On behalf of the National Grand Rounds and Spotlight Committee, thank you for joining us this evening. Our goal is to provide you with innovative content and inspire new ways of thinking, and I think this presentation is certainly going to meet those goals today. I see some familiar faces in the audience and names, so thank you guys so much for joining us. Thanks also to Brian Thompson, our AAPM&R staff liaison, for all his help and logistics of putting together today's presentation. Our speaker tonight is Dr. Jason Bitterman. I'm fortunate enough to work with him at UPMC University of Pittsburgh, where he specializes in musculoskeletal pain problems. Dr. Bitterman has a long-term interest in art, has worked as a medical illustrator, and also has the hobby of cartooning. He's actually won the AMA Journal of Ethics, Arts, and Medicine Award for a comic he drew about opioid addiction. To start off today's presentation, we're going to do some polling questions, and even if you're not a typical poller, please, please respond to the questions. We're hoping to get some information from the audience so that we can improve future arts-directed presentations coming up for the Academy, so please respond to our questions, and also grab a pen or pencil and some paper, because we want to make this a very interactive session today. So Brian, go ahead with those polls. All right, so we have a believing audience today, with nearly everyone agreeing that art can impact clinical work. Let's go to the next question. All right, can you guys see the answer for question number two? So thank you for those polling. This is a great variety of answers, and I think we have another question. All right, so we have a high percentage that wish they had a creative outlet, so today might be your day. And Brian, do we have one more? Is that it? Wow, so again, all over the place, but oh, today's your chance if it's been over a year ago, because I think you're going to get some chance to do some drawing today. Well, I'm going to turn this over to Dr. Bitterman. I'm really looking forward to it, and I'll jump in at the end to help field questions. All right, can you confirm for me that you can see my screen? Yes. All right, thanks so much for the introduction, and we're going to get started. In 1850, you were a brand new doctor fresh out of medical school in France. You get your first job at Salpetriere Hospital, a walled hospital village outside of Paris. You're smart and ambitious. Unfortunately, Salpetriere Hospital, an academic wasteland, not well regarded. Your boss wants you Your boss wants you to examine and differentiate thousands of patients with different neurologic disorders. How do you capture what you see among these undifferentiated patients? How do you share with others what you observe? You decide to use art to capture your observations. This is a patient you saw with a stroke. She has left-sided neglect. You draw her eyes, to the right, the loss of the left nasolabial fold, and you make her right sternocleidomastoid muscle prominent. She's always looking to her right side. Here's a patient you saw after a brain injury. You've noticed other patients are in this position after they've had a major injury to their head. This is decerebriate posturing. You have many patients with this sort of look to them. Fingers are thin and trembling. Their faces are almost mask-like. They have unusual movement patterns. This, you come to see, is Parkinson's disease. Here's a drawing you make of a patient with spastic hemiplegia. You want to capture not just the clinical findings, but the patient's discomfort as well. You also draw to decompress, drawing from your imagination, and sketching cartoons of yourself and your colleagues. Who was this artistic physician? This was Jean-Martin Charcot. As you may know, Charcot was a world-renowned physician during his era and is still famous today. Charcot was industrious enough to have 18 disorders and clinical findings bearing his name. Including Charcot-Marie-Tooth, Charcot joints, two different Charcot triads, one for multiple sclerosis and one for the gallbladder, and Charcot's disease, now better known as ALS. Art was a major portion of Charcot's clinical practice. He used art, not just in documented disorders that he had discovered, but also for teaching. Charcot wanted to elevate Salpêtrière Hospital's academic standard. In order to attract students, Charcot created a lecture series built around visual aids, mainly drawings and photographs. These lectures eventually became famous. People traveled from across the world to learn. The students included not just physicians, but painters and sculptors. The visual nature of these lectures meant even those who didn't understand French could find them valuable. Charcot's vision for the future was to make the world a better place for people. Take a look at this painting. This captures one of Charcot's clinical lessons. Note the charcoal drawing in the top left, which is showing a patient posturing. Charcot represents, at least in this romanticized view, the fascinating pairing of art and medicine. His art modeled his clinical approach. Both were