7.1 - Art and the Moral Imagination with Margaret Chisolm

What is the role of the moral imagination in medicine? How can engagement with the arts shape better clinicians? What does it mean to cultivate human flourishing through medical education? Join us as we discuss with Dr. Margaret Chisholm how art can deepen moral imagination in healthcare and why it is essential to the practice of compassionate medicine. Dr. Chisholm is a professor of psychiatry at Johns Hopkins and a leader in integrating the humanities into medical training.

42 minutes • Published Apr 28, 2025 • Download • Transcript

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The Paul McHugh Program for Human Flourishing

Transcript

[Intro music]

Hi and welcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic Society.

In the podcast, we aim to reflect on deeper questions in medicine, all with the aim of rediscovering the ideals that brought us to medicine in the first place in order to better serve our patients and colleagues.

Thank you for joining us and we look forward to engaging with you through this podcast.

Hi and welcome back to the Hippocratic Society Podcast. My name is Michael Egan and I'm joined today by Dr. John Rhee and Dr. Margaret Chisolm.

Dr. Rhee is a neurologist, neuro-oncologist and palliative care specialist at Dana-Farber Cancer Institute and instructor of neurology at Harvard Medical School.

He co founded the Hippocratic Society and serves as its executive director.

Dr. Margaret Chisolm is a professor of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine.

She has over three decades of clinical experience,

has served as PI or co investigator on multiple nationally funded research projects,

and has published over 100 scientific, clinical and medical education papers, as well as two textbooks.

She has completed the Harvard Macy Institute Art Museum Based Health Professions Education Fellowship and is a certified Visual Thinking Strategies facilitator and coach.

Currently, she also directs the Paul McHugh Program for Human Flourishing at Johns Hopkins.

Thank you both very much for joining us on the show today. It is an honor to have you here.

Thank you, Michael.

Margaret Chisolm

Yeah, thanks so much for inviting me. This is exciting.

Absolutely. And thank you again, Dr. Chisolm, for being here.

And so, given your expertise in arts and humanities and medicine,

we wanted to discuss today how art can help us shape our moral imagination and why that's important in medicine.

And so to frame the discussion, I wanted to break it down into three parts.

First, we could talk about moral imagination in general,

then how art fits into the picture there, and finally, how we can develop our moral imagination both in training and in clinical practice.

So why don't we just start right at the beginning? What is moral imagination?

What?

Yeah.

Is there a specific definition and what's so important about moral imagination in medicine?

Margaret Chisolm

Yeah, thanks, Michael, for that question.

Margaret Chisolm

So, I mean, I think stepping back,

Margaret Chisolm

what I always say, and I actually get a lot of nods when I say it, which surprises me among very diverse groups, is that medicine is a moral enterprise.

Margaret Chisolm

Right. The act of take one person taking care of another person is a moral act.

Margaret Chisolm

And so that's really at the heart of our profession.

Margaret Chisolm

And you know, to make decisions about what are the best actions really requires practical Wisdom.

Margaret Chisolm

Right. Because oftentimes these are complicated questions that require reflection and consideration of all sorts of perspectives.

Margaret Chisolm

And so it's really important to engage in those moral decisions in a way that engages the patient's perspective and an understanding of what's going to be the best decision, the most ethical decision that can be made.

Margaret Chisolm

And in order to do that, you really have to invoke your imagination. You can't just.

Margaret Chisolm

This isn't just an algorithmic,

Margaret Chisolm

you know, follow some general protocol approach. You really have to be able to enter in to the patient's world as best one can, as one can to empathize with what they, you know, by empathize,

Margaret Chisolm

try to understand what is going on in their minds, in their hearts, what their values are,

Margaret Chisolm

so that you can work with them to arrive at a decision that is the most ethical decision for them.

Margaret Chisolm

So medicine's a moral enterprise, and it involves imagining various scenarios for the patient,

Margaret Chisolm

with the patient, and coming up with a plan together that is ethically sound.

Margaret Chisolm

That's how I think of moral imagination and its relevance to medicine.

Yeah. And one of the reasons, Meg, that we were very excited to have you here on the podcast is because of this idea that we often talk about medicine or medical education.

It's very framed in like an evidence based framework. And so something you mentioned was this idea of algorithms and part of art, part of the humanities, part of just the kind of social sciences too, but especially, I think in art,

it helps us draw away from this focus on the algorithmic and helps us to enter into this,

I think, state of more perhaps creativity, I guess.

And I think that creativity is perhaps essential in cultivating one's sense of the good, because there's in the good,

not just that which we think about intellectually,

but also,

like, what moves us from an aesthetic point of view.

