Sunday, December 8, 2013

As Harvard Fellow, Connecticut Physician Seeks to Cure Healthcare's Ills—With Opera & the Arts

Connecticut Magazine December 2013

As Harvard Fellow, Connecticut Physician Seeks to Cure Healthcare's Ills—With Opera & the Arts

Dr. Vincent P. de Luise has character of operatic proportions—he’s larger than life, not in physical stature but in his polymathic interests and talents, his command over essences of life ranging from medicine to Mozart, his hard-wired belief in the primacy of music and the arts as vital for a balanced life, and his determination to bring their transformative powers into realms that remain dark like the medieval night when most assume that they must—by definition—be enlightened.
Consider the “aria” that the Assistant Clinical Professor of Ophthalmology at Yale University (just one of his current appointments) delivered Dec. 5 in New Haven: With an Artistic Vision: An Ophthalmologist Looks at Visual Perception, the Arts and Eye Disease.
Dr. de Luise at the home of Country Loft Antiques owner Carole Winer, left, talking about a Connecticut Summer Opera Foundation event; file photo by (Laurie Gaboardi/The Litchfield County Times.)

Here’s the description of the presentation from Yale: More than all the other senses, the brain's visual system largely defines how humans perceive the world. Herein lies an intriguing intersection between vision, perception, the arts, and eye disease.

A brief overview of visual perception will be followed by a survey of visual archetypes in the history of art (the Lascaux cave paintings, the limestone bust of Nefertiti, the Pantheon, the “evil eye,” and linear perspective), which will lead into the optical problems of self-portraiture, David Hockney’s “Secret Knowledge,” “Vermeer's camera,” trompes l'oeil, eye disease and art, and will conclude with an analysis of the artists Monet, Goya, Seurat, van Gogh and O'Keefe, pondering the question: is eye disease an obstacle to, or the catalyst for, their creative genius?

It’s a big artistic/philosophical/medical mouthful, but for Dr. de Luise it’s just one narrative thread in a larger, denser and ultimately profound libretto that must be heard in the world of medicine if we and our progeny are to thrive during our lifelong series of duets with doctors and hospitals, an interaction that the way of all flesh ultimately renders non-elective.
The Adjunct Assistant Clinical Professor of Ophthalmology at Weill Cornell Medical College, who lives in Woodbury and is fostering young operatic vocalists through his role as president of the Connecticut Summer Opera Foundation, is attempting to fuel the transformation of physicians and medical professionals into caring humans who put empathy first and see patients as three-dimensional, complex people who defy easy diagnostic quantification.
Quite literally he’s out to save medicine from itself—and in the process save all of us (the chorus of humble, hopeful, vulnerable patients) from the vagaries of the Wagnerian realm that contemporary care uncomfortably resides in.
To do so, he first had to diagnose the full nature and extent of the illness. Here’s a fractional look at some of his findings, which he described over breakfast recently at Dottie's Diner on Main Street (Route 6) in Woodbury.
Even as medical students (future) physicians are already showing signs of burnout—whose symptoms include disengagement, exhaustion and a questioning of purpose—and often in their third of four years.
That’s before their education is finished, before they begin to endure the rigors of residencies and internships—and, for current students, long before they’ll come up against the phalanx of very ill patients eagerly being funneled into the healthcare system by so-called Obamacare.
If the burnout doesn’t happen early in the cycle, the benchmark danger zone comes in the internship period, when most physicians are around age 30 and at the point of contemplating the next mountain as a Sisyphean character, that of building a practice.
Some of the status quo surely results from a collision of expectations and realities. Medicine, Dr. de Luise points out, is really a “high-end guild,” and physicians have expectations of pulling down $200,000 to $300,000 a year but are finding that the way the elements of the healthcare system are now aligned, it may take a flat-out pace every day to take home $150,000.
All in all, burnout is “an incredibly ominous opponent,” Dr. de Luise says.
It can easily defeat the well-being of what should be the most crucial elements in a physician-patient relationship: empathy flowing from the caregiver, for one, deep listening, time spent by caregivers being fully engaged in the “moment” of the interaction, and seeing the whole patient rather than just responding symptomatically to information gleaned from an iPad or other electronic device.
Enough said; the full range of issues plaguing the medical industry is well-documented and generally understood.
What about the solutions?
“We have to go back to the arts to find healing,” says Dr. de Luise, who also sits on the Humanities and Medicine, and Music and Medicine committees at Weill Cornell Medical College.
The building blocks underpinning this prescriptive are ancient, from the power of music and art that predate written communication to Aristotelian humanistic ideals like Eudaimonia—translated these days as “human flourishing"—combined with Hedonia, or pure pleasure, experienced in context of the flourishing. Together these elements are meant to create virtue of character and a feeling of true meaning and purpose, a level of engagement that Dr. de Luise calls “flow” in a classical mode.
Like a martial arts master becomes the movement itself, say, or a professional athlete is the ball—or, in this case, the physician is so in the moment, in “flow,” that he or she “is” the patient.
Wouldn’t that be something?
It’s not theoretical at this point. Similar approaches, or pieces of Dr. de Luise’s larger suite of aesthetic antidotes, are already in place at progressive-minded medical schools around the country.
Taking it to the next level is where Dr. de Luise comes in.
He is a 2013 Fellow participating in the Harvard University Advanced Leadership Initiative, and his just-completed final paper is entitled High Touch: The Course in Compassion: Rebuilding a Curriculum of Caring for Healthcare.Here are some highlights from his work leading up to that comprehensive final paper, starting with a deeper look at the problems:

