The Art of the Patient-Narrative
Padraig Totten
When taking a patient’s history, we are often regaled by round-about stories and long-winded explanations that can often miss the essential information needed to diagnose. At the same time, some colourful layman – descriptions paint a picture that enlightens and informs in vivid detail. I am thinking in particular of a patient’s visit to the GP at a stressful time of his life when he suffered a flare-up of ulcerative colitis. He described his symptoms to be not unlike a hedgehog fighting a python over nesting rights in the pit of his stomach. As I recall, this elicited guffaws of laughter rather than empathy from the GP, but in his own way, described his debilitating symptoms viscerally – albeit in a self-deprecating fashion.
In my creative piece I used a pale tone to depict a sickly man who gazes down on the all-consuming discomfort of a bloated abdomen and writhing intestine. His nakedness depicts his vulnerability whilst the black, fading inwards to purple, vignette – often used in photography to isolate the subject, reminds us that the patient often doesn’t have the ability to graphically express their pain, anxiety or emotions and as a result, can feel isolated in their suffering.
Effective Consulting, Year One, 2017 – 2018
this is a fantastic piece of art, i love the attention to detail and the fact that around the outside of the painting is dark and the light fades outwards. this really reinforces the effect of the man being lonely and isolated. i really like the use of animals to represent his feelings as the hedgehog is done here it is a very creative piece.
What I find most striking about this piece is the relationship between a patient’s mind and their body. What is quite fascinating about the human body is that despite the mind being a part of the body, both physically and biologically, it is very much an entity of its own. The idea of pain and discomfort may be simplified to an explanation of sensation and the routes that various sensory neurons take around the body, but I think it paints a more profound picture of the relationship between mind and body.
Despite the patient owning their own body, feeling it and touching it with their own hands, they still cannot see what is going on and are almost oblivious to the events going on within their body. The artwork shows the patient’s body, and we see within the abdomen, the metaphor that the patient has used to describe what he feels to the doctor. Of course, although it is highly unlikely and almost impossible that this is actually what is happening within the patient’s body, this is how the patient is able to interpret his pain, and, as a doctor, sometimes, rather than being paternalistic and super-imposing your view on the patient, it is more helpful to allow them to express themselves and try their best to explain and interpret what their body is telling them, and what the doctor does not have access to. This is also portrayed by the fact that the patient’s metaphor is actually what the doctor can see and what the reader can see. We, as health care professionals, also make diagnoses behind a veil, and it would be arrogant not to ask the opinion of someone who can put their hands behind the veil and feel what is happening.
I find it interesting that the artist mentions that the patient is unable to paint or graphically visualize their discomfort and pain. I agree that this can lead to a sense of loneliness and isolation. In life, when we face problems, being able to describe these problems to a friend or relative can sooth the pain. However, when we have this problem that we cannot even see and is only felt, the feeling of powerlessness to fix the problem, and inability to share the problem with someone else can add to the pain and can be very isolating.
The patient in this piece attempts to visualize his pain as much as possible with a metaphor of two animals fighting each other within this stomach. It is ambiguous in the piece whether this effort to visualize his pain has a soothing effect on the way he feels.
This piece explores a topic that I have not thought about before. We have discussed in our tutorials how doctors have to tailor their language to effectively communicate with each individual patient, but we have not discussed the challenges a patient may face explaining their symptoms in words to a doctor. I like that this piece has visualised the pain this patient is describing, showing the power of language.
I was immediately drawn to this piece as I thinks it highlights a really powerful point that is often overlooked by medical professionals. A patient’s goal is to place the practitioner in their shoes and as a patient it can be very difficult to articulate the pain or symptoms you are experiencing. A breakdown of communication leads to a breakdown in care. A description as visceral as ‘a hedgehog fighting a python’ describes the exact pain the patient is experiencing. This artist has shown how the patient is expressing precisely what he is experiencing but it is being overlooked as it is not classically how a practitioner may expect information to be translated. The focus on the belly highlights that the pain is glaringly obvious and when contrasted with the darker surroundings it shows how it is being contained and unable to be expressed. I really enjoyed this piece and I thought it brings light to an overlooked area of consultations.
To me this piece really captures the perspective of a patient who considers their pathology, its symptoms and the feelings it causes them to be a separate entity or organism removed from themselves. The idea that whatever is within them is completely alien is perhaps more easy to accept than the idea that their own body is causing them problems.
This image resonates with me as I often use metaphors and similes in place of a description when trying to get a point across. This image and description demonstrates how, to a patient in pain, a pathogen can feel aggressive and malicious rather than a simple organism doing it’s base function. It illustrates how the body can feel like the battleground of a vicious fight when it is out of harmony, and the stigma around men admitting when they’re in pain. As shown through the isolating colour theme and how the doctor laughed instead of showing sympathy.
At first, I was intrigued by the artist’s use of a porcupine and a snake instead of actual gut imagery. It’s interesting how they used these animals to reflect the symptoms of the patient, almost like they’re acting out the pain and discomfort – like a battle between the porcupine and snake in his stomach.
The darkness around the man could represent the loneliness he feels during this experience. The artist also shows vulnerability by painting him naked, which really fits the feeling of being exposed and fragile when dealing with a health issue.
Even though this focuses on an ulcerative colitis patient, I think it could represent anyone dealing with a condition that causes pain or uncertainty. The animals mimic that feeling of not fully understanding what’s happening inside, which, along with the other parts of the painting, really brings out the emotional and physical struggle.
What immediately struck my eye was the animals found within the gut of the man, acting as a replacement for the organs within the man. The animals are also what I and I think many others would link to pain, (hedgehog because of spikes and a snake because of their predatory instincts of biting and constricting). The artist is using this as a way to show how patients may convey their symptoms to patients, using metaphors and examples as they lack the ability to tell their doctor exactly how they are feeling, similarly to what the artist said. This can then result in the patient feeling alone, especially because they are not able to get on the same level or wavelength as the doctor in terms of displaying emotions and vocabulary. This is further represented by the man being surrounded by darkness, showing he is again, alone and also confused about his symptoms, as he been unable to shed any light on his symptoms, and the doctors may have been unable to shed a light on his symptoms as well.