The University of California Institute for Research in the Arts supports embedded arts research through critical exchange

Why We Need the Arts in Medicine

by  Minnesota Medicine
07-26-2011

Studies show that incorporating the arts can save money, improve the patient experience—and do a lot more.

By Gary Christenson, M.D.

 

“We need the musician stat!” the physician called out. A young boy with severe spasticity was scheduled to receive a series of painful injections of botulinum toxin. The doctor knew that getting the boy to cooperate was always a challenge. He had a history of bolting around the room, making it difficult and time-consuming for the staff to do their work. The doctor had learned from experience that music could be used to relieve a child’s fear and anxiety, be a distraction from pain, provide comfort, and increase the likelihood that the child would be cooperative during a medical procedure. And music therapy had helped this patient in the past.

Upon hearing the request, Sarah Dobbs, artistic director for the Centre for the Arts at Toronto’s Holland Bloorview Kids Rehabilitation Hospital, recruited one of her music therapists and hurried to the treatment room with a drum, djembe, shakers, and guitar. Their plan was to engage the child by drumming and singing together while the physician and nurse completed the procedure. It worked.

Dobbs told me this story as I was on my way to tour the new Laguna Honda Hospital in San Francisco during the April meeting of the Society for the Arts in Healthcare. Dobbs explained that using live music had been requested previously for children when they needed an injection. However, the immediacy of this demand wasn’t so typical. After all, stat requests are usually reserved for blood work, medications, X-rays, and transportation to the operating room. Dobbs’ story is just one example of how the arts are becoming a regular part of daily medical practice. And it shows how physicians are coming to see their clinical value.

Although some might be inclined to dismiss the arts as a triviality, luxury, or unjustified expense in a time of concern over rising health care costs, research is showing that use of the arts in health care can be cost-effective. For example, a recent study done at Tallahassee Memorial HealthCare demonstrated that using music therapy when preparing children for CT scans significantly reduced use of sedative medications, associated overnight stays, and nurse time, and resulted in a cost savings of $567 per procedure.1 It also decreased the need for repeat CTs because of poor-quality scans. When extrapolating those numbers to all pediatric CT scans done in the United States, researchers estimated a potential savings of $2.25 billion per year.2 Such findings support the business case for adopting arts programming in health care facilities and practices. But there are other reasons why physicians, educators, and health care administrators should become advocates for incorporating the arts in medicine.

1. Studying the arts makes medical students into better doctors.

Medical students must master an array of clinical skills in addition to an increasingly complex knowledge base. They are expected to hone their observational, listening, and critical thinking skills while expanding their capacity to empathize with the patient. To accomplish the latter goal, most medical schools have added some element of the humanities to their curricula. A number of schools have students read literature written by physicians and patients that portrays the experience of illness and treatment from dual vantage points. In our state, storytelling and theater have been used to teach students how to effectively take a medical history. Last year, for example, Mayo Medical School and the Mayo Clinic Center for Humanities and Medicine partnered with the Guthrie Theater to offer the one-week selective “Telling the Patient’s Story,” which drew upon improvisation and storytelling to teach students to take and report patients’ medical history.

Other programs encourage medical students to relate their own experiences through story or the visual arts. For example, first-year medical students at the University of Massachusetts participate in One Breath Apart, an arts-based reflective module that has been incorporated into their anatomy class. A collection of drawings and writings generated by the students has been published by the curriculum’s director, Sandra Bertman Ph.D., in a book of the same name.3

Harvard Medical School has found that training medical students in the visual arts can help them develop their clinical observational skills. Students who participated in formal training consisting of art observation exercises, didactics that integrate fine arts concepts with physical diagnosis topics, and a life-drawing session demonstrated better visual diagnostic skills when viewing photographs of dermatological lesions than students who only received conventional training.4

The arts also can convey lessons in ways traditional lectures cannot. It isn’t surprising that the top-rated lecture by first-year medical students on the University of Minnesota’s Twin Cities campus for seven consecutive years was a reading of physician and playwright David Feldshuh’s Miss Evers Boysby Guthrie Theater actors. The play, about the Tuskegee syphilis experiments, illustrates ethical issues related to informed consent and human experimentation.