about observation. He needed this. This allowed him to properly depict them on the page and to detect the clinical patterns of many neurologic disorders. And by the way, Charcot, Tourette, Marie, Charcot, Mavinsky. All right, here's a new painting. I'll give you a few seconds to look at it. What do you see? A little background. This is a painting by Rembrandt. When you were looking at this painting, what did you focus on? Perhaps you saw these three students huddled in the middle. The guy on the bottom left is very interested in the anatomy, snaking his head way over the cadaver to get a closer look. On the other hand, the guy on the bottom right seems a little bit uncomfortable. Is he concerned? Nauseated? Compare them to the student lying above. He also looks like he's a bit overwhelmed. I can sympathize. I felt like this sometimes in my medical school anatomy course, desperately reviewing my cheat sheet and notes while trying to keep up. This guy confused me. What does this expression mean? Where is he looking? Maybe, as physician, you focused on the anatomy lesson itself. Robert Culp is teaching the students about the muscles of the forearm. Rembrandt impressively captured the flexor compartment. However, you may have also noticed that he made an anatomic error. Can you spot it? Flexor compartment here is attached to the lateral epicondyle, not the medial epicondyle as it should be. Creating and appreciating art is all about observation. Observation is also a critical clinical skill, one that may be neglected in this day and age, where so much of our work is focused on computers and tests. Of course, we don't work in the era of Dr. Culp or John Martin Charcot anymore. Medicine has changed. The art of medicine, the age of medicine represented in this painting is gone. Charcot may represent a more artistic type of doctor, one that helped the Victorian era of medicine to advance. Medicine today is different. We've traded the black suits for white coats and scrubs. However, we shouldn't romanticize Charcot's era too much. Look at that painting again. What is Dr. Charcot teaching about? He's teaching about a woman with what he believed was hysteria, the hot medical topic of his time. Needless to say, we don't use Charcot's eponym for the same reason. He's teaching about a woman with what he believed was hysteria. Needless to say, we don't use Charcot's eponym for this antiquated disorder any longer. Medical knowledge has advanced by light years, since the turn of the century. So how does art fit into medicine in the year 2022? When I was a trainee, I was often confused when attendings would say, medicine is as much an art as a science. What does that mean? Is our day-to-day clinical work The art of medicine often means the interpersonal, unmeasurable, soft side of our work. Though sometimes it also means the stuff I do which I can't explain well. There's an assumed dichotomy. Science is in the lab. It is precise and rigid. Art is a painting. It is subjective and somewhat nebulous. But does this ring true? When I see patients in my clinic, I am not dealing with chemicals in a lab. We are not yet at the point where we can distill humans to pure data and numbers. Science can be nebulous. Research isn't always clear-cut, and studies can contradict one another. It can be difficult to know where the truth lies. Art can be precise, capturing fine details that seem almost hyper-real. Science can be playful and creative. German chemist August Kekul creatively discovered the ringed shape of the benzene molecule after imagining a snake swallowing its own tail. And art can be rigid with its own rules and maxims. One of these maxims, the Golda Ratio, has been used by many artists such as Leonardo da Vinci to guide viewers' eyes through a painting. Rembrandt was inspired by da Vinci and followed these principles as well. Art and science are not dichotomous disciplines. As I said earlier, science is not yet at the point where we can distill humans to pure data and numbers. The art of medicine, like all art, is how we distill the complexity of human experience into something understandable. The art of medicine, like all art, is how we distill the complexity of human experience into something understandable. Art and science are not antagonistic. Artists let doctors observe their work closely and critically. Okay, let's jump forward in time. It's now 2020-12. You're a slightly nerdy 20-something entering medical school. You've been making comics since you were a kid, and you're not sure whether going into medicine will spell the end of your artistic endeavors. Okay, this is the part of the presentation where I talk a bit about myself. I struggled as a medical student to balance the demands of medical training with continuing my drawing hobby. What could I do? I realized that drawing along with my anatomy dissection was not only a way to keep my drawing skills sharp, but also a pretty good memorization tool. I was then able to translate this into some medical illustration projects. As I awkwardly moved through my clinical medical school rotation, I made comics poking fun at my experiences. I continued making comics as a