With all the technological advances of the last several decades, with genomics and PET scans, MRIs and super-subspecialists for every conceivable body part, what in the world is happening to the very doctors who care for us?  We have all this “High Tech,” but, where is the “High Touch?”  Is being a physician no longer a calling?  Has it become just another job?  Have patients become commodities? Why has doctoring gone astray?   
Patients are being viewed by their health care providers more as the sum of their diagnostic testing, or as the "I-patient," to use the term coined by Abraham Verghese M.D. of Stanford University, which is to say, the "virtual" patient, seen by the physician more through the lens of that physician’s pda, laptop or computer screen, and not as the real, live, hurting individual in front of them.
We cannot have it any other way. We cannot be a healthy society, with healthy citizens contributing to the success and happiness of that society, without an engaged health care team. We need to (re)-train physicians for a lifetime of caring, so that they continually demonstrate empathy in their work, and so that they themselves remain energized and happy in their careers, as this will improve patient outcomes over time.
We must re-embed a pathway of caring in our health care providers and transfer a lifelong set of skills that will inform them throughout their careers, certainly in the physicians who still lead the health care team. What is needed is an overarching and cohesive rubric, which I have entitled The Course in Compassion: A Curriculum of Caring (The Course). These skills can be identified, quantified and measured, and will populate The Course.  The Course will be divided into modules, and taught using an accepted paradigm in most medical schools, the Problem-Based Learning (PBL) format. Six core modules, which are termed “Frameworks in Medical Humanities,” would be taught over the four years of medical school in weekly two-hour sessions:

 Sensory Experience               Motor Task

Dance and Movement                     Motion Research
Deep Listening and Music             Rhythm/Melody Making
Narrative & Reflective writing      Diary-Keeping
Mindfulness and Spirituality        Yoga/Meditation 
  Art & Aesthetic Appreciation       Drawing/Sketching
Empathy and Compassion Training      Care-giving

The Course does not have to be built “from scratch.”  There exist a number of programs which have pilot projects aligned with my vision and ideas. A number of medical schools, (Harvard, Yale, Weill Cornell, Johns Hopkins, Stanford, UCSF, and Columbia, inter alia), offer courses which champion aspects of The Course.
Medical humanism is a core set of ideals that should be taught from college through medical school, internship and residency, and that should continue to inform a physician through their career. Medical humanism serves as a beacon and lodestone for how physicians listen, respond and care for their patients, as well as providing a road map for the well-being of a physician’s own mind and body over the course of their professional lives. The Course in Compassion will be a foundational paradigm around which physicians can be better engaged, and more motivated and passionate about providing care. Patients will achieve better outcomes, and physicians and their healthcare teams will enjoy longer and more fulfilling careers. This is an initiative which can no longer be fragmented, ad hoc and elective. The Course must become the epicenter of medical education and professional practice.

Developing The Course in Compassion is second-nature for Dr. de Luise; he’s lived it, and incorporated its elements into his own practice, and now he wants to help others—physicians and patients—to reap its rewards.
While operating, for example, he played Mozart, Haydn and Handel. “It lowered my anxiety, lowered my stress level,” Dr. de Luise says. “It put me in flow.”
And not just him. “We put earphones on the patient,” he says. So they both were in the same moment, in flow, together, which resulted in healthcare high notes worthy of La Scala.
So next time you see a doctor, ask if he or she has seen any good operas lately? The answer is likely to be a look of confusion—at least for now.
To learn more about the Connecticut Summer Opera Foundation, see its website, and keep in mind this parting thought, a quote Dr. de Luise used in opening his Harvard paper:

"Grow into your ideals so that life cannot rob you of them"
                                                                     Dr. Albert Schweitzer

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