Interview by: Kara Hounsell
Dr. Lisa Richardson is a general internal medicine physician, with a research interest in integrating non-biomedical, Indigenous, and feminist thought into medical education. Together with Dr. Jason Pennington, she is a Co-Lead of Indigenous Health Education at the University of Toronto. Prior to the interview, I had the opportunity to attend both Dr. Richardson’s guided tour of Indigenous art at the Art Gallery of Ontario and the Indigenous Health Panel, at which she spoke.
KGH: I noticed that you did a double major in literature and biology. I was wondering if you could tell us how that affected your interest in medicine or how that affects your practice of medicine?
LR: I think I should talk about briefly how that ended up evolving – I got to McGill, and I was actually enrolled in the biology program, and I felt that there was something that was really missing from my life, from my academic life, and I realized that I wanted to take courses other than bio, physics, organic chemistry, calculus. So I took one elective in American literature and realized that what I was missing was story, creative thinking, critical thinking, and opportunities to reflect on the world around me, and so I ended up negotiating this second major in English literature.
I’ve always since then felt like I’m balancing art and science, and [that] they co-exist and [that] they’re inter-related. And medicine seemed like actually a really beautiful way to bring both of those two together, because we talk about all of the basic science, and the clinical trials, and evidence-based medicine, but you have to learn as a clinician to actually enact that at the bedside in conversation, based on conversations with your patients and their families and what is going to work, and listening to patients’ stories, and helping guide them and support them to navigate the scientific world, so it seemed like a really nice place to bring together art and science. And I’ve said, I didn’t realize I would end up going into medicine back then, but it’s been a great place to have these two approaches co-exist, and not just co-exist alongside one another, but actually to really be woven together.
KGH: My undergraduate degree was called Arts and Science, and a lot of the things you said sort of resonated with what I was thought about as I applied to medicine. I remember that at the Indigenous Health Panel, you talked a little bit about patients’ stories and the way that finding a diagnosis can be narrowing in on only one part of their story. I’m wondering if you have any other comments on that?
LR: Well, it’s very interesting because we teach you, and we learn as physicians, to elicit particular aspects of a patient’s experience and a patient’s story, and fit them into our boxes – history of presenting illness, past medical history, chief complaint, reason for referral – there are all of these terms that we use. And we’ll pick out what we hear selectively from our interviews with patients and we’ll then fit them into these boxes, and
anything that doesn’t fit in won’t make it into our documentation, and consequently doesn’t make it into our conversations with our colleagues, with our students, and into the care of that patient. So for example, I recently was caring for a man and I noticed that he was extremely tall, because he was not fitting into the bed. And he said to me, well, I was a professional football player. Well, three other members of my team had interviewed and spent time with this man, and no one had determined that. Which to me is significant in terms of his life achievement, but also in terms of how he might present, in terms of the clinical syndromes, etc. But it also just gives him humanity and a face and story, which is so much more than a diagnosis.
So, my pet peeve is when we admit a patient and say “Oh, the heart failure patient.” No; we can say that, “Kara is a young woman, who has heart failure.” Her disease should not become a metonym, to use an English literature term, for her. It [shouldn’t] come to represent your whole being. We need to be thinking about that as we’re interacting with our patients, but also as we’re planning and moving forward in our treatment plans with them, for example.
KGH: I agree, I think sometimes topics in the arts can be considered more of an add-on, than an integral part of medical education, but I think those types of examples can show that beyond affecting the way that you interact with a patient, this information can also actually be clinically relevant and if you’re missing it then you’re missing other important information as well. These types of stories remind me of the field of Narrative Medicine. Is that something that you’re interested in?
LR: I’m very interested in healthcare humanities, or medical humanities, and one aspect of that is Narrative Medicine. Narrative Medicine, as it’s come to exist, I think, within the field of healthcare humanities, is rooted in a very particular history, and my one concern about Narrative Medicine is that if you look at the school of Columbia, and Rita Charon, who wrote about it, etc., it might forget about the fact that narratives have been a part of medicine, and medical practice and clinical practice for thousands of years across cultures. I want us to be careful when we use the term that we’re actually just recognizing the integral role of stories in all of our practices and in teaching and in learning and in knowing. So I say, for example, Indigenous medicine always includes story, and it’s done so for thousands years, but it may not necessarily be called “Narrative Medicine.”
KGH: In another interview on the University Health Network, you talked about cultural safety, which is a topic that we have been discussing as medical students. You said, “It’s more than just [about] cultural sensitivity and awareness, it’s about recognizing the power imbalances and the relationships between patients and their care providers.” In what ways do you think the arts can be involved in the type of self-reflection that’s needed to be a culturally-safe caregiver?
