Creative Arts SSC
The engine of Creative Enquiry innovation in the medical curriculum is the Creative Arts for Health Student Selected Component which I set up in 2004 at the University of Bristol and continue to run at Barts and The London, QMUL. Working with a small group of self-selecting students allows for piloting approaches and co-creative exploration in the field. Students opt for a two-week course which is co-faciltiated by arts therapists, arts for health consultants, clinicians and patient artists. Each three hour workshop has a similar format where students:
witness patient creative enquiry work,
engage in a variety of arts-based processes (e.g. photography, collage, creative writing, sculpture),
share their creations
engage in group-based dialogue on patient and their own lived experiences in medicine.
The course ends with the production of a creative-reflective text, examples of which you can see below arising from across courses from 2004- 2021. Also student quotes on their experience of this course.
The course was developed and researched in my MSc in education. I found that creative enquiry has the potential to facilitate transformative learning, development of understanding, ideas, beliefs in profound ways as students explore, create and share.
2023-2024
Betty Liked - Aman
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My creative enquiry ‘Betty Liked’ describes the complexity and conflicting nature of narratives of patient experience between the patient themselves and those caring for them. The song was inspired by my own experiences volunteering at a hospice, encountering many patients who were nearing the end of their lives. One patient in particular, “Betty”, left a lasting impact on me, staying at the hospice for almost all my time there, over which I couldn’t help but grow attached to her, and subsequently felt deeply emotionally affected as I witnessed her health deteriorate.
I wanted to explore the concept of ‘narrative humility- in that we can never claim to completely comprehend someone else’s story or perspective in its entirety, and in the context of healthcare, the importance of clinicians maintaining a sense of humility in acknowledging that the patient’s narrative is theirs alone, and our understanding of their story is just our own reading of it, not a definitive interpretation.
The song discusses how “Betty” silently deals with many internal and external struggles, including loneliness, conflicts with her family and being unable move and think in the way that she used to, as well as coming to terms with likelihood of her condition not improving. Throughout the song we see the narrator become closer to “Betty” and share many touching moments with her. And so at the end of the song, when “Betty” finally passes away, without any fanfare or a last goodbye, the narrator is heartbroken, only left with the memories of their time together.
The writing of this song has truly shown me the benefit of creating art for those working in the field of healthcare, as a way to reflect and process our experiences, not only being cathartic for the individual, but when shared with others, providing a wider opportunity for connection and healing. It has also shown me the value of embracing emotions as future practitioners, feeling both joy and sadness when caring for others, and it not being a weakness but rather a strength, something that we should try to hold onto even when the job at hand becomes difficult, so we never forget our own humanity and that of our patients.
The morning I tried again - Naimaah Ahmed
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Burnout is a habit, caused by the repetition of exhaustion and resilience, without taking the time to have a break. For me, burnout also comes hand in hand with cultural and societal pressures, all compiling into an incessant need to be more and be better, no matter the outcome. Being a woman in any space in society calls for a balance between beauty and modesty, intelligence and submission, and desires and expectations. Within my own culture, I was encouraged to pursue medicine which required me to be curious, though I had to remain unquestioning in religious faith. This fine balancing act was its own state of exhaustion which contributed to academic burnout, all resulting in an unrecognisable version of myself. I was suddenly someone who didn’t know the difference between what I wanted and what others wanted from me. To untangle this web, I turned to poetry, an art form I often turn to in times of need. It was also important for me to visually represent my poetry because I wanted to share my experience in a new form I had never tried before. I only used images of myself, and I pieced them together to accomplish a beautiful but haunting version of me. The act of collaging this image mirrors the actions in the poem itself- I cut out the eyes and lips and plaster them on but overall, there is something not quite right…
The Transition - Isabel Sawyer & Bethan Harris
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This piece of work has been created by Bethan Harris and Isabel Sawyer as part of our SSC5B in Creative Enquiry. In order to create this piece, we conducted a survey of final year medical students and asked them to anonymously state their thoughts and feelings about progressing from medical student to doctor.
The anonymous students can be seen seated in the Perrin Lecture Theatre, a place we have spent many hours across the years. The iconic green seats, with the red singular seat is a familiar sight and one that provides a suitable backdrop for this piece. The students are faceless, preserving their anonymity and perhaps representing the loss of self and belonging that has taken place throughout their time at medical school, where one becomes part of a collective group, rather than being an individual.
Above each student, a phrase or word from the survey can be seen. The phrases vary from positive, to negative, and give us an insight into the emotions of our cohort at such a pivotal time in our careers. We have enjoyed creating the piece, hearing the thoughts of our peers and having time to reflect on our medical school experiences and our thoughts on the future.
Student Quotes 2023
2022-2023
Accepting Imperfection - anon
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When I began this piece as a final project for my SSC, I wanted to create a portrayal of the feeling of constantly having to fill in parts of yourself, repairing imperfections to fit someone else’s expectations. But as the SSC continued, and I continued to work on and receive feedback for my piece, I learnt a bit more about flourishing. I realised that I didn’t have to be so hard on myself for not meeting expectations. Throughout this SSC I found that there was a kinder way for me to grow. Now, looking at this project after finishing my SSC, I look at this piece as an expression of my willingness to grow and develop to become the best possible version of myself.
When I began my creative enquiry, I decided I would double down on the idea of perfectionism and push myself to create something within a narrow time-frame, not allowing myself to make adjustments to the imperfections which I perceived in my work. I allowed myself only a long weekend to complete the project. My first attempt took me only 2 days of work. I was happy with it upon completion, but when I looked at it again after a few days, I was displeased with it. I wrestled with myself over whether or not to restart; to start again would mean ignoring part of my initial prompt, and completely dismissing the premise of working in a set time frame; but on the other hand I knew that I could do better and would feel regretful if I did not at least try to improve the mistakes I made.
