[EAS]Lady Hamilton's Portrait

[pjk]

Subject:   Lady Hamilton's Portrait


>From NETFUTURE, Issue #119, March 27, 2001
     http://www.netfuture.org/2001/Mar2701_119.html
-------------------------------------------------------------------

Diagnosing Lady Hamilton's Portrait
-----------------------------------

A wonderful pilot program at Weill Cornell Medical College has
future doctors spending time at the nearby Frick Collection
studying famous portraits.  It's part of an effort to train the
students in the art of observation.  The idea, novel as it is in
today's medical environment, is for them to learn to see the person
in front of them as an essential part of the diagnostic effort. 
For example, the enlarged pupils in the portrait of Lady Hamilton
(mistress of Admiral Nelson) suggest the use of belladonna, a
potentially fatal herb often taken in Lady Hamilton's time to lend
the eyes an erotic quality.

Students quickly become interested in the challenge of assessing
the patient through direct observation.  One of the creators of the
Cornell- Frick program said, "Already I've had students tell me
that when they walk into a hospital room they don't go right for
the chart".

The Cornell program was modeled after one at Yale, where art
curator Linda Friedlaender

   recalled visiting her friend in the hospital the day before her
   operation.  It was obvious the woman was extremely nervous and
   needed some reassurance.  Yet when a resident stopped by to check
   on the patient, Ms. Friedlaender said, he barely lifted his eyes
   from the chart, remained standing in the doorway, and took her 
   lack of questions as permission to quickly leave.

Now Yale requires every first-year medical student to take a course
entitled "A Rash in a Frame: Enhancing Observational Skills". 
Other schools around the country have indicated an interest in
starting such a program.

All this is extremely encouraging.  I very much hope these schools
can raise their courses to a minimal level of philosophical
sophistication, since a fundamental question about the nature of
scientific knowledge underlies the doctor's decision whether to "go
straight for the chart" or instead to look at the patient.  This
decision can be understood as a choice between seeing a particular
illness as the essential thing (the illness just happens to be
"doing this particular patient") or else seeing the patient as the
essential thing (the patient just happens to be "doing this
particular illness").

But this still doesn't state the matter forcefully enough, since
what "this particular illness" is cannot even be defined apart from
the individuality of the patient.  We've been taught to think in
terms of perfectly discrete, nameable illnesses, as if each one had
a kind of fixed, atomic identity independent of the person who is
"doing it".  But this is hardly the case.  No two pneumonias are
the same disease, and the profusion of vaguely defined syndromes in
our day (such as chronic fatigue syndrome, "environmental illness",
and lyme disease) underscores the need to see the illness as a
function of the person rather than the person as a function of the
illness.

Of course, there is not really a strict line between these two
approaches. The problem today is that the willingness to see the
person has largely vanished from medicine, replaced by a focus on
symptom clusters regarded as essences in their own right.  Putting
it a little differently:  we are much more inclined to think we
understand patient A when we have established what he has in common
with cases B, C, D ... , all of whom form a neat diagnostic class,
than to believe we understand A only when we grasp his uniqueness
-- what he does not have in common with B, C, and D, and what he is
distinctively "doing" with his illness.  This distinctive doing,
and not the nameable illness, may be the more important thing when
it comes to diagnosis and treatment.

Such a focus upon the qualitative uniqueness of what we observe is
foreign to mainstream science, with its ultimate, explanatory urge
to see only featureless, indistinguishable particles.  A medicine
grounded in such science is hardly predisposed to recognize the
patient as an individual, and we can only hope that courses such as
the ones at Cornell and Yale will, over time, nudge young
researchers toward the quest for a new kind of science.

Related articles:

** "Notes on Health and Medicine" in NF #88 <http://www.netfuture.org/1999/Apr1699_88.html#2>.

SLT

====================================================================
Dear Colleagues -

I wish we made training in observation a more explicit part of the
engineering curriculum, both early on and throughout. "Going
straight for the chart" is what too many engineering courses do,
lending them a procrustean, mechanistic quality.

Some of my more notable technical troubleshooting successes as a
consultant came not from "going for the chart," but from observing
with unsophisticated curiosity the technology and also the people.
The problem may not be the need for better systems modelling,
better tuning or filtering, but the intrusion of an extraneous
variable, an unexpected thermal sensitivity, an anelastic behavior,
a power 'glitch.' And more often than not, it has been observed but
not recognized as such by the people working in that situation.
They often have "data" one needs and, like the equipment, must be
encouraged to tell it.

Very much as in the essay above, the point is not to try to
understand such situations in terms of what they have in common
with other cases, but to try to discover the subtle unique
differences. That's a proclivity engineers must develop, as far as
I'm concerned, if they are going to be constructive "citizens" in
their technological world.

All best,  --Peter Kindlmann