LR: I have a very specific example actually around how I’ve taught cultural safety through the arts – we’ve done an evening at the AGO – and what I’ve found in teaching some of those complicated areas like power, and self-location, and drawing upon your own experiences and biases that we all have based on how and where we’ve grown up is that can be difficult material to enter into in an educational way, and so when you do enter into that world through the arts, it actually is much more effective I find. So rather than having someone just sit and say, “This is who I am and this is where I come from,” to actually
perhaps read a text that may have a story from a community that’s familiar to them, or that resonates with their own experience, or to look at a piece of art where may be there’s some familiarity or it may just trigger ideas, it’s almost a safe way to approach thinking about topics that can be really difficult. It opens people up and allows you to be imaginative, creative, imagine the perspectives of others, get outside of yourself, hear different voices in a deep way, so for all of those reasons, I think it’s really helpful.
KGH: I actually attended the AGO tour, and I really enjoyed it. It seemed to me that there were multiple ways in which looking at art could be helpful for these types of lessons. For example, the Norval Morrisseau pieces – for me, those pieces were more about understanding that the way I’m looking at something may be different than how other people are looking at. But there was another piece too which was about residential schools, and the artist showed scientific specimens – and it was quite a powerful piece about the experimentation on Indigenous people in residential schools. It seems like there’s both a process component and message component to looking at art. I’m wondering if you have any other thoughts about the ways in which visual art is used in learning?
LR: I totally agree, so that’s what I really like about having the group look at art, it’s the idea that you’ve described, that when you hear other people describing what they’re seeing when they’re looking at the same piece that you’re looking at, you recognize that we all bring a different perspective and a different vantage. What we can use that to do is then to say, not only do you bring your own personal perspective, and often there are many of those perspectives – Donna Haraway calls it “partial perspectives” – your perspective as a mother, your perspective as an Indigenous, or Ojibwe-Scottish, Canadian, your perspective as a graduate student, etc. – but we also recognize that medicine, and the dominant way that we see the world, that medicine has a very particular perspective as well, and a very particular way of looking. Not just the physical act of looking, but the way we approach and think about the world – so the way we’re teaching students, comes from a very particular framework and a particular history, and we try to draw attention to that. And through that process of looking as a group, and looking at pieces of art across cultures, and so that might not just be the Canadian 1930s collection of the group of seven at the AGO, but from other cultures, like Norval Morrisseau’s work, it allows us to do that.
Man Changing into Thunderbird
Norval Morrisseau, 1977
And then, looking at, as you said, the content of the piece, the content, if you’re looking at a work that is about, well the example that you gave, I think it was Carl Beam’s work, with the example around residential school specimens – it opens up conversations about the
actual content. So we try to pay attention to both process and the actual content, recognizing that there are different perspectives on how people will see that content.
KGH: I understand that you are a Co-Lead for the Indigenous Health Education. Although this interview is primarily about the arts and their role is medicine and medical teaching, I wanted to know more about your work in this role. What are your priorities to further educate students on Indigenous issues?
LR: To link art with that role, I can say that there is a whole lot of work being done now in health across Indigenous nations, where art and culture are integral to health. So if you actually look at traditional understandings of health across many different Indigenous nations and groups, art is not separate from science. Because, for example, an elder or traditional healer may have a vision about a medicine, and go into the forest or around the lake to pick that medicine, and then there would be ceremony involved in the act of doing that. So although there is the physical science of the plant and the medicine, there’s a whole process and culture and ceremony around it. That’s a different form of artistic practice, which is culture. So to me, teaching about Indigenous health requires understanding that – and so it’s a great opportunity to bring in arts-based learning, things like writing…We did an edition of Ars Medica which is devoted to stories of Indigenous peoples, often in the healthcare system. So, this is really a very natural synergy.
Carl Beam, 1989
KGH: Are there any books that you would recommend to medical students?
LR: There’s an incredible woman named Katherena Vermette, she’s from the north end of Winnipeg, and she wrote a book called The Break which is everywhere right now – it’s very beautiful, very striking, very hard to read, but I would definitely recommend that. And then I was in Winnipeg recently for the Canadian Conference on Medical Education, and I was in a bookstore there, and she actually has a beautiful book of poetry that she’s written about the north end of Winnipeg as well, and so I picked that up. So I’ve just finished The Break and I’m now reading the book of poetry and I highly recommend those.
There is also an amazing exhibit at the AGO* by Rita Letendre, she’s an incredible abstract artist who’s Abenaki and Quebecoise, and it’s definitely a phenomenal show – so those are my two art picks.
[*The AGO Rita Letendre exhibit has now ended, but a few Letendre pieces can be found in Gallery Gevik in Toronto.]
I thanked Dr. Richardson for generously sharing her insights about the role of arts in medicine with me. After our interview, I picked up a copy of The Break, and became engrossed.