I eventually did create a second piece, followed swiftly by a third, then a fourth. It was the fifth attempt which I decided was adequate enough for me to submit to my tutor.
As medics, we are often unwilling to share our experiences of mental struggles (despite studies showing that doctors have higher rates of depression and anxiety than the general public (1)) due to internal and external stigmatization (2). Even writing about the feeling of being imperfect feels risky, like I am being caught out in some big lie. The importance of sharing with each other our stories, through creative means or otherwise, cannot be understated – it is through understanding each other that we can learn to be kinder to ourselves and truly flourish.
References:
1 Gerada, C. (2018). Doctors, suicide and mental illness. BJPsych Bulletin, [online] 42(4), pp.165–168. doi:https://doi.org/10.1192/bjb.2018.11.
2 Knaak, S., Mantler, E. and Szeto, A. (2017). Mental illness-related stigma in healthcare. Healthcare Management Forum, [online] 30(2), pp.111–116. doi:https://doi.org/10.1177/0840470416679413.
Third Space - Ravleena Wasan
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Feeling purple:
‘Winnicott has termed this space ‘the third space’, within which the contours of self and the other might be perceived, where mutual assertion and recognition might lead to the emergence of meaning and fresh perspectives’.
The ‘third space’, is a space which allows independent people to share the meaning of their existence, whilst acknowledging their own individuality. The colours red and blue, so different from each other, like a doctor and their patient; can join to form purple. A depiction of the beauty can be created from this shared understanding, this ‘third space’. The two people sitting in this consultation room, so independent of one another, allow themselves to feel mutual assertion, which enables both parties to understand each other more inherently, causing better outcomes for them both.
Facelessness: lacking a face, lacking individuality, lacking character.
But here, it represents universality, the ability for us, as viewers, to place ourselves as either one of these characters. It is unclear who is the doctor and who is the patient in this scenario. This enables us to place ourselves as either one, or both at the same time as both the teacher and the learner. The lack of faces also allows the normal power dynamic of the doctor and the patient to be removed, giving the viewer a sense of calm, whilst presenting the space as a shared one or mutual assertion.
How can a patient recover, if the doctor does to share understanding of their experiences and pain? How can a doctor heal, if the people do not recognise the unique independence and perspective of the doctor?
The simplicity of the colours used gives it a sense of childishness, alongside the use of cartoon characters. This sense of naivety mirrors my own understanding of this ‘third space’, which was difficult for me to personally understand and explain to others. The use of a cartoon drawing - a visual representation of the concept - made it a lot easier for me to conceptualise and therefore aim to implement in my future training as a healthcare professional.
Alienation - Melisa Toufeq
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In this creative piece I decided to represent a recurring state of mind: confusion and isolation. As a child I was hopeful that external influences will ultimately curate an ideal path for me. Yet only for so long could I thrive under such a way of thinking, and eventually was faced with the fact that every choice I took was mine. I was responsible for all their consequences. My piece represents the overwhelming nature of choice, combining the chaotic nature of cancer (histology) with pieces of eyes, a representation of being succumbed and suffocated by a fast paced, abundant world, bearing hundreds of choices to select from, with dozens of desires scouring my mind. Yet regardless of the options, I remain living in a perpetual lack of comfort and satisfaction.
The freedom of choice is suffocating and frightening, like the nature of cancer, so sometimes it is easier to become an observer, remain hidden behind it all, just like the inconspicuous eyes in this piece.
The Nurturer - Freya Qureshi
The Imposter - anon
Facelift - Denise Salar
* - Samia Rahman
2021-2022
Exploring the human dimension in medicine - Sivakami Sibi
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There was a time during secondary school where I was conflicted between choosing a career in medicine or a career in art and I always believed that these two paths were separate. I have begun to explore how I can integrate both passions in my life, which is emphasised here.
I was inspired by the conversations we had as a group and how we have encouraged each other in developing our own creative enquiry skills and building on each other’s ideas. I wanted to create something that highlighted this so I thought about the powerful imagery of hands reaching out to connect which could symbolise the power of togetherness and human connections.
To develop the symbolism of my piece further, I thought about adding details to the hands. I felt that by removing the skin of the left hand, it could be interpreted from a clinical perspective as the physical body through the visual imagery of tendons and arteries or could be symbolic of what is beneath our skin and represent the part of us deep within. This painting can also be seen as representing different people reaching outwards to develop themselves through the support of eachother or could be seen as both hands representing one person who is trying to connect the two sides of themselves (physical and mental.)
However, there could be an alternative interpretation in relevance to patients. For example, the physical hand could represent a patient reaching out to the flourishing hand which represents doctors in a consultation and depicts how patients reach out for empathy and kindness to connect with their doctors. This alludes to the importance of holistic care in medicine as physicians can often focus on the physical symptoms of a patient whilst paying less attention to their mental wellbeing.
The rose has connotations of love and kindness. Therefore, the meaning of the left hand reaching out for love becomes clearer whilst the flourishing hand tapping the rose is symbolic of spreading love and empathy. The background reinforces this message through the use of colour. As mentioned in a group discussion, people often see warmth and kindness in warmer tones such as red and orange, so I have used these colours to show the spread of warmth almost battling against the darker colours on the left, which signifies the healing nature of flourishing through human connection.