2. The arts have therapeutic benefits.

When I attended medical school in the early 1980s, physical therapy and occupational therapy were the only adjunct modalities recommended for helping patients recover from disease or surgery. At the time, we knew little about art therapy, music therapy, dance and movement therapy, expressive arts therapy, drama therapy, poetry therapy, and a host of other approaches that use one or more arts modality to promote healing. Although many of these therapies originally were intended to improve the emotional health of patients, we are discovering they have other therapeutic benefits.

Museums such as the Museum of Modern Art in New York and the Minneapolis Institute of Arts have programs for patients with Alzheimer’s disease and memory loss that use visual and cognitive stimuli to evoke memories. Dance has been shown to improve the mobility of patients with conditions such as fibromyalgia and Parkinson disease.5,6

The Dancing Heart program developed by Kairos Dance Theater in Minneapolis is offered at Park Nicollet’s Struthers Parkinson’s Center as well as other local long-term care facilities, adult day-care centers, and senior community centers. This evidence-based program strives to engage elderly patients and their family members and caregivers in movement through dance improvisation and story developed out of participants’ own memories. “Dance” is broadly defined, and it includes rhythmic movement to music for those confined to a wheelchair. A study by researchers in the University of Minnesota’s department of kinesiology found that most of the participants at a local senior center said the activities helped them stay healthy by improving flexibility, coordination, balance, and endurance. They also agreed that the shared reminiscence and discussion improved their memory and social skills.7

In addition, music and song have been used as an alternative means of communication for those recovering from post-stroke aphasias,8 and a number of programs have patients in various settings create art to increase their sense of control, distract them from pain, decrease their stress level and blood pressure, and provide them an outlet for emotional exploration and expression.9 Storytelling has been noted to improve the quality of life for cancer patients,10 increase lung function associated with asthma,11 and reduce symptoms and doctor visits.12 One report noted that regularly playing the Australia didgeridoo decreased apneic episodes for patients with obstructive sleep apnea.13 For these reasons, physicians should consider the arts among their prescriptive options and advocate for increased availability of arts programming within their institutions.

3. The arts can help prevent disease.

Physicians often find it frustrating to talk to patients about getting regular exercise. They can suggest that patients do more to increase their activity level, but patients frequently don’t adhere to that advice. However, a campaign to decrease heart disease in England found that people were much more responsive to the message, “Dance makes the heart grow stronger” than to “Exercise makes the heart grow stronger.”14 Dance is one of the best ways to improve health on a number of levels. In addition to its physical benefits, dance enhances social engagement, which is important to overall health and well-being, and it’s one of the best activities for delaying the cognitive decline associated with Alzheimer’s disease.15

In addition, the arts can be used to promote public health. A great example of this was Sidewalks Saving Lives, a collaborative project of the University of Minnesota’s Center for Urban and Regional Affairs, Kwanzaa Community Church, and Juxtaposition Arts in north Minneapolis, in which community members worked with artists during 2008 and 2009 to paint sidewalks with educational messages about HIV/AIDS and the importance of being tested.

4. The arts can improve the patient experience.

Until recently, the design of modern health care environments has been primarily based on efficiency, prevention of infection, accommodation of new technology, and cost savings. However, a body of research has shown that patients tend to be less stressed, less anxious, require less pain medication, and ready for discharge earlier when their environment includes views of the natural world.16,17

The effects of various forms of visual art are being studied so that hospitals select the most healing images for patient rooms.18 Although preliminary studies suggested that representational art depicting landscapes is the most welcomed and healing choice,19 others have questioned whether this view is too limiting.20 Considering the subjective nature of art appreciation, many hospitals including Bethesda Hospital in St. Paul allow patients to choose art pieces that will grace the walls of their room during their stay. The new University of Minnesota Amplatz Children’s Hospital even allows children to choose the color of the lighting in their room.

Bedside visits by musicians and artists also distract children from pain and help them explore their feelings about their illness. Mayo Clinic’s Art at the Bedside Program engages professional artists to work with patients to create art using watercolors, colored pencils, and clay, as well as authors and poets to guide patients in journaling and writing poetry and memoirs. Likewise, musicians play in Mayo’s patient and family lounges as well as in hospital rooms.

5. The arts can promote physician well-being.

The arts have soothing, reflective, and restorative powers that can counteract the stresses associated with medical school or practice. Although many physicians were involved in the arts before entering medical school, they put those activities on hold during their training. University of Minnesota medical students have an opportunity to keep those interests alive through the Robert O. Fisch Art of Medicine program. The program, named for the well-known local artist, writer, and retired pediatrician, provides students with a small financial award to pursue and develop their interests and skills in such diverse areas as painting, drawing, singing, clowning, photography, and playing an instrument as a way to find relief from the rigors of medical study.

