomas
28:32Chatterton looked like,
28:34but they know where he died.
28:36So this Garrett, this attic that you see.
28:40Is exactly where he where this all
28:42took place and he they don't know.
28:44Maybe took us Nick is not clear what he took.
28:48But what else happened was
28:51that the editor at Kent,
28:54University of Cambridge,
28:55Cambridge University,
28:56initially saw this post poetry
29:00and published it.
29:02And that was really quite good.
29:04And then it came time for second
29:06addition or a second printing in the
29:09editor suddenly realized he'd been
29:12duped because he suddenly realized
29:14that with this fellow had done,
29:16he had gotten a trust Syrian dictionary.
29:21And use those words,
29:22but the syntax and grammar was that of the
29:2618th century was not of the 15th century,
29:29and then he noticed that the
29:32treasury and words that he used
29:35didn't go beyond the letter M.
29:38So in the second printing he had a
29:41mea culpa that he had been duped.
29:45So that's what this kid had done,
29:49and nevertheless.
29:52The powers really loved him.
29:54Shelly and Byron and the others
29:56really loved him and puffed
29:58him up and the final straw was.
30:00And since nobody knows,
30:02nobody knew would shattered and look like.
30:05Wallace asked his friend,
30:07George Meredith,
30:08who was a very famous poet at that
30:12time in England in the eight in
30:15the 19th century to pose for this.
30:19So this is a picture of George
30:22Meredith with his flaming red hair.
30:25And then Wallace rewarded Meredith
30:28for doing this by recording his wife,
30:31courting Ameritas wife,
30:33and running off with her.
30:35And they get it.
30:37Got married six months later.
30:39And we know this is the story because
30:43this is what I think they had a
30:46child and this is what the story was.
30:50So the point of this was using this
30:53painting was to make you realize that
30:56the posture is totally abnormally notes.
30:58So this isn't how someone sleeps.
31:01There's a vial to help you.
31:04There's a symbols of the Rose.
31:06And the smoke going out.
31:08And finally the purple pans dryer
31:11attention that this is a very
31:13important figure in you know what?
31:16What is an important figure doing
31:18in a rundown place like this?
31:23So that's a story about 1:00.
31:25So let's go to another one a little
31:28bit more complicated. This one here.
31:31It's called the Gore family.
31:36And go ahead and look at it,
31:38and we'll do the same with this one.
34:56Cave. So who would like to take this one on?
35:18Who would like to do this?
35:23I got a couple of bits and pieces OK.
35:28I can't make out all the allegory's
35:31in the painting and what they
35:33have to do with with the people.
35:35I mean I, I see 3 muses.
35:38Well, there's is it.
35:40Hercules in the Medusa don't know
35:42who the ones in the water are.
35:45Looking at the scenery in the background,
35:48my guess is it's Tuscany.
35:50'cause you're angry.
35:52Cypress OK,
35:55so why do you say Tuscany?
35:58Because of the Cypress and then
36:00there's a couple of towered buildings
36:03back there. These here.
36:05Yeah, OK, what is this anyway?
36:12Further walled city looks like aqueducts,
36:15right? Yes in aqueduct. Oh
36:18OK. I OK I. I thought it was a walled city,
36:22like Joanie or something. That's OK.
36:25I want you to. I will tell you that.
36:29Embarrassed to tell you this that
36:31when we show this to the students,
36:34most of the most of them have never,
36:37never have either heard of an aqueduct
36:40or recognize it as an aqueduct.
36:42That really got me. Well, they didn't.
36:44They finally I said,
36:46what's an arch bridge and finally
36:48got someone to say aqueducts,
36:50but anyway, so there's
36:51gotta be southern France. Probably OK, so
36:54that makes it very specific.
36:56But in the in a general way,
36:58if you're seeing an aqueduct that.
37:00Most likely in some Roman province
37:03and then the hills suggests that
37:06it could be southern France.
37:08You know Italy, but what's going on?
37:12What's this thing here?
37:14It's it's grapes, said Arbor.
37:17Yes, any and you see the
37:20grapes right here. OK, I
37:22know you pointed out of mouse and
37:25then the other thing I saw was.
37:28It appears that he's wearing I would guess,
37:31and I'm saying some sort of uniform
37:33because of the stripes and there's
37:35and the drawing has chips on it,
37:38so I'm guessing. Right Navy OK,
37:41right? So so
37:42those talk about the people
37:45here in the foreground.
37:49Well, how many people are
37:51there and what are they doing?
