Medical Media Arts Lab | Medical Futures Lab

Feb 28 2014

Art, Culture, Design, Humanities, Medicine

The Art of Medicine

Is medicine a science or an art?

Physicians and artists alike have tried to answer this question for over two thousand years. The former tend to claim that medicine is predominantly a science, and that it is an art only because it involves skills acquired by experience or observation. The latter commonly say that medicine is predominantly an art, for it evolves on the basis of human values and seeks to heal above all else.

So which is it?

It’s not a science. It’s not an art. It’s both.

Effective medicine employs science to accurately diagnose and treat, but it also utilizes art to arrange our awareness of health and healing into a storied structure. This “narrative medicine,” as it’s often called, takes a medical story and unfolds it in a way that gives meaning and purpose to both illness and the experience of recovery.

Narrative medicine, however, is not the only art form to have influenced medical storytelling. Throughout history, each introduction of digitalized technology into medicine—take the X-ray, the CT scan, and the ultrasound, for example—has utilized illustrative visualization to enhance medical accuracy.

Analogous to illustrative visualization, recent development in graphics hardware has enabled the rendering of innovative medical imaging methods that are completely changing the way that we see and study the human body. These new techniques enable both photo-realism and a technical form of hyperrealism in art in which it’s possible to enhance medical visualizations to better convey information.

But medical illustration and anatomical imaging are beginning to break out of the confines of the hospital. They are beginning to crawl into the dirty gutters and cracked sidewalks of the real world in the form of something known as street anatomy.

damien_hirst_virgin_mother

(photos courtesy of http://streetanatomy.com/2007/02/15/damien-hirst-anatomical-representation/ and http://vi.sualize.us/praying_street_skeleton_graffiti_street_anatomy_picture_5Qqm.html)

Street anatomists are experimenting with new mediums, such as papier mâché, graffiti, and sculpture, to portray the human body in creative new ways. Thanks to this new form of biomedical visualization, human anatomy is no longer contained within the human body. Science no longer lives in a hospital. Take a look around and you’re bound to notice your skeletal system plastered to a telephone pole or your back muscles adhered to the side of a Metro bus. You may even discover that your heart has been spray-painted on the side of your apartment complex.

I went ahead and gave street anatomy a whirl, too. Here’s what I ended up painting:

While painting these on the concrete floor of my dorm room, I was silenced by the realization of how truly incredible the human body is.

It is a wonder of science. It is a work of art.

Feb 28 2014

e-patient, Health, Medicine, Technology

Looking Into ePatient Outlets: PatientsLikeMe

As a continuation of my first blog post discussing CrowdMed as a possible ePatient outlet, defining the movement with a community of curious patients and a medically educated crowd base, this time I will focus on PatientsLikeMe to provide a different approach.

PatientsLikeMe is a free public website that provides a patient, clinician, or caretaker to register and provide, receive, and share health information. Users are able to input symptoms, medications, and treatments to find people undergoing similar medical situations. Communication is facilitated through both a forum type infrastructure and user comments.

Individuals are able to search the information database for not only patients with similar symptoms, but also for a wide range of medications and treatment opportunities for a particular condition. Treatments can be searched based on frequency of use amongst patients, user rating, efficiency, and side effects. In addition to medical and pharmacological solutions, users can browse through dietary, physical activity, or mindfulness treatments suitable for their personal needs.

In addition to acquiring a wide range of helpful information, the website allows people to track their health and invite others (doctors, family, friends, etc.) to their “care team” and share the status of their health. The tracking information can be easily be shared with those not on the website through an easy print format which the individual can choose to print or email to someone else.

The website automatically stores the shared health history to a database to match the user up with pertinent clinical trials or be used for research.

Different from CrowdMed, this ePatient outlet is geared towards personalizing one’s involvement in sharing and receiving health information. The website is structured so that all information provided by other users is easy to understand even with low health literacy.

PatientsLikeMe is very attractive in that everything from health tracking to research can all be done under one website. With the ease of having access to variety of resources in one spot, the site is able to lower some effort barriers that may restrain patients from transitioning into ePatients.

This ePatient outlet definitely highlights the empowered definition of the entire ePatient movement, giving the individual full control over their involvement in how their personal health information gets used and how they themselves act to provide for others within the virtual community. Involved users are not only free to educate themselves with healthcare options that can easily be discussed with a physician, they are, in addition, given the chance to take their health into their own hands with clinical trials and nonmedical treatments such as wellness exercises and stress management.

If CrowdMed is a helpful resource for finding answers under the ideology of “power in number”, PatientsLikeMe is the example of self-driven medicine with an interface chosen by the user’s preferences. This is a great illustration of patient empowerment, as patient empowerment is not only choosing what to be involved in, but choosing the threshold of involvement as well.

Feb 27 2014

Design

Technology is only one piece of the puzzle

I come from a computer science background.

Thus, I have grown accustomed to immediately think of a technical solution when I am presented with a problem:

http://doreenrainey.com/wp-content/uploads/2012/01/TheresAnAppForThatHeader.jpg

For obtaining driving directions, I think of Google maps.
For spreading awareness of a cause or an event, I think of social media websites like Facebook, Twitter, and Youtube.
For improving the organization and workflows of hospitals, I think of electronic health records.
For banking, I think of Chase’s online platform.
For improving education, I think of Khan Academy.

