By Rob Press | Photos by Peggy Peterson
Medicine has been long intertwined with the arts. Today’s younger physicians are embracing that connection, from anatomical drawing to podcasting.
If you have the chance to listen to one of Vidya Viswanathan’s talks on creativity in the medical field, you might get to hear one of her favorite historical anecdotes on the subject: how a bashful Frenchman used his hobby of playing the flute to help solve a medical dilemma.
In late 1816, French physician René-Théophile-Hyacinthe Laennec was at an impasse. The young woman in his office was experiencing heart trouble, and he needed to hear it—but he’d need to put his ear to her chest to do so, and that was too awkward to bear.
Drawing on previous observations of how sound could travel through a hollow tube, Laennec improvised. He tightly rolled a piece of paper, placed one of its open ends on the patient’s chest, and placed the other end up to his ear.
He spent the next three years perfecting the design of what we now know as the first stethoscope.
Viswanathan, a second-year medical student at the Perelman School of Medicine at the University of Pennsylvania, tells Laennec’s tale as part of the reason she built a website called Doctors Who Create
. It’s just one of the many examples she’ll point toward of individuals who, as she put it, “stand at the intersection of art and science.”
“Historically, physicians have been incredibly creative,” Viswanathan said, adding that history is replete with well-known scientists who dabbled in the arts, or vice versa.
Some of her other examples: Anton Chekhov, one of history’s most famous Russian authors, was a practicing physician his entire life and published studies on social medicine. Leonardo da Vinci’s anatomical drawings—and some of the conclusions he came to about the body’s function while producing those drawings—remain relevant despite being hundreds of years old. Closer to home, William Carlos Williams was, on top of being a renowned poet and painter, also a well-respected practitioner of pediatrics and general medicine.
Creativity and medicine are no strangers to one another—and have proven to be wonderful bedfellows.
As Viswanathan follows in the footsteps of Williams, who earned his own medical degree at Penn in 1906, she is forging a path forward for medical students and young physicians who are once again turning toward and embracing creativity in its various forms. Although humanities majors still make up a small percentage of medical school classes nationally, they are admitted at higher rates than science majors—46 percent of humanities majors who applied ultimately matriculated into medical school in 2016, compared to 39 percent of all other majors, according to data from the Association of American Medical Colleges. Viswanathan, who studied Chinese history as an undergraduate and worked as a freelance writer after graduation, is one of approximately a third of Penn medical students in recent years who completed post-baccalaureate studies before applying to medical school and a similar percentage whose backgrounds are considered “nontraditional” in medicine—at least according to the traditions of the most recent generation. Viswanathan seeks to speak for a generation of medical professionals like herself who see creativity as vital to their growth and education, and who are pushing for its inclusion within and outside the formal curriculum accordingly. To them, creativity is more than just something to indulge in outside of the medical space: It’s something separate from but no less important than the constant influx of information provided by medical coursework, a tool to be utilized in myriad forms across all of medicine, and a means of infusing humanism into their lives as physicians.
Telling the Stories of Doctors Who Create
Viswanathan’s website, Doctors Who Create, highlights physicians and medical students at the intersection of art and science. With it, Viswanathan is working not just to tell the stories of historical figures like Laennec and Williams and of their modern counterparts, but to show that creativity’s place in medicine deserves representation. If that sounds like a wide net to cast, it’s because Viswanathan wanted it that way.
“I purposefully made it broad, because there are a lot of projects dealing with the humanities in medicine—which are wonderful—but sometimes there are people in medicine whose minds shut off when they hear ‘humanities,’ just like there are some people in the humanities whose minds shut off when they hear ‘science,’” Viswanathan said. “People think ‘I’m not good at that or I don’t know enough about that, so I can’t engage.’ So I wanted to make it about creativity, which is something essential to both the humanities and science.”
Viswanathan got Doctors Who Create off the ground in early 2015, right around when she was accepted to medical school. She started by contacting physician writers she’d known and appreciated, asking to interview them about their paths to medicine and what they might be working on—and the feedback was more enthusiastic than she expected. In the summer of 2016, Viswanathan received a grant from the student health-care innovation group PennHealthX to build a staff of about 25 volunteer writers, artists, and editors.