resident. There were a lot of moments in hospitals, in the clinics, and on call that I could satirize. I've also used art as a teaching tool, both for trainees and for my patients. Pictures are often easier to understand than words. As I got more experience and better understood the difficulties of healthcare in America, I also made more serious comics. Here's a page from a longer comic about opioid abuse in hospitals and harm reduction techniques. All of my art, in some way, has me critically and creatively examining my daily experiences. I'm going to spend the rest of this talk sharing a few key techniques with you so you can do the same. But first, I can say firsthand that art doesn't solve all the stresses of our jobs. It may help on a personal level, but not necessarily on a system level. Art is not a panacea for many of the issues we face as physicians. So then what's the goal? The goal to use art to improve your ability to observe and critically process your day-to-day experiences. For me, art has helped me as a physician in a few different ways. First, it helped me take a more humanistic approach. We all have the best intentions when dealing with patients, but the demands of our job can make it hard sometimes to see each patient as an individual. I find that by looking at patients from an artistic point of view, it takes on a more patient-centered way of patient care. Number two, making art requires close observation. This, in turn, has translated to me taking better attention to detail, whether I'm taking a history, when reviewing data, or doing my examination. Finally, I found art to be a great outlet for self-expression. With all this in mind, let's learn how to draw. When was the last time you drew something? Many of us don't draw much after grade school. Saying something like, I can't draw. Like we discussed earlier, art is how we distill the complexity of our experiences, our emotions, and our imagination into something understandable. The way I see it, art is your own special take on stuff. However, your special take is sometimes wrong, or a shorthand. Art, in many ways, can be like a science, learning to see things as they truly are. Learning to draw and learning how to see. This is a face, or is it? Does this icon actually resemble a real face? Our brains carry inside us mental images of the way things supposedly look. These images are reconstructions from memory. When you try to draw an object based on that mental image, details like shape, texture, proportion, and contour may be lost. Take a look at this apple I drew. It's like an okay, symbolic apple. But compare it with a photo of an apple. Our brains are lazy. Our mental images of a face or an apple don't store all the emotion. Look at how flat that apple looks, or how flat the face icon looked in the previous slide. There's a whole third dimension that's edited out of your brain. It is difficult to convincingly draw a real face or an apple from memory. That's a job that's better for your eyes. Follow your eyes when you draw. It's similar to how medical training leads us to develop a clinical eye. Proceeding clinical findings, a layman may not notice. Here's an exercise you can try to test this out. This is a picture by Igor Stravinsky by Pablo Picasso. Take this drawing and then flip it upside down. Now, copy the drawing in this upside down orientation. I guarantee you will make a drawing that will look very similar to Pablo's. Here's an example of an untrained artist who first drew it right side up and then upside down. Why does this exercise work? Drawing the portrait upside down forces you to not use your mental image of a face or a hand. You're only seeing the contours of the line as they truly are. Stop looking and start seeing. If these concepts interest you and you want to learn more, I highly recommend this book by C. Edwards, Drawing on the Right Side of the Brain. When you made a drawing as a kid, what was your measure of success? Maybe it was mom and dad putting your drawing on a fridge. Forget the fridge. Maybe it will happen someday, but that isn't the point. The goal is just to draw. The measure of your drawing success is the time you spend doing it. Now, some people enjoy drawing from observation, trying to capture what they see, but for me, I like making comics. Comics are ideal for telling a story over time. They are a sequence of images, each capturing a moment in time, that when put together come alive and create a narrative. My comments are still somewhat based on what I see and experience day-to-day. I need to be a careful observer of, let's say, a hospital bed or the way a certain type of doctor looks or acts, even if the goal is making a humorous comic. Panels are the grammar of comics. Each panel represents a moment in time, and these panels can be very flexible. The transition from one panel to another can be very different, and you can use this to your advantage. The gap between panels can be less than a second, capturing a moment, or having to depict two different actions that relate to one another, or the gap may jump years ahead or cross a continent. These are all intentional decisions that you as