In the last month and a half, however, my tendency to naturally think of technology has been disadvantageous.

When our team was confronted with the initial problem of increasing clinical trial enrollment, we gravitated towards technical solutions. Some of out initial solutions were an online game, a Yelp/eHarmony-like website, and an online clinical trials matching system with human navigators. When I was thinking of these ideas, I was operating under the assumption that clinical trial enrollment is low because the solutions we thought of don’t exist. This was partially because our project was in its preliminary stages, but it was mostly due to my orientation towards technology.

After performing more research, we found discovered that there is a wealth of technologies and platforms that exist online. Websites like Emerging Med and The American Cancer Society’s Clinical Trials Matching Service are just a few examples of the many existing implementations of the ideas that we came up with.

http://cdn.cultofandroid.com/wp-content/uploads/2012/04/shock.jpg

I was in shock. Some implementations of our ideas had already been around for over a decade. If our solutions had already been implemented, then why is the clinical trial enrollment rate still so low? My scope of thinking began to expand. As it expanded, I began to see the importance of a holistic and interdisciplinary approach to problem solving. Although it is useful that I have the knowledge and skills to create a website or make an app, it is not the most important thing; technology is only a small piece in the puzzle that is improving clinical trial enrollment.

After this realization, our team has been approaching the problem from a greater diversity of perspectives. Lately our team has been viewing the problem from a marketing and public health standpoint. Rather than focusing on providing help online, it may be valuable to focus on connecting people to existing online resources. By expanding our focus, we hope to come up with an effective solution.

Feb 27 2014

Communication, Culture, Story

Live tweeting and Surgery

http://www.sbnation.com/lookit/2013/10/24/5024682/video-hospital-live-tweets-acl-surgery

In October of 2013, Memorial Hermann Hospital continued to remain at the front of the lines of technology, not by using some sort of new tool or technique, but by live tweeting the knee surgery of an unnamed teen female athlete who injured her ACL playing intramural football. The livetweet session was fairly vague as to her identity, but that girl was actually a Rice student, injured in a powderpuff game!

Using every social media outlet that they could, the doctors on the case showed off their work — across Twitter using #MHknee with both descriptions and photos, and on Vine and YouTube as well. Now there is, at the link at the top, a 6 second video summary of a standard ACL surgery done by the head physician for the Houston Rockets and the Houston Texans. (Warning- it’s fairly graphic!)

This is not the first time that Memorial Hermann has graced the internet with graphic representations of surgery over social media. In May of 2012, surgeons there documented a 21 year old female’s brain surgery, telling twitter all about the angioma in her right temporal lobe, including showing MRIs of her brain, and describing it’s removal. Concurrent posts to YouTube documented her journey of the day, including explanations of the procedures and tools used, and even video of the drilling into and removing a portion of the skull. Photos even went up on the site more known for wedding dresses and craft instructions, Pinterest.

Memorial Hermann was the first hospital to attempt such a presentation of the real time sequence of events with a live tweeting (text only, in that case) of open heart surgery a few months before the brain surgery, and they continue to lead the way in keeping the public in the know about such drastic surgeries.

Other medical institutions have followed the way, and just 6 days ago surgeons at Toronto’s Sunnybrook Health Sciences Centre livetweet a bypass, becoming the first in Canada to do so.

“This is an engaging way of keeping the public informed,” surgeon Dr. Gideon Cohen was quoted as saying in a post surgery interview with CBC News. But the same article quoted the blog of Summer McGee, “a professor of public health ethics and policy at the University of New Haven in West Haven,” Connecticut. McGee poses the question of what might occur if a live tweeted surgery like this might come to an unfortunate end– and what ethical issues might come to light in such an event.

In the era of social media, it is certainly something to think about. While more and more people might have access to and be interested in an event like this, and it can be a great PR boost for a hospital amidst a dozen other hospitals like Hermann, it certainly has the potential to go wrong. McGee recommends that “Limiting the PR elements and focusing on the educational elements of this practice is likely to help ensure the practice doesn’t get out of hand and harm patients or their relationships with physicians and health systems.” While livetweeting may be fascinating for the audience, the patients must always come first.

Feb 26 2014

Electronic Medical Record, History

History of Medical Records Systems from 19th to 21st century on Connexions

Guest post by Olivia Banner

I’ve just posted A History of Medical Records on Connexions (a Rice University-based repository for online learning modules). By showing medical record systems from the nineteenth century through the present, this project illustrates how the physician/patient encounter has been recorded, and the accompanying text begins to tease out what we can learn from the forms such records have taken.

When we teach about the history of medicine, students often take it for granted that medical records sit outside of history: that it is obvious what a hospital or a doctor would want to measure and record about their patients. Yet that information has changed over time, and what a hospital or a doctor selects as significant enough to record tells us much about the needs of medical institutions as well as what goes on within the physician-patient encounter. In addition, the format for those records has undergone constant transformations due to the introduction of new technologies, or changes in institutional needs, etc., and their format reveals much about medical practice.

The project is still in progress, and the materials I have been able to gather have been limited by what archives have saved (and medical records, seen as the stuff of bureaucracy, are often not considered important for the historical record) as well as by concerns about privacy. Materials from Los Angeles and Boston archives will be added in future months. Nevertheless, what is included here will help us all learn more about the history of medicine as it moved from the analog to the digital age.