An Emerging Creative Culture in Medical School
Lauren Kelly entered the Perelman School of Medicine five years ago with a master’s degree in narrative medicine from Columbia already under her belt—a background that she says led to her involvement with an effort in her first year to inject more creative expression into the Doctoring course in which students learn concepts of cultural competence and humanism in medicine. Kelly and seven other students worked with Horace DeLisser, MD, an associate professor of Medicine and associate dean of Diversity and Inclusion, to emphasize more small-group experiences in place of lectures in the class.
“We introduced reflective writing, paired discussions, and roleplays—creative opportunities to help us students process our experiences in medical school,” said Kelly, who graduates from Penn in 2017 with MD and MPH degrees. The altered Doctoring course has been the norm for first-year medical students at Penn since 2013.
Even without a shift in the formal curriculum, though, shifts in the backgrounds of medical students made a difference in the learning environment, according to Yun Rose Li, MD’16, PhD’16. A self-described poet and artist who specializes in cancer genomics and computational biology, Li noted there has been a growing interest from medical schools to admit students who didn’t take the standard science-heavy pre-med route she had followed. Nearly a third of entering Penn medical students in the last few years have come from non-science undergraduate majors. In Li’s experience, classmates who had diverse educational backgrounds brought something different to the table for group work and discussion.
“A lot of my classmates were extremely creative, and had interests and knowledge in areas I had never been exposed to,” Li said. “I think when used appropriately, creative outlets give an opportunity to physicians and medical students to showcase a part of themselves and highlight their interests outside of medicine.”
Those different perspectives added diversity to the class, Li said, while enabling a dynamic in which students try to help one another. Referring to herself as “book smart,” Li said some aspects of clinical education were especially challenging, and classmates who had majored in the humanities or had life experiences apart from medicine provided her much advice and support. She reciprocated in the form of basic science and biochemistry assistance.
Outside of the formal curriculum, Li’s embrace of the humanities led to her co-founding Stylus, a literary magazine featuring written and visual work from individuals within the Penn Medicine community, in early 2012 along with two medical school classmates. Li found significant support—and a number of contributors—for the magazine from all walks within the medical school. Kelly, meanwhile, founded the Penn Med Writers group, a setting for medical students interested in writing to explore their creative sides at a relaxed pace through readings and short exercises. Numerous other Penn medical students have followed suit in establishing their own creative ventures, including last year’s debut of the Penn Med Symphony Orchestra led by second-year students Gina Chang and Dan Zhang.
Connecting with Medicine via the Creative Side
Elizabeth Card’s wall is covered in pieces of paper with little anatomical drawings on them. “That’s the most visual part of my medical education right now,” said Card, a first-year medical student at the Perelman School of Medicine. “I have to set aside time if I’m going to draw a particular concept, but once I draw it out, it’s there in my mind.”
Card, whose online gallery labels her “A Painter Who Studies Medicine,” focuses primarily on portraiture—but many of her works in addition to the anatomical drawings make readily apparent her fascination with medicine, from surgery to lab work. A self-described visual learner, Card believes her interests in the visual arts and solving visuospatial problems were fundamental to the development of her interests in biology and surgery.
Card said when she was looking at various medical schools, one of the things she focused on was what those schools were doing with the humanities and art.
“A lot of schools have embraced it,” she said. Like Viswanathan, Card recognizes that emphasis on creativity in medicine seems, at times, to have fallen from its peak in history. It’s a trend that’s shifting, but cultural changes take time.
“A medical student’s day-to-day job is learning lots and lots of information; the memorization of facts,” said Daniel O’Connor, a fourth-year medical student graduating from the Perelman School of Medicine in 2017, who plays the guitar in his free time and also exercises his creative mind through computer coding. Earlier this year, he worked with Dermatology faculty member Misha Rosenbach, MD, to create an iPhone app for rare-disease research. (See sidebar, “A Creative Solution for Rare-Disease Research Hurdles”) “Computer programming is such a different, creative outlet. It’s a relaxing, refreshing activity. It’s nice to sit down on an evening and work on things, using a part of my mind that I haven’t been able to use in a while.”