38:03Play a kid instrument. I don't
38:05know what that is, whether it's a
38:07you know the forerunner of pianos.
38:10And cello. And she's not looking
38:14at the music he is. Wow, good
38:17right? She, he's looking at the music.
38:19She's not looking at the music but
38:22you also said he's playing a cello.
38:25But is it a cello?
38:30So awful big yeah. Well, there's no,
38:34there's no tooth on the bottom haha.
38:36So there's no tooth on the bottom,
38:39so we can't call it a cello.
38:41So this is the predecessor to the cello,
38:44and it's called the Viola da gamba.
38:47OK OK so So what what you know?
38:51For the purpose of this exercise, yes.
38:54Everyone's also most almost everyone
38:56would say this is a cello because
38:59they assume that there's a peg here.
39:02There's a coming down.
39:04An if they looked at it more
39:07closely and realize that it wasn't,
39:09then they might not know that there
39:12was a predecessor to the cello.
39:14Or maybe cellos come this way,
39:16but it should raise some sort of a question
39:20in their mind that this isn't the usual
39:23cello that I see they know about anyway.
39:27It's a minor point,
39:28but it is trying to focus people on the.
39:32On the subtle features that are
39:35present in your environment.
39:37OK, so.
39:38There are four women here, right?
39:43And so.
39:44There are three daughters and one mother.
39:49So who are the daughters
39:50and who is the mother?
39:56I'm gonna guess the mother
39:57is the one on the far right
39:59wearing a cap for some reason,
40:01whereas the daughters have these
40:02other things in their hair.
40:04OK, and that's the correct answer
40:07because married women wore caps
40:10and unmarried women did not.
40:13OK, so let's take these two So what?
40:16What's the action going on here?
40:25Reading and writing. Well, well aniki
40:29be more specific than that. Well,
40:32the daughter has a pen or pencil in her hand.
40:35Yes Ann. What is she doing?
40:39She's looking beyond her mother.
40:42She's looking at her mother for
40:44beyond her. Maybe she's drawing.
40:50What it what is she doing with her left hand?
40:58Old and mature. Yeah, you get the
41:02left hand on the back of the chair.
41:04But the chair. How is it?
41:08How is the mother sitting on the chair?
41:12Awkwardly. On the inside.
41:17And what is the mother doing?
41:19Staring something yeah.
41:21Who is she staring at?
41:23Don't know yet you do. Us, yes,
41:28he's looking at us.
41:29The mother is the mother is looking at us.
41:33The daughter of is, you know,
41:35has her arm behind the mother supporting
41:37her back or chairs and she has a pencil
41:40and the mother may be saying something
41:42and she's going to write it down.
41:45It looks like the daughter is
41:47waiting for some sort of response.
41:49The mother though is looking at us.
41:52The weather all these funny looking
41:54people doing looking at us.
41:56OK, and you talk about the
41:59father as looking at the at the.
42:02Music the daughter is not.
42:03She knows the music so she
42:05can play and look that way.
42:06But what is this daughter doing?
42:11She's looking at whatever the other
42:12daughter is looking at somewhere over
42:14to the left side of the picture.
42:19OK, but what else is she doing?
42:24Flipping the pages for the
42:25other system, what does
42:26she have in her hand? Turning in music.
42:31Yeah, but she's not turning the pages, she's
42:34just holding it haha.
42:35Very good because the first response
42:37usually is that she's turning the
42:39pages when you look very carefully,
42:41she's actually holding the music.
42:44So she may have been singing,
42:46but she has her own set of music.
42:49Anna's she's not turning these
42:50pages 'cause the page has just
42:53been turned over here, OK?
42:57On with the with the expression on her face.
43:00What does that expression on her
43:03face suggest to you? But she's doing.
43:13Thinker or board, yes, or
43:15looking off into space or something. OK,
43:18so we have this guy here dressed in green.
43:22You will respond in looking fellow
43:25with a wig. What is he doing?
43:29He's looking at her, but she doesn't want to
43:32look at him, right?
43:33So she's really he's looking at her.
43:35And what about his posture? Well,
43:37how would you describe his posture?
43:47Well, you know how is he standing?
43:50What, what do you
43:51actually say? Relax,
43:52he's leaning on the chair not
43:55showing right?
43:55Yeah, he's got his feet crossed,
43:57his ankles crossed.
43:59He's relaxing, he's nonchalant.
44:00He's looking at her.
44:01She's looking elsewhere.
44:04We got taken care of the medical
44:07of the the musical instrument.
44:10Players were gonna get to this in a second.
