Out of Touch.

This Viewpoint discusses the role of touch in medical tradition and its importance in medicine today.

The observation of art and the art of observing individuals with physical differences.

Astute observation is a fundamental skill in medical care because not only it is crucial for the detection of patients' emotions (which is a prerequisite for empathy) but also it can often yield diagnoses at first sight. The Germans call this technique "augenblickdiagnose," and indeed, gestalt diagnosis together with systematic review is used by dysmorphologists to identify syndromes. Artists have traditionally excelled at skilled observation since it is necessary for realistic portrayal of the human form. Thus, not surprisingly, they have also often depicted syndromes and defects in artworks, decades or even centuries earlier than their medical counterparts' description. Although physicians should avoid overdiagnosing or medicalizing what may be ethnic variations, personality traits, or just artistic style, this commentary will review how syndromes and various physical differences have been represented in artworks. It will then provide practical tips on how to become better observers. The historical relationship between artists and physicians provides context for our mutual diagnostic and interpretative pursuits.

Mazzini at 150: the Italian death of a London exile.

The year 2022 will mark the 150th anniversary of the death of Giuseppe Mazzini, the spiritual father of the Italian Republic and one of the best political minds of the nineteenth century. In this review, we revisit the events surrounding Mazzini's death, based on a report published in 1872 by Dr. Giovanni Rossini, the Italian physician who cared for him during his last days in Pisa. The detailed clinical information provided by Dr. Rossini suggests quite strongly that Mazzini's most likely cause of death was gastroesophageal cancer complicated by aspiration pneumonia. Surprisingly, there are no published medline entries concerning the cause of death of this Italian patriot and revolutionary, who spent 41 years of his life in exile, was admired by Dickens, Meredith and Carlyle, and is considered not only one of the founding fathers of Italy but also one of the visionaries behind the idea of a United Europe.

The Moral Lessons of Covid-19: A Call for Renewal.

The Covid-19 pandemic struck physicians at a time of unprecedented dissatisfaction and burnout, providing a stress test whose lessons might guide structural changes in healthcare. While selflessly rescuing patients from death, many doctors were exposed to unacceptable risk, with little protection for themselves, and, by extension, for their families and patients. This essay examines the basis and limits of duty to treat in a time of crisis and explores how these experiences could leave doctors morally stressed and even compromised. We question whether a physician-patient relationship that treats patients' safety and well-being as separate from their doctors' personal and professional values, needs, and dignity is the best way to deliver care. Such questions predated coronavirus but were brought to the forefront because of the epidemic. As physicians process their experiences, we hope to begin a deeper moral and social conversation that might help us be better prepared for future crises.

When Disease Strikes Leaders: What Should We Know?

Diseases of heads of state can affect national policy. Yet, cases of cover-up are numerous and involve not only dictatorships but also open and democratic societies. No system of full disclosure is currently in place to ensure that the public has access to all the information needed to establish whether a candidate to the presidency or an elected leader can discharge the powers and duties of the office. Hence, this essay reviews how the illnesses of democratically elected heads of state have changed history; addresses how to ensure greater transparency, so that leaders will not only be unable to conceal incapacitating disabilities, but also be removed from office once impaired; and lastly discusses how illness does not necessarily imply incapacitation, even though separating the two might often be difficult. These are issues of great relevance to national politics and medical ethics. They are particularly important as the 2020 presidential election is underway, and four out of the five leading candidates are well into their 70s.

The Archetypes of Medicine: A Job Description for the 21st Century.

Medicine is facing an identity crisis, one that might find resolution by revisiting a past rich in multifaceted individuals who transcended the strict definition of 'doctor', excelled in other fields of human endeavor, and showed us different ways of being physicians. This paper reviews 12 archetypes that have been part of the profession since its inception, but that, as of late, might have been forgotten. Our goal is to elicit discussion and introspection, with the premise that being a physician ought to be something larger than being a mere technician. If our premise is accepted, then the next step would be to identify those personal traits that made those archetypes possible, so that we can start both recruiting for them and then nurturing them during training.

The Art of Observation and the Observation of Art: Zadig in the Twenty-first Century.

Astute observation is a fundamental component of the art of medicine. Yet most schools and residencies offer little formal teaching of this skill, with some outsourcing the entire subject matter to art museums and instructors. Curiously, it was nineteenth century medicine that may have provided the conceptual framework for what is now known as Visual Thinking Strategy, the technique used by many art-based programs in order to teach observation. We suggest that the time is ripe for medicine to regain ownership of the teaching of this skill, not only because it may enhance clinical care but also because only the eyes of a skilled physician can best interpret crucial medical details. To this end, we shall revisit both the method of Zadig, which William Osler practiced and taught to his students, and its application to the observation of art first pioneered by the Italian physician Giovanni Morelli. As an example of this skill, we shall use focused observation to decode a fifteenth century portrait that hangs at the Philadelphia Museum of Art, thus turning a seemingly non-descript Renaissance painting into a treasure trove of personal, social, and medical information.

Medical Students' Exposure to the Humanities Correlates with Positive Personal Qualities and Reduced Burnout: A Multi-Institutional U.S. Survey.

BACKGROUND: Literature, music, theater, and visual arts play an uncertain and limited role in medical education. One of the arguments often advanced in favor of teaching the humanities refers to their capacity to foster traits that not only improve practice, but might also reduce physician burnout-an increasing scourge in today's medicine. Yet, research remains limited. OBJECTIVE: To test the hypothesis that medical students with higher exposure to the humanities would report higher levels of positive physician qualities (e.g., wisdom, empathy, self-efficacy, emotional appraisal, spatial skills), while reporting lower levels of negative qualities that are detrimental to physician well-being (e.g., intolerance of ambiguity, physical fatigue, emotional exhaustion, and cognitive weariness). DESIGN: An online survey. PARTICIPANTS: All students enrolled at five U.S. medical schools during the 2014-2015 academic year were invited by email to take part in our online survey. MAIN MEASURES: Students reported their exposure to the humanities (e.g., music, literature, theater, visual arts) and completed rating scales measuring selected personal qualities. KEY RESULTS: In all, 739/3107 medical students completed the survey (23.8%). Regression analyses revealed that exposure to the humanities was significantly correlated with positive personal qualities, including empathy (p < 0.001), tolerance for ambiguity (p < 0.001), wisdom (p < 0.001), emotional appraisal (p = 0.01), self-efficacy (p = 0.02), and spatial skills (p = 0.02), while it was significantly and inversely correlated with some components of burnout (p = 0.01). Thus, all hypotheses were statistically significant, with effect sizes ranging from 0.2 to 0.59. CONCLUSIONS: This study confirms the association between exposure to the humanities and both a higher level of students' positive qualities and a lower level of adverse traits. These findings may carry implications for medical school recruitment and curriculum design. "[Science and humanities are] twin berries on one stem, grievous damage has been done to both in regarding [them]... in any other light than complemental." (William Osler, Br Med J. 1919;2:1-7).