O’Connor has that experience in common with Li, who said her chosen field of computational biology “is medicine, but the work is basically computer programming.” That balance between the scientific side and the creative side—even when they may look similar—is less about whether you’re engaging with science and more about how you’re engaging with it, she said. Computational biology is medicine, but it isn’t a shift at the hospital.
“What I’ve learned is I couldn’t do both,” she said. “I couldn’t code something and see patients. So I switch things on and off. But when I’m able to take a day off and work on that, I’m still doing science, but I’m devoting myself to it. That takes me away from being in the hospital and thinking about patients. That’s what I need, sometimes.”
Creativity and Care
“We tend to write songs that incorporate some of the language we find ourselves immersed in during medical school, but we use such language to symbolize universal experiences such as love and heartbreak.”
– Joseph Park, MS2, on writing music for the funk-rock band Trisomy Rescue with fellow medical students.
The writers’ group Kelly founded is now in its fifth consecutive year of new first-year leadership—in fact, Viswanathan led it last year—while maintaining a core group of returning members.
“If anyone feels comfortable sharing, we listen to each other read aloud and allow the discussion to weave among our different ideas,” Kelly said. “At times, we find ourselves leaning on one another, acknowledging similar emotions and reactions to some of the most difficult aspects of our training.”
Li sees writing as a way to channel her passion for medicine and handle the emotional highs and lows inherent to the field. “Sometimes on days like today, when I experience something that is too difficult for me to process, I’ll write poems or a short piece the next day to reflect on my experience,” she said at 2:00 a.m. one night this spring after a hospital shift—the best time she had available for a phone interview conducted three time zones away. “It helps me let go,” she said. She had lost a patient that day and knew she wouldn’t be getting to bed anytime soon.
“It struck me a lot as an intern: We talk about patient care a lot in the medical sense: which tests to run or what medications to give. But I rarely ever have an occasion to talk to my attendings or my colleagues about the care of a patient emotionally,” she said. “I see my love for writing and doing creative writing in the medical community as an outlet for the lack of that in my day to day life.”
In talking to Li and Kelly, it becomes clear that the push to create a space for creative expression within the medical community is also rooted in a need to recharge a part of the mind that might otherwise not find relief. According to Kelly, allowing the creative mind to flourish—or at least see regular exercise—is a way to keep physicians and students more connected with the world around them, promoting empathy with their patients and themselves, and allowing the more scientific, analytical side to rest for a bit.
“Mindful creativity is not unlike empathy. It involves recognizing the influence that other people have on us,” Kelly said. “I think this is the most important lesson that creativity has for medicine. I know this because I’ve lived in both a creative mind and in a tired, simple mind, and I see how it affects my engagement with the world and people around me. Within the span of a single day, I can shuttle between those ways of being multiple times.”
Carving Out Time to Create
Like others trying to explore their creative inclinations during or after medical school, Card has found that time is the most critical factor: However you plan on using your creativity, it won’t do anything for you if you can’t make the time. For some, that can be less about actually having the time and more about finding it difficult to justify creating art or exploring another pursuit when they could be dedicating more time to medicine.
“When you have so much to do and so many deadlines, it’s hard to prioritize art, to have that push to work on creative pursuits,” Card said. “When I was in college, art was always on the back burner. It was behind the oven, sometimes. When I got to medical school, I decided: This is the beginning of the rest of my life. If I don’t create the artistic habits I want to have in adulthood right now, when things are easier than they’ll be in the future, it’ll never happen. When I got to medical school, I was doing the most art I’d done since high school. I’m glad I started it right then, and I’m keeping it up as much as I can right now—because once I get to residency, I don’t know what will happen.”
As a fifth-year MD/MPH student, Kelly has experienced that difficulty with balance firsthand.
