Studying great art can help improve everyday observation skills

April 13, 2015

150330ArtPerception0088Gray Edelen, left, an art history student from Bardstown, talked with medical students Taylor Gilbert of Lexington, center, and Amanda Pursell of Louisville about Robert Tharsing’s 2011 painting “A Natural History of Kentucky”, which hangs in the University of Kentucky Chandler Medical Center. Photos by Tom Eblen

 

On a recent afternoon, small groups of University of Kentucky students huddled around paintings and sculptures on display at UK’s Chandler Medical Center.

As you might expect, some were art history majors. But they were there to help 17 medical students.

The medical students weren’t really there to learn about art, but to observe it — very closely — and then describe what they saw and what they thought it meant.

The goal was to improve the medical students’ observation and communications skills to make them better at diagnosing patients’ illnesses.

“It’s good to learn how to see the bigger picture by looking at the details,” said Taylor Gilbert, a medical student from Lexington.

The exercise grew out of a presentation by Amy Herman, a lawyer and art historian who travels around speaking about what she calls “the art of perception.” In early February, Herman spoke to a packed classroom at UK’s College of Medicine.

Herman began this work more than 15 years ago when she was education director at the Frick Collection, an art museum in New York City. She had heard how art historians at Yale and the University of Texas worked with medical students to improve their perception skills, so she set up a similar program at the Frick for the nearby Cornell University medical school.

Amy Herman. Photo provided

Amy Herman. Photo provided

When a friend heard what Herman was doing, she suggested that these skills could help other professionals, too. Homicide detectives, for example. Herman contacted the New York Police Department and, within six months, she was training every newly promoted captain.

A Wall Street Journal reporter wrote about the program in 2005 and, Herman said, “My world exploded.” She left the Frick to start her own consulting business. In addition to medical students and New York cops, she now trains agents for the FBI, CIA and even Navy SEALs.

As Herman began showing slides of paintings to the UK medical students and asking them to describe them, she forbid the use of two words: obviously and clearly.

“We work and live in a complex world, and very little obvious and even less is clear,” she said. “No two people see anything the same way, and we have to understand and enrich our appreciation for that fact.”

Herman showed what appeared to be an abstract painting, but was really a picture of a cow. Few saw the cow until she brought attention to it. She then drew lessons from landscapes, still life paintings and portraits of “handsome women of the 18th century” that held subtle clues about their lives.

“Perception goes both ways,” she said. “How do patients perceive you when you walk into the room? Do you put them at ease? Is it easy to ask questions? Your patients may have an entirely different perspective than you do.”

Herman said people often make mistakes by trying to “solve” problems too quickly, before they have taken time to assess a situation.

“Before you decide what to think and what to do, you need to say out loud what the issue is,” she said, adding that some of those things may seem too obvious or be embarrassing to mention but can be vital details.

Herman showed a painting of an elderly, obese and naked woman sitting on a sofa. When asked to talk about it, an audience member began by describing the sofa’s upholstery.

“You need to say what you see and not dance around it,” Herman said. “I always tell police officers you will never get in trouble for saying what you see. Saying what you think is an entirely different story.

“Raise the issue, even if you can’t explain it,” she added. “Raise any inconsistency, because with more information somebody else may be able to answer the question for you. Also think about what’s missing. What should be there but isn’t?”

Herman said she recommends that child abuse investigators ask a child to smile. Seeing whether a child’s teeth are clean says a lot about the care they are receiving.

“Small details can provide volumes of information,” she said. “Body language and facial expression tell us a whole lot.”

When describing observations, choose words carefully to be precise. And don’t make assumptions. The three most important questions to ask when problem-solving: What do I know? What don’t I know? What more do I need to know?

“There are often things hiding in plain sight that you are consciously or unconsciously not seeing,” said Herman, who gave an embarrassing personal example.

Several years ago, while running in New York, she noticed a man in a wheelchair walking a puppy. She loves puppies, so she asked him if she could pet it. After playing with the puppy for several minutes, they parted. Within minutes, she realized that the man had looked familiar. It was Chuck Close, a famous artist she admired but had never met.

“He’s one of my favorite artists in the world, but I was so focused on his puppy that I didn’t even notice the man was a captive audience right in front of me,” she said. “Don’t miss what’s right in front of you.”

150330ArtPerception0095Christina Romano left, an art education major from Louisville, talked with medical students Katie Donaldson, center, of Independence, and Amy Chen of Davis, Calif., about Warren Seelig’s stainless steel and fabric mesh sculpture, “Gingko”.


Baby Health Service celebrates 100 years of caring for kids

May 12, 2014

140407BabyHealth0038Alivia Cooper, 3, coughed so Dr. Tom Young, a pediatrician who has volunteered at Baby Health Service for 30 years, could listen to her chest with his stethoscope. The child’s mother brought her in because of respiratory problems. Photos by Tom Eblen. Old photos courtesy of Baby Health Service.