44:14There is a watercolor here of some boats.
44:18We place this in some Roman
44:20province with the hills.
44:22With France.
44:23The Tuscany does an aqueduct and you
44:27picked up on the mouth could be a rat.
44:31Ann, you picked up in the vineyard,
44:34so, so the vineyard and these other
44:36things tell you that is likely
44:39an Italy or France 7 friends.
44:41But there is this creature with the
44:44tail annual notice that as it racist,
44:47and it comes down to this guy,
44:49shoulder the vine.
44:52So why he put a rat in or
44:55a big mouse is unclear.
44:57We interpret it as a rap.
45:00OK,
45:00so So what is the general
45:03atmosphere of these people
45:04here in this living room?
45:13Entertainment entertainment.
45:15They were happy lot.
45:18They're not a sad life is
45:20a pretty much happy life.
45:22But then in this painting is a
45:24painting inside the painting, OK?
45:30OK, here we are in this is pretty much
45:33the whole painting and Anne when you
45:36look at the painting what do you see?
45:42There are a number of Al
45:45Gore's OK but.
45:48Forgetting what their interpretation
45:49maybe what they actually see though.
45:52How if you had to describe it
45:55to somebody who's not here.
45:57Who's not seeing the painting?
45:59How would you do that?
46:08There's a lot of
46:09action, right? There's a lot of action,
46:12but is there something about the
46:14action that you can actually dissect
46:16the action and isolate it in play?
46:18An isolated in different parts? In
46:23looks like there's some worship going on of
46:26the statue. OK, so we got this pair is
46:30something to do with worshipping OK?
46:33Do you see any other peers?
46:35Well, there are three. There are
46:37three ***** ***** probably muses.
46:40OK. Where? What are the?
46:44What are the pairings? Do you see
46:47is number of chairman?
46:50Hey, you got those right?
46:56What what others?
46:59I can't remember which God is had
47:01a mirror, but that's the one.
47:03In the center coming down
47:05from the rainbow. Oh OK, yeah,
47:07these are the least important people in here.
47:12It's the others that are out. Tell a
47:16story with this producer
47:17and probably Hercules.
47:19OK so, but how would you describe this
47:23couple? Objectively. Not interested.
47:28You're fighting by then. He had
47:30more than that. How are they fighting?
47:35What? What are they actually doing?
47:39How would you describe the
47:41action hand to hand combat now?
47:43Yeah, I know, but still I still don't have a
47:46picture of what they're doing to each other.
47:50He's grabbing the snakes and
47:52trying to hit her on the head.
47:54OK, so you're saying there's a man there?
47:58We had something in his hand that is going
48:01to hit her on the head with right club,
48:03yes, and she had got a club OK and so
48:06he's holding the club in his right hand.
48:09And what is he doing with his left hand?
48:12Grabbing the snakes.
48:14Well, well, see the snakes or
48:17it's just a terrible hair day,
48:19but he basically pushing her away,
48:21pushing that the head away and he has a
48:25club in the other hand an and what is?
48:29And what is she doing?
48:32Which
48:32doing she's pointing to
48:34something or pointing to
48:36him right with her left hand, she's pointing.
48:40With her finger at him, right?
48:48He's pointing with a finger.
48:50That may mean something like mean anything.
48:54And in the other hand,
48:56what does she have?
48:58Torch and torch OK?
48:59Now down in this corner and
49:02Andrew ***** are hanging out.
49:04OK down in this corner we got
49:07this couple right and what's
49:09going on with this couple?
49:12You're bathing. All
49:15right there in the in water,
49:16but what else is going on?
49:21What do you notice about this person?
49:23Versus this person.
49:25She's much younger, haha right?
49:27So we got this young,
49:29beautiful girl who's hanging,
49:31holding on to him he's
49:33your hand on his shoulder.
49:35And he has a basket of something.
49:37And what is he doing?
49:44He's looking away or looking
49:46out. Yeah, he's looking away.
49:48OK, so this older man is looking away
49:52you got the beautiful young girl.
49:55Singing is saying something
49:57I don't know, So what?
49:58What does this suggest is going on?
50:02Between the two of them.
50:07Young, pretty girls do some
50:09what she's trying to seduce him.
50:12Yes, OK this substance
50:14seduction going on here, OK?
50:18Over in this corner we have this woman.
50:22Who has what?
50:24Maybe your baby's right.
50:29And with an look at the expression on her
50:32face, she's looking over here, right?
50:38Quit. What's the expression
50:41on her face? Other. 1.