I feel like from this beauty point of view,

that which draws our hearts,

and I feel like a lot of the moral imagination is also that this sense of fostering empathy, developing deeper bonds and relationships,

the sense in which we reflect together on creatively also solving problems, but then not thinking about people as just like algorithms of aspirin versus not for myocardial infarction, but rather the art aspect of medicine itself, which is like, just as crucial as the algorithmic, perhaps understanding of treatment paradigms.

Margaret Chisolm

Yeah, I think students are often really surprised to hear that our evidence base for most of our decisions is pretty scant.

Margaret Chisolm

They're sort of shocked because I think in the first two years of medical school,

Margaret Chisolm

they hear a lot about Evidence based medicine and algorithms.

Margaret Chisolm

And so they're surprised when they start encountering patients during their clerkships and realizing that, ooh, things are a lot more complicated. And a lot of the decisions we're making,

Margaret Chisolm

you know, are made on the basis of either scant evidence, weak evidence,

Margaret Chisolm

or sometimes no evidence.

Margaret Chisolm

And so I think that this idea of,

Margaret Chisolm

you know, certainly evidence based medicine is meritorious. I'm not trying to at all say that we shouldn't rely on evidence as to inform our decision making, but it's only one source of authority.

Margaret Chisolm

So, you know, scientific evidence is one thing, but also one's experience is relevant.

Margaret Chisolm

One, one's own expertise as a, as a clinician is relevant.

Margaret Chisolm

And also kind of wisdom from other traditions,

Margaret Chisolm

like faith traditions, can be relevant in making decisions. These are all sources of authority.

Margaret Chisolm

So we've put evidence up on a pedestal and it certainly has a place.

Margaret Chisolm

But there's so much more to decision making in medicine than just kind of slavish adherence to various protocols.

Margaret Chisolm

And I like what you say about,

Margaret Chisolm

you know, the beautiful. So beauty is one of the transcendentals, one of these,

Margaret Chisolm

you know, goods that I think can lead us to what's true and what's right.

Margaret Chisolm

So I often think about patience and how in the medical system,

Margaret Chisolm

we aren't really taught to think of our patients themselves as beautiful and their desires as beautiful and their experiences as beautiful.

Margaret Chisolm

And so even apart from the art, I think in terms of using the aesthetic experiences to spark reflection and spark the moral imagination. I think just thinking about our patients as these beautiful creations and how getting to know them and getting to know more about them as people can really help open us up to what's good and true for them.

Thank you both. That was very informative. And it's very obvious why moral imagination is so important now both in decision making. As you were saying, you can't strictly 100% rely on evidence that may or may not be 100% accurate.

And then also getting to know our patients and becoming more empathetic and diving into that role as a physician.

And so I think this transitions very naturally into our next part about art. And where, where does it fit into the picture? How exactly does it contribute to the moral imagination?

And what specifically about art allows it to form us in this way?

Margaret Chisolm

Well, you know, one of the things that John said was this,

Margaret Chisolm

the relevance of the emotional to decision making. Right. And art is, I think, often designed to be emotionally evocative.

Margaret Chisolm

So we respond to beauty, we respond to aesthetic experiences on various levels,

Margaret Chisolm

but often there's curiosity,

Margaret Chisolm

wondering about what story the art is telling.

Margaret Chisolm

But there can also be,

Margaret Chisolm

you know, a strong connection just on an emotional level. This reminds us of something in our own life, or we have emotional reaction to the art, whether it's delight and joy or sadness.

Margaret Chisolm

And so because of art's potential to evoke emotions, it can be a really great prompt for reflection.

Margaret Chisolm

It can bring to mind things that one might not have considered.

Margaret Chisolm

So we often use art as a way of prompting an introduction when we start a class or a program with learners to prompt an introduction to one another.

Margaret Chisolm

Because if I just ask Michael for you to introduce yourself to John,

Margaret Chisolm

you might have sort of a typical way that you introduce yourself with your role and whatever your title.

Margaret Chisolm

But if I ask you to find a painting or pick an image on a, on a card that you want to use to introduce yourself, that you connect to in some way, you might see something that, oh, reminds you of something about yourself, some aspect of yourself that, you know,

Margaret Chisolm

you typically might not use to introduce yourself. But,

Margaret Chisolm

you know, say we've had students see a violinist, a painting with a violinist, and it sparks a memory of, oh, you know, this is how I met my husband, was, we both played in an orchestra together.

Margaret Chisolm

And so they might use their connection with music to introduce themselves to somebody else. So it can spark connections, art can spark connections and open us up to new ways of thinking,

Margaret Chisolm

new ways of connecting with one another.

One thing that, as you were talking, Meg, that I was reflecting on is how sometimes in our culture there is a sense in which allowing strong emotions to play out is almost always a bad thing,

especially perhaps negative emotions.