the artist make, and this is where the creativity kicks in. Once you've practiced drawing from observation, you may start to develop your own style. One of the great things for me about art is choosing how to process what you see and what kind of style you want to take. Some people's styles are more abstract and more simplified, while others are more realistic. With all this in mind, we're now going to start a live demonstration. I encourage you all to draw along if you have some paper and a drawing utensil nearby. Just bear with me for one minute to switch screens. Can you see the drawings? Yes. Great. All right. Now the drawing lesson. Let's say I make a comic about a doctor meeting a patient. Let's say I'm not someone who has much drawing experience, so let's say I'll draw my doctor, and here's my unhappy patient, and maybe the doctor's introducing themselves. Hi, I'm your doctor. We'll say doc. Not a very interesting, not a very interesting drawing. We have to take on some skills to kind of, you know, elevate this to at least the way that we can really express what we're seeing, and the things that we want to express. So number one, I want you to stop using stick figures if you do already. To begin with, I want you to first transform your stick figure. We all took anatomy classes, so we all have at least a basic understanding of how the musculoskeletal system works. So I'm going to turn the stick figure into something a little bit more realistic. Also, I have a head. Let's give the stick figure some shoulders, give him elbow joints, a torso, a pelvis, and then some knees as well. I want your character to be a stick figure with joints. Now you actually have articulation that you can use to manipulate, that you can use as a skeleton for the actual character. Number two, you can see in the cartoon here, both the doctor and the patient are looking straight on at the camera. I want you to think of the heads as a three-dimensional object, a sphere really. So, you know, when I drew the original comic, if I had like almost like a globe, and you imagine a face and head on, you know, it's a symmetrical face. But we can manipulate that face into a lot of different positions. You can rotate it about, you can rotate it about 70 degrees. You can get something like this. Now you have a little bit more dynamic pose. Or if you want to show him from the side, you can do it like this as well. Again, each time, so each time you can rotate and manipulate the head as a three-dimensional structure, it allows you to, you know, create different angles, different types of expression in a way that's more dynamic than just drawing every single face from head on. Like I said before, I don't want you using just stick figures for your character. I want you to create personality with your characters. And the approach I want you to take of that is think about each character as a shape. Let's say I'm trying to create a character, and they have almost like a bouncy, happy kind of personality. You know, I think about kind of bouncy characters, I think about like a round shape, like a ball. So we're going to design a character almost like a ball. And every time, whenever I'm drawing a character, like I think about, you know, I try and keep the shape constant with all the aspects. So nice round eyes, a round little nose like that, you know, round smile face, comes around ears, maybe like a nice little, you know, kind of like a nice little interesting hairdo, you know, a white coat. So he's very happy to see his patient. Tie, pants, then stubby little legs. The main focus is that kind of round circular body. You can see how much more expression I'm getting out of this character, compared to stick figure there. You can tell it about his personality just from the shape of him. And when I'm drawing characters, I'm still always thinking about that anatomy, even though he obviously has a very unusual kind of shape to him. I'm thinking about the head, thinking about those, you know, the shoulders and the elbow joints. He's got a torso, he has hips, and he's got knees like that as well. I'm always thinking about that stick figure anatomy when I'm drawing characters, because it allows me to manipulate each parts of the body piece by piece. If you break things down, you can make your character a lot more dynamic, and it's not as intimidating as you may think. All right, so that's our first character. I maybe want to create his counterpart, and maybe more of a rigid, strict kind of doctor. For that, I kind of think more like a sharp, right, you know, maybe right angle, rectangular kind of shape. So I'll draw my rectangular shape here. In this character, he's going to have a lot of right angles. I want to kind of get that rigid, strict kind of personality. So it's like a big square. Classes, you know, maybe he's kind of angry. I think, Dr. Nasir, your microphone is on. We'll give him a rectangular nose, more rectangular kind of ears. I'm thinking about that shape, that rectangular right angle shape, with every aspect of the character, every component of each of those. You know, maybe I'll have a mouth like that. Maybe this is the kind of character