50:47MSN Yeah I mean there.
50:51Yeah fear there's just this
50:54fear on her on her face.
50:56OK, and now we come to this couple an
51:00what is what is physically he doing?
51:04And what are they both doing?
51:08This reunion thing, and this was he
51:11actually doing? What is he? You
51:15gonna describe the night he's
51:17leading her by the hand, right?
51:20She's kneeling, yeah. Or falling.
51:25Or she's kneeling on something
51:27there with his helmet.
51:29OK, yeah, I think it is and what
51:32is he doing with his left hand?
51:39He's leaving her with his right hand, right?
51:43And with his left hand it's behind her back.
51:48But what about the expression on her face?
51:56You're looking up at this statue.
51:59Is this the face of?
52:02Of someone who's happy,
52:05or someone who's fearful. It
52:08could be fearful it could be idolation
52:10too. Yeah, OK, so this is. So
52:14this this statue is supposed to represent.
52:19Hymen they go out of marriage.
52:23And so in in this particular.
52:26Painting this young woman is being
52:28brought to the altar of hymen,
52:31but she is some resistance.
52:33She's not exactly enthusiastic,
52:34and he's pulling her tored the statue.
52:37This woman was two babies look
52:39sort of terrified and fearful.
52:42She's not exactly happy.
52:43And then here is the young woman in
52:47straight out of the top of her head.
52:50It's like a cartoon.
52:51There is this figure with a
52:54club who happens to be Hercules.
52:57This is supposed to be the skin of a lion,
53:00and he's pushing away this figure with
53:03wild hair supposed to be not Medusa, but.
53:08Glad I'm blocking it.
53:11Gordon no, he represents slander.
53:14Look, you know I should have written
53:18it down like it will come back to me.
53:21Anyway. This is Hercules driving.
53:23Slander away that's what it's supposed to be.
53:26Not knowing when I looked at it I hit total.
53:30They didn't recognize this is Hercules I
53:33thought it was a man pushing a woman away,
53:36representing violence in marriage,
53:38but it's actually Hercules pushing this
53:41woman away who represents slander and
53:43down here we have a seduction scene.
53:45In all, the only happy people in here
53:48or I will care about is flying around.
53:51OK, so.
53:54This painting, oh,
53:55and this is a high.
53:56I'm sorry it shouldn't show this
53:58is a higher view.
54:00Of Hercules and this Medusa like
54:02figure and then it's coming right
54:05out of her head like a cartoon and
54:08this is the seduction figures here.
54:11So with this.
54:13This painting
54:17was commissioned by the father.
54:23To celebrate the wedding.
54:27Of his youngest daughter.
54:30Who's 16 to the Earl of George?
54:33The Earl of Cowper? Who's 37?
54:39And so this painting was done actually
54:42before the marriage ceremony took place.
54:44It was several months before.
54:48Anne Anne so this was the
54:50celebrate this impending marriage.
54:52So the answer. True story.
54:54So the background is that the
54:57Gore family bum bum bum bum bum.
55:01Left England and went to Florence
55:03to live because the mother had some
55:06sort of a chronic illness and they
55:08thought a better climate in Florence
55:11would help the mother when they
55:13get to Florence they meet George,
55:15the Earl of Cowper and George is an
55:18expat from England who left England
55:20long time before and moved to Florence
55:23and he was living there and he was
55:26hoping to eventually get some sort of
55:29diplomatic posts in the Broly home and.
55:32In the arm in the Holy Roman Empire.
55:36And so he was living in Florence,
55:38and at the time he was having
55:41an affair with a married woman,
55:43and this was in all all the newspapers.
55:46Actually was, uh, it was an older woman.
55:49Maybe she was a widow by this time,
55:51but it was in all the newspapers and
55:54there was a long already about this.
55:57He then drops the woman and is
55:59a marriage contract between the
56:00father and him that he's going
56:02to marry the youngest daughter.
56:04So she's 16. He's 37.
56:07And this is before the wedding,
56:10and while they may be happy here,
56:13this is like a big cut balloon
56:16cartoon coming out of her head.
56:18But she's concerned about.
56:20So.
56:20This is Hercules driving,
56:22slander away,
56:23slander being the notoriety that
56:25this fellow had with this woman.
56:28She's concerned that maybe after
56:30they get married he's going to be
56:33seduced away by some younger woman.
56:38This represents her reluctance about
56:39getting married in the 1st place.
56:42He's being pulled toward the statue
56:44and here is this woman with a couple
56:47of young babies, and she's 16.