Ultimately, this painting is a visual reminder that I should be compassionate towards myself. In times of difficulty, I should reach out for help from others and that can allow me to develop as an individual. As a medical student, it reminds me of the need for compassion with patients, to see them not only by their disease but also from a human perspective and always offer my support and empathy. This idea has resonated with me after hearing the profound impact that empathy and kindness has had on patients throughout my medical journey
You can’t put anyone in a box - Hamzah Asad Iqbal
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People in general always talk about how ‘’You can never judge a book by its cover’’ but I feel as though this expression sometimes gets lost within the medical world, whereby doctors may be in a rush to diagnose patients with a list of black and white questions so that they are then able to put them in ‘a box’ labelled with ‘diagnosis X’. Having always been into fashion (especially streetwear and trainers), I immediately thought of how a new pair of trainers always come in a box. I wanted to create my own pair of customised trainers to reflect that each and every patient is unique and how they cannot be placed in boxes. Sketching and sculpting with playdough throughout the SSC somewhat felt reminiscent of being back in school sat in art class which used to be one of my favourite lessons; naturally with this experience came many childhood memories. I wanted to create something bold, vibrant, and unique which not only represented memories from my childhood but also with the underlying message of ‘’I can’t be put in a box.’’
A Deeper Communication - Holly Griffith
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In the piece, the flower on the left represents the doctor and the flower on the right represents the patient.
The ‘doctor flower’ is in full bloom representing the doctor who is compassionate and intelligent and flourishing in their work. Whereas the ‘patient flower’ has a wilted head on representing illness, struggle or loss. The roots of the two flowers represent their stories, what lies beneath the surface which you don’t initially see; both the doctor and the patient have them and aspects of both of their stories can be shared and spoken about in a safe and open conversation. They are intertwined in the centre to show connection between the two individuals.
To me the connection is the highlight of the piece. It represents how the doctor needs to be attentive and tune into the patient’s narrative in order to obtain a complete and whole picture of the patient and their illness. The idea is that this connection has allowed the ‘patient flower’ to begin to grow a new bud and to heal and flourish.
2020-2021
Breaking free from the chains of expectations - Natasha Alia Razman
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This piece is a symbol of all the hardships faced by everyone in the medical profession, including even medical students. Different mediums such as a digital tablet, newspaper and yarn were used in this piece as it gave it more of a physical connection and more significance to me.
The faces represent the ‘mask’ healthcare workers tend to put on, by pretending that nothing fazes them. We often hear that healthcare workers need to pretend that they are not affected by any form of emotion when treating patients, as it could be seen as a sign of unprofessionalism. Unfortunately, sacrificing compassionate care towards patients, as well as compassion to oneself. The strings are connected to the faces, which symbolise the big expectations that are weighed on healthcare workers’ shoulders. People often expect them to never make mistakes, and achieve extraordinary feats. As a result, healthcare workers become too hard on themselves for not being perfect.
Finally, the hands at the bottom represent the power that we potentially hold. The power to potentially break free from expectations and take control of our own lives. The power to be more gentle with our souls and allow ourselves to flourish, instead of pursuing perfection. The power to be able to grow from a difficult situation instead of simply persevering. Regardless of interpretation, I hope this piece allows others undergoing their own struggles to connect with it and inspire them to be more compassionate in their journey to become a better, happier version of themselves each day.
Working on Flourishing - Elle Tallgren
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The creative piece is a combination of photography and digital art. The photograph shows two individuals, which are in reality the same person. The other one is shown to wear a piece of sheer fabric, with only the legs and the other hand bare, peeking from under the fabric. The free hand is holding a small bouquet of dead flowers. As the viewers eye moves towards the right side, they can see that the fabric extends and is finally folded on the arm of the other individual shown on the image. This person is standing in a more calm and stable position, holding the hem of the fabric on one arm, and a big bouquet of healthy, colorful flowers. They are wearing the same clothing as the person who is underneath the sheer fabric, signaling that they are just another version of the same human.
Personally, I created this image to tell a story of a journey towards flourishing. The veiled individual represents the forcing of academic success, limiting themselves to strict working hours and learning outcomes. The viewer can notice that their gaze is pointed towards the dead flowers, signaling an obsession with the outcome, rather than the process of getting there. I see my past-self in that veiled person, struggling with perfectionism and the idealization of resilience, overanalyzing what the world expects of me. The continuation of the sheer fabric represents the shift in perspective as well as attitudes. We can see that the person holding the fabric carries flourishing flowers but is looking at the journey they have taken to come to that position in life. The yellow sketches aim to catch the attention of the viewers to think more about the meaning of the image, and also to showcase the relationship that the two figures have.
We’re all individuals on this planet - Elle Tallgren
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A response to a patients wish for every future doctor to see their patients as an individual and to treat them with compassion and empathy.
I was taught about these concepts even before medical school, and they are something that are often mentioned, so this very much resonated with me. I created this piece to showcase how I would hope to form a safe atmosphere with every patient. The image shows the doctor and the patient on the side, but in between them is the connection (or "third space") they formed through the consultation to ensure that they will be taken care of.
The caption says "We're all individuals on this planet". I thought that this phrase is a good reminder for all health care professionals. The concept of a planet can also be seen on the image, with the "rings of Saturn" around the third space.
The concept of flourishing is also involved, as it is something I want to keep with me throughout my medical career. The patient and the doctor are in a way flourishing together as they have created a safe space for both of them to exist and grow in.
To Flourish - Yunrui
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Verse 1
Thursday,
you stare at yourself into the soul
Asking where you should go
It’s a new day for you and life’s just
Happening,
Flower’s blooming so ~
Chorus
You
shall soar like eagle
Thrust your heart forward
Embracing the sun
And you will know ~
That life’s just begun
Hear,
the river’s calling
For you to look inside not down
And you will see how much
There’s
In the power of your heart
Verse 2
It’s 3 am
You’re nearly buried under the books weighing down
Lost a piece of your heart
But life’s more than just the trivial happenings
You have the power to love ~
I wrote this as both a self-reflection and encouragement to others in a phase of our life that seems so uncertain and wary. Being in med school, we often find ourselves burnt out from expectations from ourselves, others etc. and we lose the energy or will to explore true passions or aspirations in life. Our life sometimes is reduced to a repetitive, mundane cycle of assignments, exams, sleep, repeat – and this creates a deep emptiness in me, probing me to ask the “why” behind what we do.