She said the style of thinking—and sheer amount of information to memorize—didn’t leave much room at all for creative development or expression in her first two years of medical school. At that time, even just indulging in the creativity of others through reading, listening to podcasts, or going to exhibits had fallen by the wayside, to say nothing of doing her own writing and painting. In her third and fourth years, Kelly decided to focus on reinvesting herself into the creative mindset.
“It’s much like endurance training,” she said. “Once you’ve been away from the gym for some time, the body feels languid and sluggish.”
It was during that reinvestment of time that Kelly realized the divide between her medical training and her desire to create wasn’t as impenetrable as it seemed.
“During my public health coursework, with dedicated time and support to explore creative avenues, I found I didn’t have to choose between the two callings: being a medical student and being a creator,” Kelly said. “I could, in fact, merge the two. That’s when I decided I wanted to use oral storytelling as a platform to advance my goals as a public health practitioner.”
A Creative Solution for Rare-Disease Research Hurdles
When Daniel O’Connor overheard Misha Rosenbach, MD, an assistant professor of Dermatology and Medicine, discussing his frustration with a clinical challenge, he saw the opening of a creative path to a concrete, practical solution.
“[Rosenbach] was talking with a resident about how he’d just seen a patient with a rare disease, and how it was frustrating people were living in this age where everyone has a smartphone in their pocket—everybody’s connected through social networks—but we still couldn’t find a way to easily connect to patients and do research with that technology,” O’Connor said.
Shortly afterward, O’Connor approached Rosenbach and mentioned he might be able to work up a solution. It was the sort of idea-driven thinking that had initially gotten him into app development in college in the first place: See the problem, figure out the solution, then learn how to build that solution.
Originally, O’Connor and Rosenbach intended to build a simple application that could provide basic information to patients with sarcoidosis, an inflammatory condition that can affect the lungs, skin, eyes, heart, brain, and other organs, while also offering a survey they could fill out which would relay data back to researchers. The scope of the app quickly expanded, however, with the release of Apple’s ResearchKit—a set of tools designed to help researchers and developers build exactly the sort of thing O’Connor and Rosenbach were working on.
Developed in collaboration with Marc Judson, MD, at Albany Medical College and the Foundation for Sarcoidosis Research, the app, called “Sarcoidosis,” helps deliver informational resources to patients by supplying links to disease information and advocacy groups as well as directing them to specialists in their area (which is determined via the phone’s GPS).
Patients also have the ability to opt in to a research study, which will in turn help provide researchers with a trove of data. Optional, once-a-month surveys will query users about, for example, their symptoms and flare-ups, medications, and how sarcoidosis affects their lives. To help researchers spot trends, patients can also opt to provide further information, such as physical activity, through the iPhone’s sensors.
The information could help researchers answer questions about patient activity during flare-ups, seasonal variability of symptoms, and how quickly patients respond to treatment.
Due to the novel nature of the data’s collection, O’Connor cautions it should be approached with “a healthy scientific skepticism” until everything is more rigorously validated—but, he noted, that’s the case whenever a new technology is introduced.
“We’re excited about future opportunities to repurpose the app for other rare diseases, as well,” O’Connor said in a Penn Medicine news release when the app was launched. “With a strong app framework in place, ‘sarcoidosis’ could be swapped out for another disease, allowing wide networks of patients all over the country to participate in Penn studies without traveling to Philadelphia.”
Infusing Creativity within Medicine
“Creativity can do a lot of things in healthcare and science, some of it largely about making care and people more humane—but there’s also a very concrete, practical side that hasn’t been fully utilized. It’s becoming a more important tool to have in our quiver.”
– Zachary Meisel, MD, MSHP’10
In May 2017, Kelly released the premiere episode of a podcast focused on death and dying. “When I Die, Let Me Live” was inspired by Kelly’s numerous observations throughout medical school of physicians guiding patients through some of the most difficult decisions and emotional situations imaginable.
“As a medical professional, I have unique access to this world that’s full of story,” Kelly said. “I have also learned a great deal about the skill of applied storytelling—how the crafts of creative writing and oral history can be used to change conversations and initiate new dialogues in medicine.”