 

Baby Health Service has spent a century caring for some of Central Kentucky’s most vulnerable residents — and outgrowing its name.

A group of Lexington women started the Baby Milk Supply Association in 1914 to provide free milk to infants and toddlers of poor families, regardless of race. But Margaret Lynch, the first chief nurse, was soon making thousands of home visits and overseeing a free weekly clinic with volunteer doctors in an old downtown house.

The clinic was seeing 1,600 children a year by 1928 and 5,800 a year by 1957. The charity’s mission had grown so far beyond “milk supply” that the name was changed to Baby Health Service in 1959.

140407BabyHealth0006That name only begins to cover the scope of the organization that will celebrate its 100th anniversary May 31 with a fundraising dinner at Keeneland.

“The staying power of Baby Health speaks volumes, that we have been around for 100 years providing a service that is unique in our community,” said Kathleen Eastland, who chairs the organization’s board. “We can’t find another service quite like this in the United States.”

While America’s social safety net for low-income families has expanded over the years, most recently with the Affordable Care Act, there are still many children and teens who fall between the cracks. They include many refugees and immigrants.

Baby Health Service tries to fill those health care gaps. Last year, the organization served about 2,100 young people, from infants through age 17. Patients’ families must be low-income and not covered by private or government health insurance.

140407BabyHealth0002“You have a lot of people in between,” said Dr. Tom Young, a 30-year volunteer pediatrician at Baby Health who is now the organization’s chief executive. “We’re kind of a safety valve.”

Working on a shoestring budget, the mostly volunteer organization provides an impressive array of health services from basement space in an old office building beside Saint Joseph Hospital on Harrodsburg Road.

A small paid nursing staff and eight regular volunteer doctors have a clinic each weekday morning to treat sick children and do well-child exams. Several physician specialists donate their services when needed. Through various arrangements, the clinic also can provide free X-rays, lab tests and medications.

Baby Health’s 59 board members — all of whom are women —volunteer at least 12 two-hour shifts each year to do all of the clerical work and patient scheduling.

“It’s not written in the bylaws ‘no men,’ but in my years on the board it’s been all women,” said Eastland, whose mother was on the board before her. “I think it would be interesting to see if any men would break the barrier.”

Baby Health’s offices have a stash of clothing for children and adults and a book giveaway and lending program. The book program was started by a board member’s daughter and has been supported by the University of Kentucky law school.

Donations following the death of a board member allowed Baby Health in January to restart a monthly dental clinic with help from volunteer dentists and dental hygiene students at Blue Grass Community and Technical College.

Through a partnership with Save-a-Lot Food Stores, patients’ families can get $10 monthly vouchers for fresh fruits and vegetables. Baby Health nurses and volunteers do a lot of health education with families, including a fitness program for children and teens identified as in need of physical activity.

Baby Health soon hopes to start a telephone triage service, staffed by on-call nurses, to advise patients after-hours so they don’t just go to a hospital emergency rooms.

Thanks to all of the donated time and services, Baby Health’s annual budget is only $191,000, Eastland said. The organization gets no federal funding, and this year didn’t receive city support as it has in the past. Most of its funds come from grants and donations solicited by board members.

Although Young has been with Baby Health for 30 years, the senior volunteer physician is Dr. William Underwood, who has been a regular since 1966. Young said he introduced several of the other regular volunteers to Baby Health when they were residents working under him.

“Anybody who starts here usually continues here,” Young said. “That’s why we go into pediatrics, to take care of kids. And the families here really appreciate what we do for them.”

IF YOU GO

What: Baby Health Service’s 100th anniversary celebration

When: 6 p.m., May 31

Where: Keeneland

Cost: $125

More information: Babyhealthlexington.org, (859) 278-1781

Click on each image to see larger photo and read caption:


Doctor has seen a lot, from World War II to 1,000 newborns

July 31, 2013

FRANKFORT — When we recall history, we often think of famous leaders, pioneers and heroes. But history is mostly shaped by ordinary men and women just trying to do their best under the circumstances.

I was reminded of that recently when a friend introduced me to Dr. James T. Ramsey of Frankfort. Ramsey, 91, was a child of the Great Depression who grew up in a small, northeast Ohio town.

“We had a general store, a blacksmith shop, a cider mill and that was about it,” he said.

“We were Methodists, and my mother was bent on me being a Methodist minister,” he said. “She somehow located Asbury College in Wilmore. Spent all of her inheritance on the first year’s tuition. After that, I was on my own.”

ramseyBut Ramsey preferred chemistry and physics to theology. He wanted to become a doctor. “I guess it was my admiration for the old country doctor who delivered me in the home,” he said.