And the fact that. Well, I would say that generally that is true in the sense that, like, exhibiting rage or anger is not helpful in almost all contexts. But the importance though, of being able to recognize the emotion, though, that's arising inside oneself and see, like, where is that coming from?

Like, why, why am I experiencing that in medicine feels like such an important work, right? Because we are going through a typical day like so many emotions because our patients might be suffering deeply from their illness and all the consequences of it, but also just emotions of naturally feeling like,

more bonded to certain patients, like with deeper relationship with other patients that may, like, also be very frustrating or kind of provoking in us or even reminding us of different past experiences that we have and how we could still both recognize those, but then not allow the emotions just to act in a kind of non reflective or automatic way,

but to see where those are coming from and therefore still Be able to respond towards that which we think is good,

good for the patient. Also good in the sense in which we think our actions are directed towards the good.

And so just the exercise of like recognizing and accessing those emotions seems to me like a very also important exercise in general in medicine.

Margaret Chisolm

Yeah, I mean, this is something that,

Margaret Chisolm

you know, when we do any activity in the museum or any arts based activity, we usually preface it with, you know, look, art can evoke strong emotions and we just want you to,

Margaret Chisolm

you know, remember that kind of experiencing emotions can be a place of learning and a place of growth.

Margaret Chisolm

Obviously, if something's really upsetting for people,

Margaret Chisolm

you know, they might not, they might be so distracted that it's not a valuable experience anymore.

Margaret Chisolm

But we try to encourage people to at least sit with the emotions. Most of our activities allow people to go to kind of the level, emotional level that they want to or that they feel comfortable with.

Margaret Chisolm

You know,

Margaret Chisolm

if I ask you to pick a painting,

Margaret Chisolm

you could pick a painting that is a more kind of surface level connection, like, you know, oh, this reminds me of when I met my partner. Or it could be deeper, you know, this remember, reminds me of a loss I've experienced or,

Margaret Chisolm

you know, a more painful memory or something like that. So people can,

Margaret Chisolm

you know, modulate or moderate the depth of what they want to share.

Margaret Chisolm

So that's, I think, an important factor, I think also is this idea of emotionally powerful experiences like we experience in the hospital all the time can be points personal and professional growth.

Margaret Chisolm

But the thing is, if you have those powerful experiences without opportunity to reflect,

Margaret Chisolm

and I would also say without opportunity to get support,

Margaret Chisolm

you know, to be able to share those ideas with other people and to hear, you know, their perspective and to get their support, that it's not going to be a very useful experience.

Margaret Chisolm

It's not going to be very growth promoting. So that's one of the things I love about the work that we do in the art museum is we can design activities that will predictably result in powerful emotional experiences.

Margaret Chisolm

And then we provide an opportunity for reflection and we provide an opportunity in these small group settings for sharing and for support.

Margaret Chisolm

So I think that's why these experiences are so effective in terms of promoting professional development.

Margaret Chisolm

Professional formation, moral formation,

Margaret Chisolm

is that they have those elements. They are emotionally powerful.

Margaret Chisolm

People are given time to reflect and encouraged to reflect. And then they're also conducted in a small group setting in which they can process their emotions with support from other people.

Yeah, it reminds me of a podcast we did previously on this idea of the physician discretionary space that we talked about where in training, but also even after training,

the importance of being able to have that space where clinicians are both exploring, like their identity formation as clinicians, but also in the work of the Hippocratic Society. What I see so often, too, is that they end up being a space in which people can process some of those experiences that they're going through,

whether it's a strong emotion with a patient experience,

or sometimes the opposite, like, why did I not have an experience there, an emotional experience there, and was that somehow bad of me? Or was that somehow like, is there something missing in me?

Or perhaps like a habitual way in which one may have become kind of more numb to certain experiences and then reflecting on how one may have arrived there and how one can change the way in which we receive these experiences and integrate them in a way in which that processing happens,

that reflective activity happens.

Margaret Chisolm

Yeah, and I think that, you know, the thing about art, whether it's visual art or literary art, is,

Margaret Chisolm

you know,

Margaret Chisolm

Parker Palmer's written about this. How it is can act as a third thing so that it,

Margaret Chisolm

you know, it's.

Margaret Chisolm

It might remind you of an experience that you had,

Margaret Chisolm

but it provides sort of this object that you can kind of project your emotions onto without sort of on approaching a problem, sort of on the slant is how I would say it, you know, that we're not.

Margaret Chisolm

It makes it more tolerable and easier to talk about challenging subjects with the art as a mediator of the conversation.