who wears a bow tie. So I'm kind of doing that as well, and a little more right here. He's long, you know, maybe long legs like this. Good arms, of course, and some hands. Maybe he's got a reflex hammer as well. So yeah, thinking about the shape, you can, by comparing these two characters, you have two different personalities, just by looking at them before I start putting words and letting them kind of express themselves. The picture kind of tells us a bit of a story. Now, one last character, one last character we'll draw. I find when you just use a shape, patients kind of lose their necks in a way, but sometimes, you know, as you get better, you might want to start with just a pure primary shape, and take a more of a certain sort of line. The little character's got more sweeping kind of moves to them. You know, I have like a sweeping head, sweeping down to the neck. Maybe she's got kind of a sweep of her hair like this, bottom of her hair sweeping like this. The lips maybe have more, you know, kind of sweeping aspects. Again, I'm always thinking about those characters, it's all about the sweeps and how they're made. Something like that. You can see, so she's got, yeah, part of the personality is expressed by this kind of sweeping kind of theme I'm putting into the shape and the character. Lesson number one is to summarize. Think about this to kind of, you know, and add some anatomy to it. Maybe think about the head as a three-dimensional globe. When you're doing your character design then, always, you know, I think of a shape or a type of line that express the character, you know, and play around with it. Sometimes I have a character, I'm not sure what shape I want them to have, what kind of line, you know, theme. I'm going to start drawing shapes and see, you know, when I have a character in mind, you know, I'm going to start drawing shapes and see, you know, when I have a character in mind, theme. I'm going to start drawing shapes and see, you know, when I have a character in mind. And as I start doing that, you know, something comes out, you know, it's kind of this where inspiration kind of comes in. And from there, you know, maybe you start adding eyes, put a nose there, you know, already have a little personality. So again, it's all about just playing around. That's a character design lesson. Lesson two is environmental design. Going back to our cartoon here, which are, you know, hi, I'm your doc, almost in a void. There's nothing really going on here. Where are they? Obviously, you know, we want the reader to know that they're in a hospital, they're in a clinic. So you want to add features to it. This is where the observation I was talking about earlier comes in. I want, you know, you have to think, okay, I want to, let's say I want to have my characters in a clinic. So first, let's put some of our characters we just drew before. So we've got our round character that we designed. He's very happy to meet his patient. I'll say our patient here, they're a bit more right angle, we'll say. So they have one of those unflattering gowns on. So already I'm thinking about the environment. I'm giving them the gown, those very ugly shorts we sometimes give patients. Making it identifiable. Make the reader know where you are. Figure it out, not just based on what you're saying. He's sitting. They're in a clinic. I'm going to put them on the clinic bed. Maybe they have those cheap little papers that they use to put on the beds. Put them here. Always in the clinic you have the cabinets on the side. Maybe there's a little cup here that has the doctor's reflex hammer. And of course, like all clinics in the year 2022, the doctor is looking at his computer. Not looking at the patient. So already you can see I'm thinking about the environment design. I'm thinking about what I see day to day. I'm thinking about how much more life there is and how much more expression there is just by putting some props in. Think about the environment. Sometimes it's about observing. What's in a clinic room? What's in a hospital room? What's in the doctor's lounge? Make it identifiable. Make it more real. Make it more specific. Don't just use the whiteboard or void or just a line. Very boring. This is the camera. Not making movies, but there's always a camera when you're imagining when you're ever making a panel in a clinic or a single painting. Where is the viewer looking? In these pictures here, we're looking straight on a medium distance from the two different characters we're trying to show. One character here, the other character, we're looking from behind here. Let's imagine you're on a movie set. We can move this camera. There's a tendency in a lot of drawing, whether you're painting something, drawing something, or making a comic, to depend upon this one view. Putting in variety to the camera makes everything more dynamic. Rather than this middle distance view or this close. Sometimes you want to do a close-up. Get right in your character's face. The benefit to that is those close-ups are great for showing expression. You can use them for different purposes. It can be kind of humorous. You can show a really excited... If