What You Don’t Know Might Be the Key

I was intrigued to hear about a class at UW Medical School called “Visual Thinking: How to Observe in Depth”. The class is  co-taught by dermatologist Andrea Kalus and an art historian Tamara Moats, and teaches dermatology students how to hone their visual assessment skills.   Specifically, students are taught to put aside their assumptions and training, spend more time looking, and see what they see. They start by looking at paintings, and then transfer those skills to observing skin conditions, and even observing their patients and themselves.  The end result is more accurate diagnoses — but also more compassionate doctors.

Visual Thinking Strategies is a methodology that was originally created for school teachers and museum curators, to help them foster meaningful discussions about art.  VTS also teaches kids critical thinking skills, by asking them to explain their conclusions and interpretations. This video from gives examples:

In the medical classroom, students are taught to slow down and keep looking. Jen Graves at The Stranger observed the class in action back in 2008.  She explains that one of the goals is to fill a gap in a medical system where doctors spend less and less time directly observing their patients, and are losing the skills of clinical observation.

“Physical diagnostic tools,” as Dr. Kalus calls them, used to be emphasized before the rise of technology. Today’s gap in visual training is made worse by the fact that medical students are extremely goal-oriented, the doc says: They want to get to the answer. The gift of art, for them, is that it can’t be diagnosed. All they can learn from it is to keep looking. 

And when they do keep looking, investigating assumptions, looking again —  they notice a lot of details that they would have otherwise missed.  These details lead the medical students to question and change their first assumptions, and take time to fill in the picture more completely. This means more accurate diagnoses and better care.  Doctors can notice their own biases — ideas they hold about certain conditions, certain patients, how they’re reading body language and facial expressions in an interaction.  And they learn to look at and see their patients more clearly.  “For example,” a student at a similar class at Harvard explained, “if a young mother looks run down, it might indicate she’s too stressed to take a medication that requires five doses a day”

All of this catches my attention because as a yoga teacher and a massage therapist, my work centers around perception.  I don’t have access to x-rays or MRIs; I have to rely on my sense of touch to determine what will help my clients.  So I’m continually practicing palpation skills.  In yoga asana we fine tune our awareness of physical sensation, and in meditation we try to set aside assumptions and just see what is present.  In a session, these are the tools that my client and I have to work with.  And I want to put them to good use.  How much can I understand about my own body, my own aches and pains and how to care for them, through careful observation of sensation?  How much information can I gain from my clients’ descriptions of their sensations?  What can we learn when we set aside filters, expectations, agendas, and become more curious about the experience?  I don’t in any way disregard the value of MRIs and other diagnostic tests, but I’m happy to see acknowledgement of everything that gets left out of these scans.  And I’m happy to walk with my clients again and again into that space of pausing, not knowing, sensing, listening, uncovering.


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