56:49She's not ready for that either.
56:51So so in the front in the foreground we have
56:54is very happy scene to celebrate something,
56:57but in the in the background we probably
57:00have the true state of her mind as
57:04to what she's thinking about so.
57:06So it turned out that this marriage
57:09is 16 to 37.
57:10Doesn't have a lot of probability of working
57:13out and a matter of fact it didn't work out.
57:16It was a terrible marriage and
57:18was known all over England.
57:20They were always talking about this couple.
57:23She spent all the money on Silver Ware
57:26and porcelain and he wouldn't pay for it,
57:28so she had to go back and
57:31Hock it to get the money.
57:33It was a terrible story.
57:37An so they asked the they asked the artist
57:40Dakhani who's a very famous quote artist,
57:43why did you paint this?
57:45What what's his story here and he said,
57:48well, he said, you know this is
57:51what the future is going to be like.
57:54Happy at etc. But this is what the
57:58past was like and so that's the past.
58:01This is the future.
58:02Well when you think about it,
58:05that's that's a lame excuse.
58:07Because.
58:11She's here worried about seduction, slander.
58:14She's really to get married,
58:16so this is not the past.
58:18This is what she's really thinking about,
58:21but he got away with it and I don't know
58:26if the I guess he did pay the artist.
58:29But then I found a note,
58:32a letter that he Gore had
58:34written to the father and said,
58:37don't you ever talk to me again?
58:40Write to me in that tone 'cause
58:42he was something about the
58:44marriage contract and money,
58:46and I never found the
58:48original settlers about,
58:49but he was essentially saying don't
58:52bother me with this is it is closed.
58:54The watercolor here is to represent
58:57the fact that this fellow Gore was
58:59actually a very fine watercolorist,
59:01and he went on expeditions with other
59:04people and he painted what they saw.
59:07Was he pulled the year of cameras,
59:09so he recorded.
59:11But they saw in watercolor,
59:13so the fact is that this rat is coming
59:17out of here because that's exactly
59:20what that is thought of of the groom.
59:24That he was her fresh,
59:27and that's sort of the story behind this.
59:31This painting.
59:32It turns out, though, that this guy,
59:36George, the role of copper,
59:38was actually had a lot of money,
59:42and for his time in the 1700s
59:45in his home in Florence,
59:48he had the latest equipment for physics
59:52lab have thermometers, hygrometers.
59:55All kinds of things,
59:56and he's doing experiments and he.
59:58So he was smart and he was supporting
01:00:01the arts, but he was a terrible husband.
01:00:06And then he tried to get Tesla.
01:00:09Tesla.
01:00:11It's the same name as the current
01:00:14Tesla who invented with radio,
01:00:16but this had.
01:00:17The Tesla was interested in magnetism
01:00:20and he tried to get test for inducted
01:00:23into the Royal Society in England.
01:00:26But the English said now we can
01:00:28possibly have him as a member of the
01:00:32Royal Society 'cause he's Italian.
01:00:34He's not English,
01:00:35so they even though Tesla had
01:00:37actually done some very good work.
01:00:40So that's the story behind that.
01:00:42And so if you have any questions or
01:00:45any comments, please let me know now.
01:00:49Any questions?
01:00:52Hercules and to learn and Hydra
01:00:55was a second label. Looked it up
01:00:57on Google while you were talking.
01:00:59What was that? Hercules
01:01:01and the Lernaean Hydra.
01:01:03It was his second labor OK.
01:01:08That was a great shot.
01:01:09Doctor Braverman,
01:01:10with the analysis thank you
01:01:12for leading us through,
01:01:13was very informative.
01:01:15OK, I'm glad you liked it,
01:01:17so this is what you know we do
01:01:19with the students an with the
01:01:21students come over like time.
01:01:23Now be 1/4 of the class.
01:01:26Now we divide them up into
01:01:28groups of four or five with the
01:01:30dose in Tonio some like that,
01:01:32and each student gets his own painting.
01:01:36Yeah, and he stands in front of
01:01:37the painting he studies at the 1213
01:01:40minutes and then we get them all
01:01:42together and then that student will
01:01:44stay in stand in front of his painting
01:01:46and describe what he saw and then
01:01:49when he runs out of comments then
01:01:51the other students will chime in.
01:01:53And it's been really very effective
01:01:55and we were really surprised when
01:01:58we learned that while we thought
01:02:00we were teaching observation,
01:02:02ull skills,
01:02:02we didn't realize that we were teaching
01:02:05him something about how they made decisions,
01:02:08which I think is more important
01:02:10than than the observation.
