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Biomedical Optics & Medical Imaging

Richard B. Gunderman: Learning to See

A keynote presentation from SPIE Medical Imaging 2018.

28 February 2018, SPIE Newsroom. DOI: 10.1117/2.3201802.01

Richard B. Gunderman, Indiana University (USA)

In this keynote presentation, Richard B. Gunderman of Indiana University, considers how seeing is learned and weighs the respective contributions of science, technology, and the arts in cultivating this remarkable human capacity.

Gunderman notes that human beings are born with a remarkable visual apparatus, but even if all the parts - lens, retina, optic nerve, and so on - are present and in working order, seeing remains, in large part, a learned skill. This is reflected in the fact that some people can see and understand things that others find meaningless or even fail to notice.

One striking example is the radiology education of medical students and residents, who over the course of their training move from not knowing what they are looking at, to quickly making complex diagnoses.

Gunderman notes that his talk is "a little off the beaten path," but he is absolutely convinced that one key ingredient in a recipe for a flourishing program of investigation and innovation is to connect what we do every day with rich cultural resources that many of us don't have an opportunity to think about much at work.

Gunderman opens his presentation with a self-portrait of Rembrandt, "perhaps the greatest artist in the Western world." Painters and artists help us learn to see, he says. Their works of art are opportunities to train our eyes to see the world anew.

Rembrandt_Self-portrait 1661
Gunderman uses the works of Rembrandt's as examples of seeing human beings with empathy instead of judgement.

"I think paintings like these create at least the possibility in our mind that we need to see not just with our eyes and our minds, but also with our hearts." says Gunderman. "By learning to see, we can educate not only our detective abilities, but also our capacities to sympathize or even empathize."

To help the audience understand what is meant by "learning to see," Gunderman recommends, A Young Doctor's Notebook by Mikhail Bulgakov. First published in the 1920s, this collection of short stories shows how a young doctor, "trained within the halls of the Academy," comes to a place where he's forced to learn what it really means to see what ails his patients and what opportunities they present him with to care for them.

Mary Shelly, author of Frankenstein, the Modern Prometheus
Mary Shelly's novel, Frankenstein, is a cautionary tale about a doctor whose ability to "see" is restricted by his own judgement.

To illustrate how "seeing can go bad," Gunderson uses Mary Shelly's novel Frankenstein, published 200 years ago this year. He notes that the "real monster" in the novel is not the creature, but its creator, Victor Frankenstein.

"Frankenstein is a cautionary tale about someone who is so narrow, whose professional field of vision is so restricted, who so restricted his curiosity, that he ended up with a very distorted view of the world," says Gunderson.

The novel isn't so much about bringing the dead back to life than it is about learning to see and the disastrous consequences that can flow from a failure to learn to see what's really there.

"We can't afford to let that happen to our learners," says Gunderson. "We can't afford to let our educational programs become so disciplinarily restricted, so narrow that they can't see where they are, because all they can see is where they are."

Poster from Das Leben Des Menschens
Der Mensch als Industriepalast (Man as Industrial Palace) shows how people can be seen as collection of parts.

Gunderson notes that Victor Frankenstein's problem was that he began to see human beings strictly in terms of tissues.

"Guess who that happens to every day?" he asks the audience. "Radiologists in the room, please raise your hand."

Pretty soon, Gunderson explains, we begin to see human beings as nothing more than an assemblage of tissues. A doctor can read a scan, then walk out into the hall to get a cup of water and unknowingly meet the person whose scan he or she just read. The doctor may have seen that person's brain, heart, or liver, but know nothing about the person to whom they belong. This becomes problematic over time, particularly as health professionals get more and more isolated from patients, just by virtue that they spend less time with patients.

"If you want to heal someone," says Gunderman, "learn to see better, more deeply, more richly, and make a stronger connection with what you see, and in particular other human beings.

"We need to connect the images with a human being, otherwise we're failing to see what those images really are. Connect images to patients -- at least occasionally and well."

Richard Gunderman is Chancellor's Professor of radiology, pediatrics, medical education, philosophy, liberal arts, philanthropy, and medical humanities and health studies at Indiana University (IU). The author of over 600 articles and 10 books, he has received the highest teaching awards of (IU) and the Association of American Medical Colleges. His latest book is, We Come to Life with Those We Serve.

Multimedia presentations from SPIE Medical Imaging 2018