Pieces of Conversations

While digging through files, I stumbled upon comments made by reviewers of “Art Informs Medicine,” an article that I submitted to the Journal of Clinical Oncology in 2010. The reviewers were oncologists. And, it was they who would decide whether my piece would be accepted for publication in a journal for cancer care professionals.

In the article I describe a scene of a nurse looking at an abstract painting on a treatment room wall announcing, “I’m trying to make sense of what I see in this painting.”

A doctor who is standing nearby hears the nurse’s comment and steps into the room. He asks, “What are you supposed to say to patients who tell us they don’t like the art?”

“Ask them what they don’t like about it,” I suggest.

The nurse adds, “What if the patient says they don’t understand what the artist is trying to say? Then how do I respond?”

“You can say it’s like being diagnosed with cancer. You don’t like it and don’t understand it.”

“Are you implying that abstract art can be a way to open the conversation with patients about what it means to have cancer?” the doctor asks.

I note, “The work of an artist is not unlike that of a patient. A patient, like an artist, has a choice of whether to explore the landscape of the lived world of illness.”

A reviewer said, “I think it will raise questions and thought among many. Others, like the doctor who doesn’t like or appreciate abstract painting, will not think much of it and dismiss it as irrelevant. But that is no reason to dismiss it.”

Another reviewer wrote, “I enjoyed reading this. It is different and thoughtful (even though I have no idea what it means to ‘explore the landscape of the lived world of illness’).”

A third remarked, “Very interesting. I have never heard of a ‘medical humanist consult.’ Does Medicare or BC/BS pay for this?” Yet, he went on to say, “I like the way the article gets at several of the communication difficulties and the ‘unsaid’ or obtusely phrased pieces of conversations.” He concludes, “I think voices that one does not understand or clearly support should be heard.”

For patients, there are questions and concerns that often lurk beneath the surface and go unspoken but can be prompted into existence through art, literature, music or the use of SpeakSooner: A Patient’s Guide to Difficult Conversations, a communication tool that I developed for this purpose.

Doctors need to understand the lived experience of illness in order to be helpful in guiding patients to make thoughtful decisions about care. As one reviewer concluded, “In the choppiness of the writing, I find the choppiness of these kinds of conversations, and the challenge of staying ‘with’ the patient’s point of view.”