You can use your existing Medical Independent, MediLearning or PharmacistCPD account to log in. is Ireland's only investigative medical news website for doctors, healthcare professionals and anyone with an interest in health issues.

Established in 2010, along with its sister publication The Medical Independent, our stated aim is to investigate and analyse the major issues affecting healthcare and the medical profession in Ireland. The Medical Independent has won a number of awards for its investigative journalism, and its stories are frequently picked up by national digital, broadcast and print media. The Medical Independent is published by GreenCross Publishing.

Address: Top Floor, 111 Rathmines Road Lr, Dublin 6

Tel: 353 (01) 441 0024

GreenCross Publishing is owned by Graham Cooke.

The benefits of registering: only registered users:
  • receive the ecCopy two days prior to the printed edition.
  • have automatic access to our free CPD sites.
  • can partake in our online MCQs.
  • can enter our online sports quiz.

Sign up now for ease of access to The Medical Independent, Ireland’s most frequently published medical newspaper, delivering award-winning news and investigative reporting.

Download the new Mindo app for both IOS & Android.

  • Get notified when a story goes live
  • Access Premium Content
  • Read Offline
[the_ad_placement id="main-ldb-public"]
[the_ad_placement id="main-ldb-mobile-public"]

The art of looking at patients

By Dermot - 04th Jul 2017 | 9 views

Clinical diagnosis involves history-taking, examination and investigation. Examination is subdivided into inspection, palpation and auscultation.  Medical students and doctors spend many hours learning how to palpate and auscultate. 

It is often assumed that inspection is innate, something that everyone will do equally well without much effort or instruction. When a medical tutor asks a student ‘what do you see?’, he expects that the student sees exactly what he himself sees — the physical signs of disease. The medical student tries to give the ‘right’ answer. If tutor and student concur, it is usually taken as evidence of successful observation. As doctors, we learn to look quickly; to make ‘spot’ diagnoses; to recognise patterns; to ‘see’ as many patients as we can, as quickly as we can; make a diagnosis, a management plan and attend to the paperwork.  This is considered good medicine: Efficient, effective and productive.

William Osler, the Canadian physician responsible for moving physicians-in-training out of the lecture theatre and to the patient’s bedside, wrote that “the whole art of medicine is in observation”.

Prior to the development of the advanced imaging technology available today, human observation of patients often made the difference between good and great medicine.  But is this still true for today’s patients and doctors? In our fast-paced world, is there any value in slowing down and practicing the art of looking at patients?  If so, is there an effective way of achieving this?

‘Training the Eye: Improving the Art of Physical Diagnosis’ is a museum-based course for medical students at Harvard Medical School. It is a trans-professional initiative involving art educators, curators and clinicians. Students are encouraged to look at art, interpret it and discuss it, in a facilitated group setting. The objective is to enhance observation skills, increase awareness of one’s emotional response to art, use this awareness to enhance meaning-making, consider the evidence for this meaning and respectfully engage in dialogue with others. Students learn to be comfortable with uncertainty and become familiar with their individual thought patterns when trying to make sense of art. They learn that there is no ‘right’ answer. Following the museum sessions, students are given the opportunity to employ the same skills with patients. The students have subsequently been found to have increased diagnostic accuracy and enhanced clinical reasoning compared to students who did not participate in the course.

Apparently, our responses to art reflect our responses to people. Simple scenes are interpreted quickly without much attention to detail or attempts at analysis. Just as in medicine, a dermatomal rash is quickly diagnosed as shingles.  A more complex or abstract piece of art requires closer observation.  Sometimes, after a longer period of looking, the discovery of a specific detail may completely alter the big picture, causing us to change our mind about the artist’s meaning or a comment from a fellow observer may lead to a new interpretation.

Not long ago, a young man presented to me with stridor. On examination, he had a goitre. A respiratory examination did not reveal any further abnormality. I referred him for surgical assessment. While waiting for this assessment, the man developed shortness of breath and was diagnosed with metastatic lung disease. My spot diagnosis was wrong. 

Closer observation may have uncovered the true cause of the stridor earlier. There may have been a detail that was missed that would have altered my diagnosis and management. It would not have made any difference to the outcome in this case, but the lesson I learned was to look a bit longer and bit deeper. To remain open to the possibility that what at first glance appears obvious can be significantly altered with the addition of less obvious details. Humans are much more complicated than art. Time spent in observation and reflection is time well-spent.

Observation is a skill that can be learned and enhanced at any stage of our career.  With the rise of medical technology and specialised medicine, we may forget that our observations are powerful influencers of our decision-making. Art observation may not seem like a useful skill for doctors, but looking at art has a lot in common with looking at patients. It involves paying attention to what is present, forming an impression and communicating it. 

However, there is one major difference. Observing art is not as overwhelming as observing humans. Art does not verbalise joy or distress. Art allows us to sit in silence, engage, or turn away as we see fit, without fear of being judged or misinterpreted. Art observation can renew our interest and enthusiasm for patient observation, increase diagnostic accuracy, decrease referral rates and investigations. Observation skills can still be the difference between good and great medicine. 

For a useful toolkit to enhance your art observation skills, visit  and don’t forget to claim your study leave for your summer visits to the galleries.  

Leave a Reply

[the_ad_placement id="main-ldb-public-2"]
[the_ad_placement id="main-ldb-mobile-public-2"]
Latest Issue
The Medical Independent – 24 June 2021

You need to be logged in to access this content. Please login or sign up using the links below.

[the_ad_placement id="main-mpu-public"]
Most Read
[the_ad_placement id="main-ldb-public-2"]
[the_ad_placement id="main-ldb-mobile-public-2"]