Arts and Medicine: An Interview With Smithsonian Secretary Dr David Skorton

Interviewer: Tricia Ward; Interviewee: David J. Skorton, MD


April 25, 2017

Background: David J. Skorton, MD, is the first physician to serve as Secretary of the Smithsonian Institution. At the 2017 American College of Cardiology Scientific Sessions, he delivered the Simon Dack lecture, "Values: How the Arts and the Humanities Nurture our Careers and Our Lives." He remarked that "as a doctor, it is a great privilege to experience how the arts and humanities make me a better professional and a better person." Medscape interviewed Dr Skorton to learn more.

David J. Skorton, MD | Medscape: How do you define "the arts"? Is it more than just the visual arts for you?

Dr Skorton: I think broadly about the liberal disciplines, the non-STEM (science, technology, engineering, and mathematics) disciplines—the arts, the humanities, and the social sciences. That includes visual arts, literary arts, and performing arts, so it's the breadth of arts disciplines. | Medscape: Leaving art therapy aside, how do you see the arts having a role in medicine for the average practicing physician?

Dr Skorton: If you think about the way that problems present themselves in life, be they personal or medical problems, they don't present in narrow categories. If someone has a heart ailment, that also changes their self-image; it makes looking at life enthusiastically or fearlessly much more difficult. To understand and communicate with our patients, we have to become humanists, in a way. We have to understand language better. The arts can help us do that through literature and through performances that show us aspects of different cultures.

Much of how we think about problems and opportunities in life has to do with our understanding of the general human condition. Literature, performing arts, visual arts, the humanities—all help me gain perspectives far broader than I would gain from my own life, no matter how observant I might be.

In short, the arts allow us to understand what it means to be human.

Figure. Origami-inspired coronary stent prototype by Zhong You and Kaori Kuribayashi-Shigetomi

Then there are the granular and perhaps more obvious examples of the practical side of the arts, such as where art and design intersect. In the Dack Lecture, I cited the origami example. The Japanese art of paper-folding inspired a type of collapsible stent developed by a team from Oxford University. Its shape was based on a water-bomb base that is the foundation for many origami forms. In 2012, the stent was part of an exhibit at the Japanese American National Museum in Los Angeles.

Honestly, playing the flute and saxophone taught me a lot about humility. | Medscape: You were a practicing cardiologist and a musician. Was there anything about being a jazz flutist that made you a better physician?

Dr Skorton: I practiced cardiology until recently. There is some debate about whether I am a musician. I am a failed musician—that is for sure. I mean this quite genuinely, not facetiously. Honestly, playing the flute and saxophone taught me a lot about humility.

Jazz also taught me about improvisation in life and in medical practice. If you are a member of a group of any kind (musical, family, work, medical), you are going to have your thing that you do, and as the situation evolves you are going to improvise and try to find appropriate responses to that evolution. At the same time, you have to be in sync with the other people on your team, whether that is family members or work colleagues.

Outside the group setting, I still think that the arts are important to the individual, because when you are writing a haiku, a novel, or anything in between, you have to have some concept of where you are going and what you want to communicate. With the exception of some savants, most of us gain that destination of orientation by reading, seeing, or hearing other people's work.

Forgive me if I dive into a musical metaphor and example. Western music has a so-called 12-tone scale: On the piano, there are 12 notes between C and C, counting the white and black keys. The scale has seven tones and you build a number of chords on those tones.

Those chords are the underlying foundation of a dizzying number of songs that are wildly different, from country to jazz. There may be different melodies, lyrics, and rhythms, but a handful of chords are the basis of many songs that we know. I think that phenomenon is humbling.

If I come up with what I think is a brilliant "new" idea, the chances are overwhelming that I am treading on well-worn ground. It's also likely that my idea would have been shaped by things that I read or heard, or performances that I watched, even if subconsciously. | Medscape: A big issue in contemporary medical practice is burnout. Do you see the arts helping overcome burnout?

Dr Skorton: Yes. To use the medical model, I see the arts helping in both a preventive and therapeutic way.

I don't like the term work-life balance because it suggests that we have two different entities that are quite separate, and that we somehow balance one versus the other. I haven't achieved this, but what a wonderful concept if we could somehow blend work and life. We should aspire to a unity of living more convergent than a jarring 9-to-5 workday, followed by coming home and walking the dog, and then coming back to do it again the next day.