My lyrics, and even the melody as well, wish to remind people to look up, see all that is beautiful around us, and be reminded that life is so much more than just our immediate goals. It is easy to forget that to flourish, we do not need to be perfect, we just need to be at peace with who we’ve become, where we are and how our hardships have molded and helped us to grow.
This is why the idea of nature is tightly interlinked with the lyrics, firstly because the growth and renewal associated with it is just so healing for our soul – it teaches us to embrace changes and appreciate the world. However, what is perhaps more neglected is the need to love ourselves and listen to our heart – being surrounded by nature gives us that safe space for all these, a quiet moment of self-reflection and hyperawareness to our feelings and thoughts. Indeed, the power of “our heart” is so great, it contains so much rich emotions and thoughts that deserve us digging laboriously, for the glimpse into the human condition and insights about ourselves can be so meaningful. These insights can grow and heal us.
Moreover, there is always an emphasis about caring for other’s feelings, be empathetic etc. However, it’s only through understanding ourselves that we can understand others – and treat patients’ stories with the insightfulness and sensibility that they deserve.
I hope this song becomes a source of comfort and safe-space for all of us, reminding us to love ourselves, and look up from our textbooks into the blue sky and flowing rivers.
Doctor-patient relationship - Inova Lee
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Within the doctor-patient relationship, doctors ask patients to uncover their story, so that a full picture of them can be built for the right care to be decided. But how much is discovered is often dependent on how well the doctor and patient are able to connect. In other words, it is reliant on there being a strong doctor-patient relationship. What I have come to realise is that for such strength to be established, there needs to be a two-way reveal of the doctor’s narrative as well as the patient’s, where “the clinician must not only see, but be seen”. (1)
My creative piece aims to reflect this idea and explores more of the features that influence the doctor-patient relationship. Each party is represented by one of the hands.
I have deliberately painted these very similarly to make it difficult to distinguish which hand corresponds to the doctor and which to the patient. This denotes the concept that there isn’t a hierarchy between the two. It is a mutual relationship where each party needs to share and contribute for the relationship to work. It also shows that despite the differing roles within the relationship, underneath it all, doctors and patients are the same.
Both are humans with the same emotions and vulnerability. Whilst the doctor’s degree of vulnerability and emotional expression needs to be shown on a professional level, it does not mean that all emotions need to be hidden and stripped in the effort to remain objective with a patient.
Additionally, in the same way that patients can become ill, so can doctors. Whilst doctors tend to be characteristically hardworking and driven to do their best, their health and well-being should not be sacrificed for this. There should not be the assumption or expectation for doctors to be healthy at all times. (2) I also chose to have the hands open so that they appear to reach out to each other. This conveys the process of the patient reaching out for medical help. Then to begin building their doctor-patient relationship, both the patient and doctor give and receive each other’s story. Consequently, the doctor is able to grow in their understanding of the patient’s situation and help “change the narrative trajectory” for the patient (3) by suggesting treatment.
Within each hand, the silhouette of a face can be found. Like the hands, these are also very similar as a reminder that one is not more important than the other. The use of silhouettes also makes the identities anonymous to incorporate the theme of patient confidentiality. This is an integral part of the doctor-patient relationship to reassure the patient that they can trust the doctor with their story. So when I look at this painting, I like the idea that the two parties are able to interact within the painting and see each other. But we, as a third party and viewer of the painting, cannot.
Out of the mouths of the silhouettes flows the stem of a plant. This represents the patient and doctor verbalising and delivering their story to each other. Successful communication within the doctor-patient relationship is another vital component for the relationship to operate. Also for the patient, it can be a really empowering experience to be able to tell their story to someone. On the doctor’s side, their choice of words and way of speaking can “be gate-openers or gate-slammers” (4)
At the ends of the branches, there are flowers which convey how successful communication can blossom into breakthroughs, such as the development of trust. There is also a mix of pink and blue flowers on each side of the painting, where one colour belongs to the doctor and the other to the patient. In the past, I have imagined the doctor and patient sitting separately on opposite sides of the consulting room desk. However the mixing of the flowers dismisses the idea of the desk forming a boundary between the doctor and the patient, allowing the doctor to connect with the “patient’s Lifeworld” (5) and not just operate in their own realm.
I also wanted to acknowledge other difficulties that can get in the way of the doctor-patient relationship growing. I have done this by adding a clock to represent the limited time that is often experienced in consultations. The actual positioning of the clock in the middle of the painting also means that it acts like a boundary between the two parties, preventing them from coming together.
Looking at the sides of the clock, you can see that they are dissolving away and that cracks are forming throughout the clock. This portrays the fact that rejecting the restrictions of time can encourage patients to be more open, as removing parts of the clock would allow the branches of the two sides to come closer towards one another. The pieces of the breaking clock are also fading into water droplets which feed the plants around it. With this, I wanted to show that when broken free of time limitations, the doctor-patient relationship is able to grow. This continues in a cycle. The more the time constraints break down, the more the relationship can develop. Realistically, however, the restraints of time will always inevitably be present. This is acknowledged by the fact that there are a few branches that are still linked and curled around the clock.
I also wanted to include the idea of different perspectives in this piece. This involves the viewer having to change their perspective physically and look at the painting differently. The painting is intended to be viewed portrait. But if you look at it from the side, the centre clock turns into an eye (see Figure 1 below) to represent how we see the world. The way we view things around us can be affected by so many different things like our culture, upbringing and religion. Our unique perspective impacts the way we see our patients. At times this can be a positive and help us to connect, for example, if there are things in common. But at other times, it can obstruct our ability to form that doctor-patient relationship. Nevertheless, regardless of what the bias, opinion or prejudice is, it is important that we are able to acknowledge and recognise how it shapes our perspective. That way we can try to prevent it from compromising patient care negatively. Our individuality also means that it is not possible to wholly understand a patient’s perspective. However, that does not mean that we shouldn’t try.