For many of us practicing physicians, pursuing the arts can help us rebalance our busy lives. Art provides not only an opportunity to explore and express our feelings but a respite from the heavy responsibilities inherent in our profession. It also provides us with a chance to develop our creative potential.

Given the growing evidence of how the arts can improve clinical skills, promote healing and prevent disease, increase patient satisfaction, and help us find balance in our own lives, physicians should be advocates for the arts in general and, more specifically, in medical education and practice. MM

Gary Christenson is director of the mental health clinic at the University of Minnesota’s Boynton Health Service and president of the Society for the Arts in Healthcare.
References
1. DeLoach Walworth D. Procedural-support music therapy in the healthcare setting: A cost-effectiveness analysis. J Ped Nursing. 2005;20(4):276-84. 
2. Wood B. CT scans and radiation exposure. AAP Grand Rounds. 2008;19:28-9. 
3. Bertman S. One Breath Apart: Facing Dissection. Baywood Publishing Co., New York:2009. 
4. Dolev J, Friedlander L, Braverman I. Use of fine art to enhance visual diagnostic skills. JAMA. 2001;286(9):1020-1. 
5. Bojner-Horwitz E, Theorell T, Anderberg U. Dance/movement therapy and changes in stress-related hormones: a study of fibromyalgia patients with video interpretation. Arts Psychother. 2003; 30(5):255-64. 
6. Hackney M, Kantorovich S, Levin R, Earhart G. Effects of tango on functional mobility in Parkinson’s disease: a preliminary study. J Neurolog Phys Ther. 2007:31(4):173-9. 
7. Tabourne C, Lee Y. Study of Kairos Dance Theatre’s Dancing Heart Program. University of Minnesota, Department of Kinesiology, 2005-2006. 
8. Schlaug G, Norton A, Marchina S, Zipse L, Wan CY. From singing to speaking: facilitating recovery from nonfluent aphasia. Future Neurol. 2010;5(5): 657-65. 
9. State of the Field Committee State of the field report: Arts in healthcare 2009. Washington, DC: Society for the Arts in Healthcare. 2009; p. 19. Available at: www.thesah.org/doc/reports/ArtsInHealthcare.pdf. Accessed June 13, 2011. 
10. Morgan N, Graves K, Poggi E, Cheson B. Implementing a expressive writing study in a cancer clinic. Oncologist. 2008;13(2):196-204. 
11. Bray M, Theodore L, Patwa S, Margiano S, Alric J, Peck H. Written emotional expression as an intervention for asthma. Schs. 2003;40(2):193-207. 
12. Pennebaker J. Writing about emotional events: From past to future. In Lepore SJ, Smyth JM (Eds.) The writing cure: How expressive writing promotes health and emotional well-being. Washington, DC: American Psychological Association. 2002:281-91. 
13. Puhan M, Suarez A, Lo Cascio C, Zahn A, Braendii O. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomized controlled trial. BMJ. 2006;332(7536): 266-70. 
14. White M. Arts development in community health: a social tonic. Radcliffe, Oxford, UK. 2009:24. 
15. Verghese J, Lipton R, Katz M, Hall C, Derby C, Kuslansky G, et al. Leisure activities and the risk of dementia in the elderly. New Engl J Med. 2003; 348(25):2508-16. 
16. Ulrich R. View through a window may influence recovery from surgery. Science.1984; 224(4647):420-1. 
17. Ulrich R, Simons R, Losito B, Fiorito E, Miles M, Zelson M. Stress recovery during exposure to natural and urban environments. J Environ Psych. 1991;11:201-30. 
18. Ridenour A, Goldman K, Goodwin L. Architecturally Integrated Art Program: Case Study of Rady Children’s Hospital. Presented at the Society for the Arts in Healthcare 22nd annual conference in Burlingame, California, April 15, 2011. 
19. Ulrich R, Lunden O, Eltinge J. Effects of exposure to nature and abstract pictures on patients recovering from open heart surgery. J Soc Psychophysiological Res. 1993;30, suppl 1, S7. 
20. Nanda U, Hathorn K. Nature vs. abstract art in healthcare: What we know, what we don’t know & what we really should find out. Presented at the Society for the Arts in Healthcare 22nd annual conference in Burlingame, California, April 14, 2011.

 

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