you want to show how excited the doctor is to meet his patient, a big close-up where you can show details, get the teeth in, in a way you couldn't show in a middle-distance panel. That can be kind of funny. That can get the reader's attention. You can also use a close-up if you want to do a more serious comic. Use a close-up to really show a person's expression they're trying to take on in a way you can't do from a middle-distance panel like this. The other camera move you can do is pull it way back. One tool you'll see discussed is creating an establishing shot and showing where the location is before you establish where we are. You're almost showing a picture of the building the scene is taking place. The reader knows where we are. In this comic, before I even show this panel, I zoom out. I move the camera outside the hospital itself. I go to the hospital. across there, and entrance, and all these entrances kind of have like this little interesting little archway, some windows, and you know, I'm thinking about what I see when I drive in because sometimes seeing stuff like, you know, signs up like, you know, welcome heroes or something, you know, kind of becomes part of our daily, you know, seeing, you know, observation and putting those things that you see. Maybe, you know, maybe kind of like also maybe like a dark kind of scene, put some dark clouds here, you know, maybe that make a little foreboding as well. You know, again, establishing a tone for what you're trying to set for the reader. So, three lessons we're teaching in the drawing here. Number one, review character design, like I kind of summarized that already before. Number two, environmental design. Think about the problem, think about what you're seeing day to day in your drawing. Don't just make things simple. Finally, lesson three, think about the camera. Shift the camera around, you know, vary things. It's going to make things more interesting to draw, so you're not drawing the same thing for every single panel. It's going to make things more dynamic. That's where the creativity comes in. So, that's the drawing, the live drawing demo. So, I'm going to head back to the PowerPoint. For the past few months, I started a new project. I began making daily journal comics. The goal was to make a small comic every night. The comic could be simple. I just wanted to make something each day to reflect on the past 24 hours. Some of the comics are small vignettes related to a patient encounter. Others are just one panel. I'm trying to capture a scene or a mood. Here's a comic about a frustrating day at work. I made the panels get smaller and smaller as I went across the page, trying to express the anxiety I was feeling as the day went on. Here's a cartoon I made one day to show how exhausted I was at the end of the clinic day. Sometimes I'd make a short comic, just trying to make a humorous moment from one patient encounter I had. Those are trying to express the loss of energy I get even in a single morning. Here's a journal comic I made. We're trying to show subtle aspects of a patient's personality. There's three different patients' personality in their exam findings. The idea of this journaling project was just to make something, anything. Sometimes, though, the most intimidating part of drawing is deciding what to put on the blank page. I want to help you, and I want to help you get started with drawing, so here are some exercises that you can potentially do. Exercise one. Offer memory a medical instrument you use every day. No peeking. When you're done, compare it to the real thing. I did this exercise myself using a tuning fork. I then took a look at the actual thing, and I noticed that I wouldn't really capture some of the shapes of the actual tuning fork. The next day, what I recommend after you do this exercise is actually repeating it, but now drawing the object from real life. Use the idea of seeing the object, not using your mental image to help you capture it. Exercise two. Observe a patient closely. See them. Don't just look. That evening, draw what you recall. Maybe in this process, you'll also notice things that help clinically as well. I did this myself in one of my journal comics. I'm going to capture the personalities of four different patients with the added challenge of the fact that they're all wearing masks. Exercise three. Draw a three or four panel comic about something that frustrated you. For me, I find that challenging moments are the most fertile ground for thinking critically and creatively. Whenever I don't know what to draw, I try and think of something frustrating, and usually something interesting comes up. I put together a worksheet that you can download at this website. It includes all the exercises that I've gone over in the talk, goes over all the drawing tips that we also went over, and also lists some resources for those who want to read more. I'd love to see what you create. Feel free to reach out to me if you have any questions or want to share anything that you've made. I hope I've convinced you of the importance of your critical observations, faculties, and I hope I've given you some tools to use art to