Overall, the success of the doctor-patient relationship is influenced by many factors. It requires respect, along with open and honest expression of each person’s story, in order to overcome the obstacles like time restrictions and differing perspectives. For the doctor, it is important to remember that sharing their side must be done in a professional capacity, but one’s own humanity should not be completely rejected and labelled as a hindrance. Instead, revealing it can establish trust and allow the patient to feel safe in expressing their own emotions, especially knowing that patient confidentiality is there as a safety net. When this occurs, the doctor-patient relationship is free to grow and strengthen over time.
References:
DasGupta S. The art of medicine: Narrative humility. The Lancet. 2008; 371: 980-981
Brown AEC, Garden R. From Silence into Language: Questioning the Power of Physician Illness Narratives. AMA J Ethics, 2017;19: 501-507.
Verghese A. The physician as storyteller. Ann Intern Med. 2001;135(11):1012-1017. doi: 10.7326/0003-4819-135-11-200112040-00028
Cousins N. The Physician as Communicator. JAMA. 1982;248(5):587-9. doi:10.1001/jama.1982.03330050069037
Leanza Y, Boivin I, Rosenberg E. The patient's Lifeworld: building meaningful clinical encounters between patients, physicians and interpreters. Commun Med. 2013; 10(1):13-25.
Waves - Freya Elliott
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I am only a second year Medical student, but have already witnessed many moving and uplifting clinical experiences, also many troubling and upsetting ones. Being part of the medical field is like having a backstage pass on humanity. You get a glimpse into the lives, thoughts, bodies, of a variety of individuals. You learn about how magnificently resilient and amazing humans can be, but you also witness so ... much pain. When I first started Medical School I found some placement experiences quite difficult to process. I even wondered whether I had what it takes to be a doctor.
The creative enquiry I have made is a painted and embroidered pillow depicting a woman. The waves of her hair form a sea, in which silhouetted anonymous people are waving for help. Some look like they are drowning. The woman represents the medical practitioner and the people represent the patients. I was trying to explore how medical practitioners, particularly GPs who see patients over many years, can be greatly affected by the patients that they see, and how they might worry about them when their head is on their pillow at night. Jennifer Best writes:
“Even more than a decade from residency, I am pierced by these tragic moments and faces— each still heart-shatteringly vivid..”1
The people waving for help could represent patients whom the doctor cannot help, unresolved and tangled in the hair, still a troubling presence in the doctor’s mind. Or perhaps patients with medically unexplained symptoms? Or perhaps patients who have died, and whom a doctor fears they could have saved? Doctors work with life and death daily, and being responsible for another human’s life is a huge responsibility. The weight of this responsibility can be extremely stressful and even detrimental to the mental health of doctors. On my course we have already been warned about the risks of ‘burn out’. This work is meant to explore how difficult it can be for doctors to process some of the upsetting moments they encounter in their daily work.
However, I also wanted to include the positive aspects of the profession. If you cover one side of the face the woman is crying, which is meant to represent anguish. However, if you cover the other side of the pillow the woman looks quite content when she sleeps. This was meant to represent how many doctors also feel that there can be great deal of satisfaction being a doctor, knowing you have made a positive difference to someone’s life.
I enjoyed making this piece of work. It gave me the opportunity to respond visually to thoughts and experiences I have had during my training so far.
BIBLIOGRAPHY:
1. Jennifer A. Best. The Things We Have Lost. JAMA. 2016;316(18):1871–1872. doi:10.1001/jama.2016.9954
medical student, creative arts SSC, 2018
Space between - Mashael
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The middle frame to me is the ‘Space Between’. An empty space that is good for the mind, calm and uncluttered and allows one to find peace. It also in the context of patients allows you to feel like you have space to create. It can often feel very difficult to have specific time set aside for yourself and for you to explore thoughts and feelings you have been having.
The words and newspaper pieces whirling around to me show how the mind can often feel, full but as if you can’t grab at one specific thing. However, the blank space could also represent a feeling of isolation or loneliness...
I wanted the middle frame to appear bare almost untouched as a space that is ready to take on whatever input it receives from both sides. The blank space is a canvas for the story that is molded by different people. It is a space where there is no right or wrong and it can be filled with anything. There are no expectations and no judgments. Everything is balanced, and it is something of a safe space, which is empowering...
The whiteness of the middle frame is also supposed to represent the mask we can often wear during our daily lives, it is easy to only look at things very superficially but uncovering emotions and looking deeper is what allows us to connect to each other and also ourselves. This is where I wanted the idea of having three pieces to tie in. The blank space is what connects both of the hands. The relationship is not imbalanced, but there is an equal relationship, the space helps bridge power divides and cultural gaps...
Finally, the hands are symbolic of everyone, either the person in need or the person providing help, and throughout life we switch between these two roles. There are always times in a person’s life where they need help and to be uplifted, and while this feeling can often be quite daunting, as it is often hard to ask for help when you most need it. When I think of myself, I think about how many people have helped me get to where I am right now in my life. I’m so grateful to be where I am, at medical school in such a vibrant and exciting city. As I drew the hands, I used various colour pencils to shade in areas of light dark, where it was more pinky or flushed with blood and where the skin was harder, more tanned or worn from daily activities. To me hands hold so much symbolism. We complete almost everything during the day with the help of our hands and it can sometimes be a very vulnerable thing to ask for help.