Ramsey’s senior year ended early when Japanese warplanes bombed Pearl Harbor on Dec. 7, 1941. Like virtually all of his classmates, he joined the military.

“But I didn’t want to die in the trenches,” he said. “I always felt it was a cowardly decision that I wanted to fly.”

He was hardly a coward. Ramsey joined the Army Air Corps and proved to be a talented pilot. By May 1944, he was in Italy piloting a B-24 Liberator. He and his crew flew 50 bombing missions all over occupied Europe. Then he returned stateside to train other bomber pilots.

What did Ramsey learn from World War II?

“Do the best you can with what assignment you get,” he said.

After he had completed cadet training, but before he went to war, Ramsey made a quick trip back to Central Kentucky. Kathleen Horn of Lexington was assigned to meet him at the train station. After that meeting, they began a correspondence.

“She was instructed by her friends that she ought to write to service people,” he said. “I happened to be the service person she wrote to. I came back through Lexington and we spent some time together on furloughs.”

After the war, they married and he enrolled in medical school at the University of Louisville. Like most of his classmates, the government paid for his education. Otherwise, he said, he could never have afforded to become a doctor.

“I think the GI Bill was great,” Ramsey said. “I’m sure the cost has been repaid in taxes many times over.”

After a residency in Cincinnati, Ramsey began a medical practice in Owen County, where there was then no hospital, x-ray machine or laboratory. He did his own lab work, with help from a local veterinarian.

Two years later, Ramsey completed a mini-residency in anesthesiology and moved to Frankfort. Over the next three decades, he practiced anesthesiology, general medicine and obstetrics, delivering more than 1,000 babies.

“A baby’s birth is a miracle, and I felt that way with every one,” Ramsey said, adding that many of them have kept in contact with him over the years.

Ramsey served on the school board, helped start Frankfort’s first nursing home and admitted the first black patient to King’s Daughters Hospital in 1959 after a federal loan for an expansion required that the hospital be desegregated.

“Prior to that, the only hospitalization we had available to black people was a dwelling house, and not a very good one,” he said, referring to a frame house that in 1915 had become Winnie A. Scott Memorial Hospital.

“It was two-story and we had rigged an operating and delivery room on the second floor, so we had to carry people up the stairs,” he said. “I thought that was disgraceful for the whole community.”

Ramsey and his wife had seven children — five boys and two girls — all of whom went on to successful careers. He retired from medical practice in 1993, but continued doing consulting work until a year ago. His wife died in May 2010.

When we sat down in his living room to talk recently, Ramsey said he didn’t see anything remarkable about his life. Yet, he fought a war, raised a family and took care of a community. Like many of his generation, Jim Ramsey helped make America what it is today.

 


Two days shadowing doctors offers eye-opening look at medicine

September 24, 2012

I’m not a doctor, and I don’t play one on TV. But I did spend two days last week shadowing doctors and talking with them about what they do and the environment in which they do it.

I was one of seven people who participated in the Lexington Medical Society‘s Mini-Internship Program. Since 1994, nearly 30 groups of community “interns” have been given a two-day, close-up look at the working lives of physicians.

One of the things I have always enjoyed about being a journalist is exploring other people’s worlds. Journalism is a license to be nosy, ask questions, observe others, and discuss issues with people who have unique expertise.

That’s how I found myself in a locker room at Central Baptist Hospital, changing into scrubs so I could spend the morning in an operating room. I watched as Dr. Kaveh Sajadi, a second- generation orthopedic surgeon, performed shoulder replacements on two patients suffering from severe arthritis pain.

With help from a skilled team, Sajadi replaced two worn ball-and-socket joints with precisely fitted new ones made of high-tech metal and plastic. If you assume this is a difficult and messy process, you would be correct. But for Sajadi and his team, it was a well-choreographed ballet.

Sajadi explained each step of the operation as I stood and watched from a distance. I had to sit down a couple of times when my knees got wobbly. But soon I was able to focus on the miracle of medicine taking place before my eyes rather than, well, you know.

I spent the afternoon with Dr. John Kitchens, an ophthalmologist who specializes in the retina, the light-sensitive tissue that lines the inside of eyes. Digital imaging technology allows him to find and treat microscopic leaks in blood vessels that can reduce a person’s vision.

His most common treatment that day was injecting medicine into eyeballs. It was a process slightly painful for the observer, though not the numbed patient. But after watching shoulder- replacement surgery, I was ready for anything.

Kitchens was a busy man, dashing from one examining room to another. But he never seemed rushed when he was with patients. He carefully explained diagnoses and treatment options. He even took time to ask about patients’ families, impressively recalling many personal details about people he had seen before.