If we think about every day in a meditative sense as being the day we have to deal with, what happened in the past is gone and we can't change it. What is going to happen in the future is completely conjectural, and all we really have is today, this very moment. I struggle, but I try the "one day at a time" approach. I find that it helps put things in a broader, more holistic context. | Medscape: What about the environment that physicians work in, such as the hospital or office setting with fluorescent lighting and cable TV on all day? Do you think there is a role there for the arts?

Dr Skorton: I do. I am no expert in interior design or even architecture, but I believe that we should put more thought into how to make our environment conducive not just to work but to our feelings of being human.

It could be visual art on the walls. It could be what we hear. Does the group want music or is that distracting and upsetting? Is it okay to put your headset on when you are at your own workplace? To my mind, design incorporates science, social science, humanities, and art; it overlaps with them all. We can use our innate sense of what feels good to optimize our workplaces. And this should be done by work teams, not just the boss.

Now, in the clinical workplace, it is much more complicated because these decisions affect not only healthcare workers but also patients and their families. In those cases, the psychological response to that feeling of loss of control, the fear of impending doom, and the sorrow over a sick child or family member all may require a different surrounding.

How nice it would be if we could enlist volunteers, patient advocates, and healthcare workers to make the environment more conducive to the type of communication, caring, and listening that should go on in the clinical workplace. | Medscape: Do you have practical tips for people on how to have a daily encounter with art?

Dr Skorton: I am responsible for 19 Smithsonian museums, the National Zoo, and several research centers. We have 216 affiliate museums around the country and many traveling exhibits, so I think a lot about the museum experience. But there are myriad ways to experience the arts.

If you want to find something to read or music to listen to, you can go to a bookstore or music store. I guess that's somewhat of a quaint notion now, but I still enjoy bookstores so very much. You may instead go to an online store or a streaming service like Spotify these days. It's certainly one way that I interact with the arts, as I have thousands of songs on my smartphone that I listen to during the day. Either way, it is a proactive choice.

You can also encounter art just by paying attention to your surroundings. Art is all around us, in the architecture of the buildings we pass by, in the advertisements we see, in the movies we attend, and, of course, in our natural surroundings that bear such artistic value. Music, of course, is ubiquitous. If you call my office and are put on hold, you will hear some of the collections from our Grammy Award–winning record label, Smithsonian Folkways Recordings. It has a huge number of fascinating recordings from different cultures, genres, and eras. | Medscape: There are some examples of using storytelling to teach medical students about communication.[1,2] Do you see a role for the arts in medical education?

Dr Skorton: Yes. In a clinical interview with a patient, we are trying to extract the story of their life or an aspect of their life. The more we can create a communicative environment in which the person feels comfortable, the more successful it will be.

If we can make the environment safe to have a conversation, then something helpful might occur. | Medscape: You are the chair of a committee from the National Academies of Sciences, Engineering, and Medicine that is looking at the integration of the arts and humanities with science, engineering, and medicine in higher education. Can you tell us about that?

Dr Skorton: The National Academies of Sciences, Engineering, and Medicine are conducting a study of the integration of STEM disciplines and the arts and humanities in college curricula and graduate school curricula. It is a big, ongoing national study.

We are trying to find out if there is evidence behind the assertion that this kind of integration actually helps the students' educational outcome and career outcome. It certainly seems likely, but is there concrete evidence to support the claims? We are in the midst of gathering the data right now. A portion of it, every session that I chair, is open to the public. (We're aiming to have a report in spring 2018.)

[T]o help people... you have to understand more than the Krebs cycle. | Medscape: What advice would you give to anyone thinking of a career in medicine?

Dr Skorton: For any young people in your audience or parents with kids starting post-secondary education, I urge them to think broadly about education after high school.

Even if you are positive that you want to be a cardiovascular surgeon, a journalist, or what have you, now is a beautiful time in life to explore more broadly the contours of the world and of one's own heart and mind. Try not to be too narrow in your choices of curricula, extracurricular activities, or even your friends. Try to think of college as a broadening experience.

Graduate and professional education is a different proposition because it's so narrow. The old joke is that you are learning more and more about less and less until you know everything about nothing. The thing about medicine is that it is a great humanistic enterprise. The ultimate goal is to help people. To do so, you have to take into account that people are wildly complex and unique—so you have to understand more than the Krebs cycle.

Follow Tricia Ward on Twitter: @_triciaward

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