Medical student, creative arts ssc, 2019
The Ups and Downs of being a Medical Student- Benita T
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When considering what to write on the ECGs, one session on a recent Creative arts Student Selected Component (SSC) course came to mind. We were asked to write down how we are finding medical school and I could process and write down specific challenges rather than just continually stating that the course was generally hard.
I found it helpful writing down what exactly I was finding difficult. It gave the challenges less power and I could write on top that to overcome these things I had to have tunnel vision. I had to have the end goal in sight –helping patients and becoming a great doctor with the tools to change lives. Measuring the challenges against the end goal allowed me to reflect and finally come to conclusionthat it was all worthwhile.
Symbolism and analysis
A theme that arose was that of the doctor’s humanity coupling ‘unrealistic expectations’ with ‘human’ and similarly ‘losing individuality’ with ‘the rawness of life and death’. Often, doctors are seen to not be human. They are expected to conform to a system and meet robotic unrealistic standards. At the same time, I realised that on the contrary -a doctor is present at a patient’s most vulnerable and pivotal moments and that the constant face of suffering helps one understand what it truly means to be human. I also noticed these themes of doctors needing to look after themselves and their human nature in the literature. One article in the BMJ spoke about a human being as someone who is an advocate for others, patient, compassionate, assertive yet gentle –qualities often linked to being a good doctor (Hurwitz, 2002). This made me think about how a doctor’s intellect as simply the tool of knowledge in which to treat patients, but it is the human being that treats the person and cries with them in their suffering and is motivated despite the overwhelming circumstances around them.
Continuing with the humanity of a doctor in the third line of the image, I coupled ‘ego culture’ with ‘confidence in high pressures’ and ‘numbness’ to ‘defence mechanisms’. I was starting to refer to the fact that defence mechanisms are often a way to cope with the traumatic incidences a clinician may face daily. Books such as ‘Do No Harm’ depict the egoist almost arrogant culture and the use of humour by clinicians and stereotypically surgeons to cope (Marsh, 2014). Defence mechanisms are ways that clinicians mentally protect themselves from their external environment defined by Freud in 1936. And Plutchik’s theory of emotion suggests that they are subconscious and allows individuals to adapt to high levels of stress. This can be done by physically creating distances between the clinician and patient or psychologically creating a separation between a patient and undermining, and disregarding the patient’s heightened emotions and explanations. Clinicians may be protecting themselves from guilt of their own mistakes or their own sense of mortality (Kocijan et al., 2007). In our sessions of the SSC we spoke about defence mechanisms being a positive outlet and a way to deliver accurate care in high demand situations but also how it is important to connect with patients on a human level to equally avoid burnout and lack of motivation.
Hurwitz, B. (2002). What's a good doctor, and how can you make one?.BMJ, 325(7366), pp.667-668.
Kocijan Lovko, S., Gregurek, R. and Karlovic, D. (2007). Stress and ego-defense mechanisms in medical staff at oncology and physical medicine departments.The European Journal of Psychiatry, 21(4).
Marsh, H. (2014).Do no harm. 1st ed. Great Britain: Weidenfeld and Nicolson.
Benita T, medical student
Flourishing - Samruddhi Joshi
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I wanted to make a piece of art which included elements of my identity, apart from medicine, that I want to be known by. I wanted to reconnect with parts
of myself that I felt are often overshadowed by the fact that I am a medical student.
The first thing that came to mind when I was planning my piece was the human heart. It is a focal point of medical examination in the doctor’s room, yet it holds a much deeper symbolism in our community. The heart is said to be the origin of feeling and humanity. Having a compassionate and empathic heart holds the key to being a good doctor and a good human being, and I believe I have one. Hence, I wanted to make this the central element in my creative piece.
Bells have fascinated me from a very young age, because of their sweet tinkling sound and their use at many joyous occasions. I have always carried them around with me in some form, whether it be attached to my pencil case, my keys or even my jewellery. I have always wanted to be associated with the happy and positive vibrations that I get when I hear the sound of bells, and I want to extend this part of my personality to my patients. Furthermore, in the Indian culture which I come from, bells have a spiritual connotation, where they symbolise wisdom – another trait I hope to bring to my practice.
Further symbols I wanted to add were piano keys, elements of nature, a shuttlecock, and a banana. Playing the piano is my favourite form of meditation and a massive wellness strategy for me. Nature is also a big part of who I am. I am a plant lover, a vegan, and enthusiastic about saving the planet. Nature is also an entity that continues to grow and heal, even if it is wounded. Hence the elements of nature in my creative piece can also be seen as symbols of resilience, an important part of me that has helped me to achieve my goals. The shuttlecock symbolises my time playing badminton at national level. Playing badminton taught me essential qualities such as discipline and hard work, something I have been able to directly apply to my studies.
Another component of my piece is Ganesha, the Hindu god of wisdom and knowledge. This not only symbolises my religion, but also makes me think about my close-knit family. The Ganesha festival is one of the most celebrated for my family, and consists of gatherings, worship and traditional home cooked food. It represents some of my fondest memories with my family.
The only explicit allusion to the health care profession that I added, is a stethoscope. The placement of the stethoscope is such that it appears to be listening to the heart. To reinforce this, I added the text “Listen to your own heart first” in the stethoscope. This communicates how important it is for doctors to be self-aware.
Staying Afloat - Georgina Haffner
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When I started writing this poem, I was completely struck by the visceral lightness I felt after articulating something so difficult. I wanted to go deeper into that feeling and challenge myself to dive into my resistance to vulnerability. This reflection will expand upon what inspired me and provide some analysis as well as insight into my writing experience.