refine those skills. Thank you. Oh, Jason, that was so good. It's like watching magic. When you make those things come alive on the screen, it was really magical. We have a few more questions, and we want polling questions for the audience, but we also are really interested in your questions and comments. Type into the chat any questions you have, and then Brian, can you run those last poll questions for us? Did you draw along with the presentation? Oh, the answers are coming in. We've got a bunch of drawers. All right, go ahead with the next one. All right, very nice. That should make you feel very good, Dr. Bitterman. I think you've inspired this group. Next question. Really interesting. Based on today's presentation, use the chat feature to describe how you think you could use creative arts to impact your medical career. And we would love to just use this as a chance to start a dialogue about people's thoughts about using arts or creativity to decrease the stress in their day. I had a question for you, Dr. Bitterman, to try to get the conversation going a little bit. Do you ever draw things for your patients to explain their illness or to describe their anatomy or anything like that? And if you have, how have they responded to that? Yeah, so I use it a lot just for explaining things. You know, I say in a talk, I mean, again, whether based on health literacy reasons or just because pictures are often easier to express information better than words can for a lot of these patients, for our patients. So I do use that. I use it for different reasons. Oftentimes I'll use it maybe to explain some anatomy concepts. Maybe, you know, if I don't have a model in the room, I'll sometimes, you know, draw out the anatomy as well as a quick way to kind of get that across. Or if I'm just trying to draw, you know, trying to teach certain aspects as well. It varies patient to patient, but I think it's a great tool for showing attention to patients. And I think the patients like it as well. I really like that. I think of, you know, how complicated it is sometimes when you're trying to explain something for the patient, looking at an MRI, you know, and you're trying to orient them to the scene and you're trying to show them the pathology and how much more straightforward it might be to sketch, right? Because then you can really let the superfluous things fall away that, you know, that they don't need to be looking at and really focus their attention on what you're trying to tell them. And I also like it as something they can bring with them, you know, to think about and look at, just like sometimes, you know, we'll write a word down for them that they can look up in Google, but I really like the idea of a picture for them to bring with them. I think that has real power to it. Yeah, definitely. I'm also curious how you use it with your teaching. So I use, for teaching, I do a tremendous, I try and do a tremendous amount of drawing. The reason is, you know, whenever I, a lot of times I teach a topic, I use a whiteboard or a piece of paper. And then I think like I said, like with a patient, you're creating a document that the student can take with them. And usually things are, you know, the same way I kind of with the drawing of what I did today in this talk, right? I kind of had a page and by the end I can zoom out and you kind of have the whole picture. You do the same thing with teaching. So I'll, you know, I'm trying to do anatomy. Maybe I'm just trying to teach almost like a learning map in a way. And, you know, I'm teaching things. I'm having the students add things to it as well dynamically. And from that, you know, the student's almost getting a learning map of like whatever topic we're going over, whether it's, again, something about, could be something specific like anatomy, could be something about, you know, patient care. I'm kind of trying to build something. And then the paper goes to the patient, or the patient, the student, so that they can then have it. So they kind of have a document of the teaching as well. So I found that to be very effective for teaching, whether it's medical students, residents, whatever. Oh, I bet they love that. You know, I love that thought. It's almost like a little gift, you know, that you're giving them. It's very tangible. And one of your learners entered into the chats that they can attest that your drawings are very helpful when you're teaching. We have a question. There's a question in the chat, has learning musculoskeletal medicine helped you see? So that's a really interesting question, right? So we know that seeing helps you be a better doctor, but does being a doctor help you be a better artist? Yes. So, I mean, I remember before I went to medical school, like everyone's like, you know, I had drawing background, and I kind of like leafed through like anatomy texts, but I was like, oh, that's so intimidating. You know, like, you're not forced to learn, like, oh, I'm not gonna learn all these muscles. I'm not gonna learn, you know, a lot of the, you know, drawing, anatomy drawing, drawing for, you know, anatomy for artists is all about learning all the muscles. It's the