The point, Kelly said, is to help make the conversations surrounding these immensely complicated, difficult topics easier on everybody involved. She described the response thus far as “overwhelmingly positive,” particularly among those in the fields of palliative care, narrative medicine, bioethics, and patient advocacy.
The podcast’s fusion of the creative format of storytelling with critical medical conversations, like Li and O’Connor’s coding efforts for medical research and even Card’s anatomical drawings, may be an example of the many underappreciated ways in which creativity has lurked within medicine and medical education all along.
“The ways in which creativity manifests may not be explicit or come in the form of writing, art, or the humanities,” said Zachary Meisel, MD, MPH, MSHP’10. “It could come through the development of a scientific protocol, or the advancement of a communication strategy. That’s kind of where I’ve gone, as someone who has these parallel interests of healthcare delivery and writing.”
Meisel, an assistant professor of Emergency Medicine at the Perelman School of Medicine who serves as one of the faculty advisors for Stylus, has given talks to medical students about narrative and writing from the perspective of a health care provider. A humanities major who attended medical school in the 1990s, Meisel observed little interest in supporting or emphasizing creativity at that time. But he sees the tide turning today, both in medical education and practice. His current research is geared toward tapping into practical applications of creativity within the medical community.
“Creativity can do a lot of things in healthcare and science, some of it largely about making care and people more humane—but there’s also a very concrete, practical side that hasn’t been fully utilized,” he said. “It’s becoming a more important tool to have in our quiver.”
Meisel recently received a $2.1 million grant from the Patient Centered Outcomes Research Institute to further study whether or not healthcare providers should be using stories as a way of communicating the risk of opioid addiction to patients who come to the emergency room with acute painful conditions. His hypothesis is that stories may be useful in bringing context and ideas to patients who are trying to understand the complexity of pain relief and the risks surrounding opioid use. Stories may frequently be used to improve one-on-one communication, but they often fall by the wayside when it comes time to garner support for a safety initiative, quality initiative, or guideline, in Meisel’s view. Developing those narratives and communicating context, he said, is where creativity can come in handy.
Seeing Creativity as Central to Healing
Last spring, a letter arrived without much context at the University of Pennsylvania’s central office. It was addressed, simply, to Vidya Viswanathan. The office contacted the puzzled medical student, who had no idea where the letter could have come from.
“It was this woman in her nineties who lives at a retirement home,” Viswanathan explained. “She had lost her husband last year, and he had donated his body to medical education.”
Viswanathan had recently spoken at a remembrance ceremony held annually by the Human Gifts Registry to honor such donors and their families. Her eulogy discussed what it means to die and what it means as medical students to learn something from those who have died. She spoke of the gratitude and the grief she and her peers shared.
The woman who wrote to Viswanathan had been unable to attend the ceremony, but she had read the speech. “She said the words helped her in her grieving,” Viswanathan said. “I was touched by that.”
Earlier this academic year, Viswanathan stepped down as editor in chief of Doctors Who Create, the website she founded in 2015. She transferred the role to another medical student while retaining the title of president to pursue an ambitious agenda. Her goal for the next year is to secure more funding and collaborations with other organizations that support creativity in medicine, while her long-term plan includes conferences and scholarship funds for creative physicians. In these myriad ways, she wants to show that creative endeavors do, in fact, have a place in medical practice: that the desire to spend time on writing, art, or app development when there’s so much work to do as a medical student is borne not from selfishness but from a desire to connect with patients and peers in more meaningful, personal ways.
Ultimately, Viswanathan wants to build a medical education system that not only accepts creativity but rewards it as central to the work of healing.
“Creativity in medical education, creativity in writing or engineering: If all of these things could be incentivized in the way academic research is, I think we’d have a much more well-rounded hospital system,” she said. She envisions that, as a trickle-down effect, patients and families would leave the hospital not only having received the best possible care for their physical ailments, but feeling they have been heard and understood—just like the widow who was moved by the written words of Viswanathan’s eulogy.
Like the inverse of Laennec’s first stethoscope, an artful creation that helped maintain a respectful distance from a patient, the letter affirmed that creativity had immense power to bring young physicians closer to the human side of medical care.
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