Before I got any words down, I was compelled by the comparison between being emotionally vulnerable and getting into a cold swimming pool. Initially the thought of either is daunting, but with both I’ve realised I can keep myself afloat and ultimately come out feeling better. The poem is organised into three stanzas - and each represents a different process. The first is the longest and signifies me choosing to explore my feelings. The second is shortest and represents the pain of accepting how advanced my Mum’s Multiple Sclerosis is. The third stanza represents diving deeper into those feelings - acknowledging and honouring them - and benefitting from that therapeutically.
I chose to write the poem in the first person because it speaks of my personal experience. I considered the differences between people that are willing to jump in (to either swimming pools or their feelings), and those that need to dip their toes in first – I am definitely the latter. The simile of “easing into uncertainty is like lowering myself into a pool of cool water” conveys what it feels like for me learning to live with the unpredictable nature of having a parent whose chronic illness is constantly deteriorating. I didn’t detail that in the poem specifically in order to create space for others to resonate with their own uncertainties – it’s supposed to be universal in that sense.
For the imagery in the second stanza I drew on an experience I had going swimming straight after my Dad had told me he had been diagnosed with prostate cancer (he is now in remission). That memory of tears collecting in my goggles has always stuck with me, I think because of how bizarre it felt for something so deeply personal and sad to be superimposed onto a public swimming pool - I felt even more exposed. Finally, the metaphor of “my fingers are windscreen wipers” conveys an image of wiping tears from my eyes. But it’s also about not allowing difficult experiences to obscure your vision and the way you see the world, and the process of working through that.
Finally, I chose the idiom “to go with the flow” as I move into acceptance. Its light-heartedness emphasises the poem’s change in tone, from solemn to optimistic. Reaching the deep end is a pun for having gone deeper into my feelings and still being ok. There is little punctuation in the poem because of the unstructured way it landed on the page, following my stream of consciousness. This reflects the process of continually working through loss – without designated places to pause or take a breath.
For me, writing means being able to honour my feelings without fear of drowning - and staying afloat in a sea of uncertainty is imperative for me at medical school, and will be throughout my career as a doctor too.
medical student, creative arts ssc, 2019
Ride a Bike - Rosalyn Suen
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The idea of this image sparkled in my head during the creative writing session. It all started when I read the poem ‘Big Good’ by Nicki Sellars, about facing illness and noticing the love, the big good, all around. The words are simple, and the lines are short, but it echoed deeply in my mind. Recently, someone dear to me, is diagnosed with cancer. He is a doctor, and despite the fact that he has great medical knowledge, the whole family, including him, is shattered with anxiety and depression. Being a medical student, I always feel like there is too many unknowns in the world of medicine, and I am always eager to find answers. However, now, watching someone close, who is very ill, and I know the cold statistics and the poor prognosis, I was losing hope.
It was sudden news, it was something unexpected, and it made me think of the loneliness that one has to face when people around you will eventually walk to different part of the life. It reminded me of the ‘yellow road’, a poem I read a long time ago, there are many directions you can choose, but once you have made your decision you could not walk back. I thought I was walking together with all my friends and families, but after this bad news, I realized the slight diversion, the slight change of angle and the different length of ‘yellow road’ around me. I could see them beside me, but I know that our destination is different, and we are all walking on our own yellow road.
After all the scans and blood tests he had gone through, he went to see the consultant. I wasn’t able to be there, but that evening, when he and his wife went home, I noticed the light of hope in their eyes. I think it was the way the consultant communicated with them, that brought them that good evening. Even though the future is still a mist in front of them, no one could know what will happen, not the patient or even the consultant, but they know there is someone beside them on the journey.
There will be people coming and going in the yellow road, and we could never tell what will be ahead of us, and we don’t know when we will fall, just like when we were learning how to ride a bike for the first time. I now see doctor (represented as the person in white) as someone, who ‘teleport’s into people’s yellow road… The patients have to ride the bike on their own, but as a future doctor, we could be there beside them, and remind them that they are not alone.
Stepping into the Frame - Essi Igwelaezoh
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OVERVIEW
I have recreated a photograph of my little brother and I, whilst also incorporating the person who has taken the photo within my drawing. The image of the photographer is fairly insignificant in the corner of my drawing. This is intentional. This symbolizes a doctor within the consultation, stepping into the frame in view of the patient, without occupying too much space. It reflects how we - as health workers - should let ourselves be seen, whilst keeping the patient at the centre of our care priority.
REFLECTION
I have recreated a photograph of my little brother and I, whilst also incorporating the person who has taken the photo within my drawing. The main reason for including the photographer within the piece, was to use the photographer as a representation of the doctor, and me and my brother to represent the patient, depicting how the health worker should try to ‘step into the frame’; allowing themselves to be in view within the doctor-patient relationship.
This is a concept which is often overlooked, as within a consultation, doctors don’t often think of placing themselves within the patient’s story when trying to offer help, but instead often paint the patient as a separate case that they’re trying to solve; immediately distancing yourself from the patient and creating a hierarchy of levels.
This is just like in a photograph, as we are constantly provided with a range of different stories and experiences within different photos, but never really think about the hidden person behind the camera- who is acting as a vehicle to capture the pictures. Thinking this way also neglects the relationship between the ‘’photographer’’ (doctor) and ‘photographed’ (patient), as it creates a space in which they’re not existing together within the photograph.
This can be detrimental as applied to healthcare, as placing yourself outside of view within a consultation, creates distance between you and your patient- making it harder to understand the whole story surrounding them.
The image of the photographer is fairly insignificant in the corner of my drawing. This is intentionally done, as it symbolizes a doctor within the consultation, who is stepping into the frame in view of the patient- but without occupying too much space. This reflects how we should let ourselves be seen, but still have the patient at the center of our care priority. The drawing of the hand in the corner, which is symbolic of a doctor, is also drawn in a way that the hand is merging into the drawing of me and my brother (symbolic of a patient). Thus this represents how the stories of both the patient and the doctor are intertwined into a single story within a consultation, with the patient looking for the doctor to interact with and change their fluid story for the better.
