Dr. Arrieta’s lesson: Have we lost something in the gain?
New York, New York, United States
|Figure 1: Self-Portrait with Dr. Arrieta. 1820. Francisco Goya. Height: 45.1 inches. Width: 30.1 inches. Oil on Canvas. Source.|
A global pandemic has transformed, almost overnight, the way medical care is delivered. Telemedicine without face-to-face contact has facilitated social distancing, eased the burden on physicians, and increased access to care.1,2 Even before the pandemic, telemedicine had a robust foundation and was being quickly adopted.3 Its first use had been in the early twentieth century to convey electrocardiographs over the telephone.4 In the 1920s, radio consultations were used to care for to patients in remote locations. By 2017, 70% of healthcare providers had used telemedicine to connect with patients.5 In March 2020, telehealth visits increased by 50%, and are expected to hit one billion by the end of the year.
Unsurprisingly, telemedicine has limitations. Some components of medical care such as the physical examination are eliminated when physicians cannot palpate or auscultate. A growing concern is that patients may become so accustomed to the convenience of telemedicine that medicine as we knew it will be permanently altered, eroding the doctor-patient relationship, and affecting patient satisfaction, medical outcomes, and physician burnout. Nonverbal cues may be missed and crucial parts of a patient’s personal narrative may be overlooked.
It is still worth considering what is lost when bedside presence is replaced by a video camera. This is especially evident in the painting titled Self-Portrait With Dr. Arrieta (1820) by Francisco Goya. Goya’s career was marked by spectacular success; members of the Spanish nobility frequently praised his work; and in 1795 he was elected to direct the Royal Academy of Art in Madrid.6
Paralleling his success, however, was a series of serious illnesses. These impacted his life so severely that biographers often separate Goya’s work into two periods, “before and after his illness. The first characterized by joy and light, the second by horror and ghosts.”6 In 1792, he fell seriously ill with severe headaches, hearing loss, visual impairment, tinnitus, right arm paresis, and eventually depression and hallucinations.6 A similar onslaught of symptoms recurred in 1819. It is thought that the artist suffered from vascular lesions, lead intoxication, or syphilitic encephalopathy, resulting in severe personality changes, bouts of depression, and progressive deafness.6 Mercury treatment may have exacerbated his neurologic symptoms. Eugenio Garcia Arrieta, an infectious disease specialist, was his personal physician who gave not only medical care but also crucial emotional support during Goya’s lapses into acute illness.
The Self-Portrait With Dr. Arrieta is an intimate snapshot of the physician-patient relationship. Dr. Arrieta is positioned on the left, Goya on the right. Their interaction is a delicate balance between health and illness, support and collapse, caretaker and patient. The two subjects complement each other. Pink brush strokes highlighting Arrieta’s lips and cheeks contrast against Goya’s pale face. Arrieta, with a physical proximity more or less foreign to modern medical care, supports the collapsing Goya. Yet the painting’s relevance is highlighted when focusing on the artist’s inscription on the bottom of the canvas:
Goya in gratitude to his friend Arrieta for the skill and care with which he saved his life in his acute and dangerous illness suffered at the end of the year 1819 at the age of 73. He painted it in 1820.
Goya describes Arrieta not as his doctor, but as his friend. In fact, the painting was a gift to his physician to thank him. Goya’s acknowledgement of his physician as his friend is a testament to the power of a positive physician-patient relationship. Arrieta did care for him medically, but by this stage of his illness, Goya was both delirious and deaf. Arrieta nurtured Goya back to health over years, enabling him to exhibit his genius. Goya went on to live another eight years, a portrayal not only of physical support, but also emotional support.
What qualities are missing when patients are treated through a computer screen? How much relationship building can occur between a patient and physician across the boundaries of a computer? Will this impact long term care? Reflecting on the Self-Portrait in light of a global pandemic, this raises questions that will only find answers in time.
- PLD L. Telemedicine and the Doctor/Patient Relationship. Arquivos Brasileiros de Cardiologia. 2019.
- JD M, S A. Telemedicine Gets a Boost From Coronavirus Pandemic. Wall Street Journal.
- S R. Telemedicine: Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth 2009. 2012.
- S R. History of Telemedicine: Evolution, Context, and Transformation. Healthcare Informatics Research 2010.
- T B. 71% of Healthcare Providers Use Telehealth, Telemedicine Tools. 2018; https://mhealthintelligence.com/news/71-of-healthcare-providers-use-telehealth-telemedicine-tools.
- D F, G S. Francisco Goya and his illness. ACTA otorhinolaryngologica italic. 2010:264-270.
ARIANA LEILA SHAARI is a senior at Barnard College, Columbia University majoring in Psychology. Her love of literature and art history fuels her pursuit of a career in medicine.
Spring 2020 | Sections | Doctors, Patients, & Diseases