01:02:12Actually, they're both important,
01:02:13but I think the fact they recognized
01:02:16that they're making decisions and with
01:02:19insufficient evidence is is what happened.
01:02:21And we when we started as 22 years ago.
01:02:26It was done as a pilot project and
01:02:28as I mentioned, that little blurb,
01:02:30one of two of the medical students
01:02:33actually worked on this for the thesis,
01:02:35and that's how we got control
01:02:38groups and intervention groups and
01:02:39got this published in JAMA and as
01:02:42soon as we got a published in JAMA,
01:02:44the school said,
01:02:45OK,
01:02:46it's now required course and
01:02:47within three or four months this
01:02:49was now sad to be picked up by
01:02:52other medical schools and as of
01:02:54now there's somewhere between 100.
01:02:56I know of 100 for sure,
01:02:59but other people looking out of 765
01:03:02school medical schools both in the
01:03:04United States and overseas who are you doing?
01:03:07The same technique either the exactly like
01:03:10we do it or just in part like we do it.
01:03:14So it really struck a vibe that you know
01:03:18observation was an important thing.
01:03:20And then I think the other thing that
01:03:24struck the vibe was that you know.
01:03:27I was taught this important to
01:03:29look to see etc.
01:03:30But then by the mid 70s doctors were
01:03:33beginning not to do this because of
01:03:36these imaging techniques that were coming in.
01:03:38You know,
01:03:39Mris and CAT scans and the rest
01:03:41and physicians.
01:03:42Now we're relying on those to make a
01:03:45diagnosis rather than looking because
01:03:47a lot of things you can make it
01:03:50diagnosed by looking to save time and money.
01:03:53An even doing a good examination,
01:03:55physical examination to make a diagnosis.
01:03:58I remember I once had a problem,
01:04:00my shoulder and I was so amazed that
01:04:02the orthopedist actually move my
01:04:04shoulder around and did all kinds of
01:04:06things to figure out what was wrong,
01:04:08and then he sent me for an X ray
01:04:10and I couldn't believe that someone
01:04:13actually spent the time doing this.
01:04:15No,
01:04:15it really was a wonderful bond
01:04:18and I think
01:04:19that by by paying attention to people,
01:04:22doctors really make good bonds
01:04:24with their patients and they
01:04:26get more compliant patients.
01:04:28So it isn't just for diagnosis,
01:04:30it's also for the relationship.
01:04:32So that was my.
01:04:33No propaganda piece about why
01:04:35I should look carefully, but
01:04:38one of the things about this last pain.
01:04:42Is I made the assumption that was a cello?
01:04:45Yeah, I just assumed the peg was
01:04:48there. Yeah, right, that's right, it was.
01:04:51Yeah, your brain fills in the missing parts,
01:04:54and that's what often happens.
01:04:57The brain fills in the missing parts.
01:05:04Thank you. Thank you.
01:05:06Good to see you, Harold.
01:05:12Anyone else have any questions or thoughts?
01:05:23OK, something that was not
01:05:25commented on is the broken vase with
01:05:28the flowers in front of the
01:05:31statue. Oh really, oh OK.
01:05:38I mean over here. Yeah, that's how I read it.
01:05:43It could very well be.
01:05:45If you know the rat that's here.
01:05:52Yeah, well it took a medical
01:05:54student to find this. We've been.
01:05:56We've been doing this for 20.
01:05:58It must have been like year 20 or something.
01:06:02I never notice the racket was a
01:06:04medical student who had this painting.
01:06:06Is this is a trap there and
01:06:08which made sense because he's
01:06:10considered this guys consider at so.
01:06:15Even we did not find everything here that
01:06:17there was in the painting and medical
01:06:20students always added something to this.
01:06:22And the best part of this
01:06:25exercise was believe it or not.
01:06:27No two students have ever described these
01:06:30paintings in the same way, never 'cause.
01:06:32If they did, you know this would be a
01:06:35pretty boring kind of exercise to do
01:06:38from the standpoint of the teacher,
01:06:40but no two students ever ever described
01:06:43these the same way they all approach didn't.
01:06:46Different way to get to the final end result,
01:06:49but they had different ways of
01:06:52analyzing it so.
01:06:53That was a good part for us.
01:07:01Well, if nobody. Have any
01:07:04more questions or comments?
01:07:05I thank you very much for joining in.
01:07:10Didn't quite know how this is going
01:07:12to go, but. Zoom is a very good
01:07:15thing for us during this past year.