same sort of stuff that we learn. And it's just like so intimidating. So finally, when I got to medical school and I got it, you know, and then likewise, you know, I came in our resident, you know, learn all this stuff. You know, now I think I'm, you know, a fairly high level, I think, in terms of understanding anatomy and being able to capture whether, you know, I'm doing a lot of going to go figure drawing, life drawing class, or from doing, you know, if I'm trying to do something from imagination, I know, you know, how to manipulate the anatomy on a much, I think, higher level than I did prior. I think it's, you know, obviously, it's still kind of something, you know, I'm doing it every single day, not as an artist, as a physician. So obviously, it's, everything ties back in. You see, I've noticed that too, I think as a physician, and you're looking at art, like you can notice an angle that's off so easy, like the head doesn't bend like that. Something like that, that you'll notice so much because you look at people's bodies and how they move all day. I could really relate to that. There's a few other comments from the chat I wanted to bring to people's attention. There was one, someone said that they like to draw on the clinic table paper to make the meeting less formal and piques the patient interest. So I think that's, what a great tip, like you don't even have to bring any paper in with you. That's very cool. And we have a musician among us that said they like, they look for ways to integrate music into discussions and into their work. So that's really interesting. You've got some fellow artists that are commenting that they feel that drawing brings a humanistic touch when explaining a disorder to a patient. And I could certainly see that how, there's something about when someone makes something for you, how it feels like they're connected to you as a human, right? Not just giving another person perhaps information about a poor prognosis, like they're actually connecting to you as a human. So I really like that perspective. We have other drawers in the chat. This has really inspired me. I've never drawn anything for a patient. I really feel inspired from these chat comments. I think I got one question that went directly to me, but I'll say anonymously. So the question was, have you ever used art to share information about prognosis, spinal cord injury, brain injury, stroke or amputation? So, I don't practice those types of rehab medicine right now as a resident. I'm trying to, I mean, it was interesting. And brain injury, I remember one of my rotations and I was almost like, I don't wanna say it's an experiment because that sounds kind of, it's not the way it is, but like, because I had a patient who was aphasic and I was like, I wonder if like using cartoons would be a way to better like, could they understand, they couldn't understand, they had a Wernicke's aphasia, so they couldn't understand like words. Would like a picture be a nice way to express things or kind of see if it can like help them understand or like have them follow commands that way. It was kind of worked, but I was trying to, I remember using that in a way to try and see if it works. But I think there's maybe that is an aspect of the brain that hasn't been well studied. Where are the communication centers for pictures? Is it the same as the communication centers for language? It's a bit outside of my scope of practice, but that might be photographed for someone who's interested in research. Yeah, that really is interesting to think of. There certainly are visually oriented learners. And so you could imagine that communication, visually oriented communication system could be really helpful for the right person. That's a really good thought. Other questions or comments from the group? Yeah. Hi, Dr. Fuentes here. I am very interested in what you were saying about that flexibility about pictures that may be in stroke or TBI that we've used. It's a base of what we use for musical therapy that some patients cannot, like a facial, for example. And sometimes we use that as music as a part of what we use for them to express themselves. Kind of have that kind of flexibility also with drawing. I've never seen it with drawing, which you mentioned that, and I thought it was very interesting. But we use it a lot for patients with musical therapy for TBI or stroke, especially. Yeah, definitely. I really appreciate your putting this talk together, I've never seen anything like it. I think we definitely hit our goal of doing something really unique and different. So thank you so much Dr. Bitterman for sharing your talents with us, and I also love that you are a spokesperson for your generation with that website, so I definitely will check that out. I really appreciate that resource for the group, and thank you all for joining us. A joy to have you with us today, and I look forward to seeing you at our next National Grand Rounds. Thanks so much everyone, have a great night.

art and medicine

medical education

observation skills

patient care

medical concepts

drawing demonstration

creativity in medicine

creative arts in medical practice