I spent the next morning in St. Joseph Hospital’s emergency room with Dr. William Wooster, an emergency-room veteran who has seen it all, sometimes in the same day. But this was a slow morning. A middle-aged man with a history of heart trouble came in with chest pains. An elderly man came in suffering from dizziness. A young man came in with an infection from a mouth full of rotten teeth.

Like more than one-quarter of all Kentuckians, the young man and several other people Wooster saw that day had no health insurance. What people forget when they debate the cost of universal coverage is that society already pays for treating uninsured people, often at high-cost emergency rooms.

I spent that afternoon making rounds at Central Baptist Hospital with Dr. Andrea Lyons, an internal medicine “hospitalist.” The young mother of two examined patients — many of them elderly and sick with a variety of issues — and worked to coordinate care with their primary physicians and specialists.

Those two days confirmed several things I already knew: Doctors have demanding jobs and exhausting schedules. They spend a lot of time updating and consulting patients’ medical records. They depend heavily on nurses, other skilled professionals and staff. And they care deeply about their work.

Like everyone else, the doctors I met had a variety of opinions about health care reform. But they all said the nation will never curb rising costs without legal tort reform. Fear of lawsuits forces physicians to pay huge sums for malpractice insurance and practice costly “defensive” medicine.

As I shadowed these physicians, I kept thinking how much of their patients’ pain and suffering could have been avoided if they had taken better care of themselves — if they had eaten better, gotten more exercise, and avoided cigarettes and substance abuse.

I wondered how we will continue to manage not only our health care system, but our rising expectations. As people live longer and get sicker, we may need to focus more on quality of life rather than simply extending it at all costs.


Group helps citizens improve Kentucky health care

June 13, 2010

Just thinking about America’s health care and insurance system can make your head hurt.

Our system costs too much, doesn’t work well enough and leaves too many people out. The new reform law includes more people, but it doesn’t do enough to improve care or rein in costs. It was little more than a first step in what is sure to be a long journey toward making health care more effective and affordable.

What should the next steps be? That is what the Friedell Committee for Health System Transformation is trying to help Kentuckians figure out.

The committee is named for and headed by Dr. Gilbert Friedell, director emeritus of the University of Kentucky’s Markey Cancer Center. It hopes to do for health care reform in Kentucky what the Prichard Committee for Academic Excellence did for education reform: engage Kentuckians, not just experts, in finding better ways to do things.

Part of the problem is that, unlike education, health care isn’t so much a system as a disjointed collection of business sectors. Many profit by exploiting the system’s inefficiencies or by providing services, not by making the system more efficient or improving health. Medicaid and Medicare, the government programs for the poor and elderly, have a huge influence on everyone’s care — and cost of care.

The Friedell Committee is a non-partisan, non-profit group of 50 people from across Kentucky. Some are health care or social service professionals, but most come from other walks of life. Many are retirees who have expertise, but no vested interest that they must represent. They research problems and possible solutions and urge community education and action.

The Friedell Committee began in 2008, but its creation goes back to 1992, when state and national leaders first started talking seriously about health care reform. Public hearings in each of Kentucky’s 15 area development districts attracted 5,000 participants; their recorded comments were collected into a 2,000-page transcript.

Friedell said an analysis of that transcript led to the group’s 10 value-based principles for health care reform. Those include making health systems accountable to the public, and making health professionals responsible for providing safe and effective care.

Among the committee’s other principles: Individuals and families should have fair and equal access to high-quality, high-value and affordable care. Patients should be treated with respect. Individuals and communities must share responsibility for health and the cost of care.

As with education, Kentucky has many health-care challenges. Kentuckians eat too much, smoke too much and exercise too little, putting the state at or near the top of national rates for cancer, heart disease, diabetes and premature death. The challenge isn’t just treating illness, but promoting healthier lifestyles.

Because this is a relatively poor state, one in five Kentuckians is on Medicaid. Because of changes in federal legislation, that number is expected to be one in four, or about 1 million Kentuckians, by 2014.

I attended part of the committee’s semi-annual meeting last week in Lexington, where working groups discussed issues they are investigating. One group is working with Kentucky hospitals to track hospital-acquired infections, which kill many patients. Another is looking into team approaches for providing primary care at lower cost. Federal legislation provides incentives for developing such new models of care; 44 states now have demonstration projects, but Kentucky isn’t one of them.

The committee just launched an effort to find at least one “success story” from each Kentucky county for improving health care, fitness or nutrition. The hope is that publicizing those stories will inspire other counties to copy or adapt them.

For more information, go to the committee’s Web site: www.friedellcommittee.org.

“We don’t claim to have all the answers,” said Carolyn Dennis, the committee’s executive director. “We just want to empower citizens to ask the right questions.”