Reunion 2016: A look at paintings raises awareness in the doctor-patient encounter

On the first Saturday in June, Robert Rock stood in the lobby of the Yale University Art Gallery, waiting for alumni attending this year’s reunion. Rock, who has completed three years of medical school, is taking a fifth year to research medical education before his final year of electives, sub-internships, and of course, the search for a residency match. Medical education has interested him since he was a first-year, when he and classmate Tehreem Rehman launched an elective course in health justice. The 10-session course explored themes of race, class, social status, and gender as they relate to the practice of medicine. It included a visit to the art gallery, where Rock provoked discussion of those issues by looking at paintings.

Last August, Rock reprised the gallery visit for incoming medical students, the first to study under the Yale’s new curriculum. For reunion weekend, his “students” were alumni who had come to see firsthand this new element of the curriculum. Once the group had gathered in the lobby, Rock explained the purpose of the visit.

In medicine, he said, it’s important to understand the power dynamic between patients and providers. “When the stakes are so high, expressing biases—whether unconsciously or consciously—can undermine and really sabotage the therapeutic relationship before it starts and influence the delivery of care,” he said. “It’s heavy stuff. We are going to use the art and the space to discuss a slippery, very difficult topic. We are going to study the expression of bias in Western culture, using works of art to critically assess the skewed lens through which we perceive the world.”

Their first stop was a work by the German painter George Grosz. Divided into two vertical blocks separated by a window, the painting’s right half shows people in gowns and tuxedos at a party while the panel on the left shows a man on crutches begging for alms.

“What do you see?” Rock asked the group of a dozen alumni.

“Wealthy people,” an alum answered.

“Let’s be objective!” Rock admonished. He was looking for nouns, not adjectives. Straight facts without the presumptions adjectives carry.

“People wearing what look like tuxedos,” the alum corrected himself.

“Tell me what else you see,” Rock said.

“The guy with the cigar looks like he’s kissing it.”

“He looks a little adrenalized.”

“Objective! Let’s be objective,” Rock repeated.

Rock elicited more details about the painting—people dressed in tuxedos and gowns who are smoking, drinking, and eating, and a man in the street with crutches—and moved on to analysis.

“What is the message the artist is trying to convey?” Rock asked.

An alumna noted the contrast between rich and poor. “They are being juxtaposed for a reason.”

“I don’t see anyone really connecting with anyone,” said another.

The painting dates from the 1920s, with Germany traumatized by its defeat in war, a shattered economy, and high unemployment. The man on crutches may be a wounded veteran. Amidst the poverty, the swells are living it up.

Rock brought the group to a hard, and revealing, question.

“Which side of the painting do you see as yourself and which side do you see as your patients?”

The wealthy in the painting, noted an alumna, are completely unsympathetic. “They are made to look like animals.”

Yet the group acknowledged its affinity with the people on the painting’s right side.

“I am privileged, as those people are,” said an alumnus, adding, “As a clinician I am more associated with the left.”

“In the past I have taken care of veterans,” said an alumna. “I take care of a lot of people who are more like the people on the right. I associate with them.”

“You did a wonderful job of interpreting the painting,” Rock told the group.

Afterwards, Cindy Crusto, Ph.D., associate professor of psychiatry, led a group discussion based on her Powerpoint, “Making the Invisible Visible: Art, Identity, and Hierarchies of Power.” It is important, she said, to include the visit to the art gallery in the first two weeks of medical school. “We really want our students to understand diversity and inclusion. We want people to understand their inherent assumptions and biases. These are things they are going to be confronted with every day. This is a way to start the conversation from the very beginning of their training.”

This article was submitted by Tiffany Penn on June 24, 2016.