The picture of my younger brother and I, has a lot of meaning to me and represents my own personal narrative. Hence, I think this reflects well how we all have a role to play within a bigger story, as well as the possibility of acting as the narrator for other stories in the future, by listening to patients who come to present to you in a medical setting.
Essi Igwelaezoh, Yr 3 Bristol Medical School
The box- Elena Priestman
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Through Creative Arts I realised that in order to heal we must confront our feelings and allow ourselves to express them in their most raw and hence its honest form. My piece Me, myself and Mum was therefore inspired by witnessing my mother’s continuous battle with depression. More specifically, this depicts a time in our lives where my father had abruptly moved out and I was left alone to deal with my mother mourning over the loss of her 25 year relationship.
In order to protect herself from the outside, she built barriers; what began with food became clothes and what then were clothes became furniture. Her hoarding reflected her crowded mind full of anger, pain but most tragically, a deep sadness.
When I began this piece, my vision was clear; my mother would be in that box. And yet, when I look at the finished project… I see myself. You see, in my mother’s darkest moments, though it became incredibly hard to witness and almost unbearable to watch her self-destructive behaviours, I kept watching and it eventually began to reflect in my own emotions and behaviours. I became consumed by that void. I began eating to cope; building a shield much like my mum’s.
Now when I look at that box, I understand that perhaps my mother wasn’t the only one that was trapped…
But the piece is abstract and intentionally so; it allows for the viewers to come to their own conclusions. In fact, many narratives we have come across in the course can be applied, such as the doctor-patient relationship, the hurdles of having a disability and even the struggle of seeking out help. I love that it connects so many people and can generate a conversation based on various personal experiences and perspectives. And I believe that that is the best part about Creative Arts; it provides a space to create a conversation.
Vulnerability - Samruddhi Joshi
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After the session, I reflected about how vulnerability was such a human emotion. I quickly sketched the image that came to my mind, which was of a naked individual curled up because they have nothing to hide their inner delicate self.
Letters of Reflection - Priyanka
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My closest friend was killed, a young man only 22 years old, and a person I had lived with and spoken to almost every day for years. I had only just started my first year of medical school and moved far away from my friends and family to another country when this tragic loss in my life occurred. After it happened, I went through a rollercoaster of emotions including anger and confusion. I was angry at my friend for drinking that night, for going out and not looking after himself. I was angry that he had left me when we had made so many plans together for the future. I felt confused because I had trouble accepting the incidents that reportedly lead up to his death and refused to believe the outcome. I couldn’t understand why he’d be at the train tracks where his lifeless body was found or leave the great life that he had. He had been there for me through some difficult moments in my life but the moment when I needed him the most he was gone.
Of all the emotions I went through, the one thing that stayed constant was that I missed him, and I so badly wanted to tell him this. There were many weeks where I would see something funny or something related to our discussions and type out a message on my phone to send to him only to realise that I was not going to receive a response. I closed myself off completely instead of opening up to my friends and family about the way I was feeling, thinking that no one could understand what I was going through and wanting to show a strong front when inside I was devastated. This went on for many weeks and the rollercoaster felt as if it had become worse when I returned to my studies. I was fortunate enough to be given a counsellor, who has been my confidante during term time and the one person I felt that I could open up to at the university. It was she who suggested that I write a letter to him, put the letter away for another day, comeback to it and write a response from him. These letters that I wrote helped me try to understand what he was thinking that night and accept what had happened and how it was going to affect my life. I now use letters and journal writing as a way to release my feelings and thoughts from my mind; the idea of these emotions flowing from my mind, down my arm and through my pen onto paper is incredibly therapeutic and stops me from bottling up and explosively releasing emotions.
I chose to use these letters in my creative piece because of their personal meaning to me and making copies of the letters into two roses. I wrote an additional letter to a future version of myself as I often worry that I will be unable to handle death of patients as a doctor after the reaction I had to my closest friend passing away. I understand that I will not have the same close relationship with my patients that I had with my friend, but I will become attached to them in a way. In this letter to myself I described the mechanisms I am currently using to try to recover, the support system that I have in place and to not close myself up. I made three roses in total out of these letters; the yellow rose is the first letter that I wrote to my friend, the white rose is the response and the blue rose is comprised of the letter I wrote to my future self. I used simple filters on the computer to tint the pages yellow and blue, and nail polishes to decorate the rose petals. In Greek mythology, roses originate from Adonis, the god of rebirth and plants. In many cultures, roses have alternative meanings such as confidentiality, wisdom, balance of strength, purity and clarity. These all played in my mind when considering how to make use of the letters.
I chose yellow for the first rose as yellow roses are given as a sign of friendship. When I originally wrote the letter, I felt very raw and emotional opening up in such a way; I wanted to demonstrate by using drops of gold polish to represent my tears and almost make it look like the rose was crying as the tears fell over the petals.
White seemed to be a good fit for the representation of the response letter from my friend that I wrote as it is an angelic and pure colour. In my family’s culture silver is seen to have healing properties, because of this I wanted to coat the edges of the petals with sliver polish as this letter helped heal some wounds that I had from the constant questioning of what happened and why.
Blue was used for the final rose as I felt that it was a calming colour and so when I need to read this letter in the future I can be soothed by its advice. I also painted a triskelion symbol on the side of the flower; a triskelion is a triple spiral or three interlocking Archimedian spirals. Triskelions have been used throughout history in various cultures, I first saw the symbol in a TV show where they used it to calm people down and each spiral represented the sun, the moon and the truth. The characters would chant this in times that they felt angry, anxious or scared. I also painted miniature spirals on the petals so that when you first look at it your mind is taken away from the worries and focuses on the intricate patterns of the rose.