Margaret Chisolm

So sometimes that can be helpful too. It's like it's not sort of person to person kind of provocation. Right. It's not like, oh, if I got angry at a patient or something, I don't have to process it then with the patient,

Margaret Chisolm

but I can use that art as sort of a proxy for that difficulty that then makes it somehow safer to have a conversation about the art rather than about the patient or about myself.

Thank you both for those responses.

In both of your answers, I understood this theme of understanding our emotions and reflecting and then even sharing, as you were saying, Meg, with the other people in maybe an exercise, or just even reflecting on your own experience and developing imagination and creativity through that.

One question that came to mind was on this focus on emotion as we're understanding our own emotions in response to art or in response to a patient experience.

That seems to be very key in this development of the moral imagination and of our understanding of ourselves. But what is it about emotions specifically that will. That allows us to connect with Others more.

What is it about that understanding our emotions and becoming more mindful of what we're experiencing opens us up to the experiences of others.

Margaret Chisolm

Well, I mean we're embodied selves, right. And these cell ourselves,

Margaret Chisolm

our,

Margaret Chisolm

you know, our psychology is really a combination of our emotional life,

Margaret Chisolm

our intellectual life, our cognitive life, our thoughts and our actions. Right. That's kind of how we express our mental life through our thoughts, feelings and actions. So you can see the actions of others and you can see your own actions.

Margaret Chisolm

And if people are sharing their thoughts, you can see their thoughts. And if you articulate your thoughts, you can hear your own thoughts.

Margaret Chisolm

But emotions are sort of more, can be more hidden. Right. So it's hard to always access not only our own emotions,

Margaret Chisolm

but those of others.

Margaret Chisolm

And I think if you don't have that ability to connect on an emotional level as well as a sort of cognitive level and then kind of through actions, I think it's.

Margaret Chisolm

You don't have a full picture of yourself and other people.

Margaret Chisolm

So I just, I think some people obviously wear their emotions on their sleeve and maybe have a much easier time of accessing their emotions. Maybe they feel their emotions so strongly that it gets them in trouble.

Margaret Chisolm

But for so many of us in medicine, I think we've been trained to not have as certainly not show our emotions and maybe to not even become aware of certain emotions because just the awareness would people might imagine would get in the way of our being able to do our job.

Yeah, it also makes me think about,

I think both in the psychology literature, but also in I think various faith based tradition literature,

the idea of the formation of affectivity and that it has not, it does not have to do with the suppression of emotions, but rather the directing of one's emotion in concert with the will towards those things that are good.

And so we often think about suppressing as something that is good, but rather it is the processing, the reflection and then, then choosing based on both the emotions one sees coming forward and then also that which we know is good.

And the coming together of that is, is like the practice of,

or a large part of the practice of, I think practical wisdom as well.

And so the accident,

just as you were talking, Mike, made me reflect on a patient that I had or have right now where I had congratulated him because he has a brain tumor and had been having a hard time just accessing his emotions because he said that's not who he is, it's not his personality.

But over time we have been working a lot on also accessing Those things that he's feeling so that he doesn't just shut down in conversation, which is like, what was happening, kind of get close to a topic that's hard.

Perhaps topics about end of life and there would just be a blunting and then a closing down, and then it was hard to engage anymore. And so I think that the shutting down of emotion also in many ways shuts down our intellectual ability to even access the emotions or even reflect on the emotions because of also perhaps the fear response that one is like suppressing.

Rather, the importance is to also even recognize and sense the fear and anxiety, but in some ways welcome it.

So that one could also reflect on, why do I feel that? What is it that's driving those responses and how can I process them and release the emotions in a way that's healthy?

And for him, we were talking about how he could use and reframe some of those emotions in the service of his children and his wife as important ways to also engage with them in discussions about this and how he had grown so much in just like a period of a couple months and being able to just even recognize the emotions that are coming forward.

Margaret Chisolm

Yeah, I mean,

Margaret Chisolm

as a psychiatrist, of course, really interested in helping people become aware of their personality type. First of all, you know, are you.

Margaret Chisolm

Is your affective temperament one that feels things really strongly,

Margaret Chisolm

or maybe you tend to not feel things really strongly,

Margaret Chisolm

in fact, might feel things rather weakly.

Margaret Chisolm

And so being on either of those extremes can be problematic because with certain provocations,

Margaret Chisolm

you might not feel things.

Margaret Chisolm

If you're feeling, you tend to feel things really weakly. You might not feel things that are important to feel.

Margaret Chisolm

And if you feel things really strongly with certain provocations, you might behave in a certain way. That's not going to be really in your best interest.

Margaret Chisolm

So while I would help people understand what their affective temperament is, and then knowing that would help guide them through life's provocations in a way that was going to be more adaptive.

Margaret Chisolm

So.

Margaret Chisolm

So I think it's a complicated topic of our emotional lives because people really differ.

Margaret Chisolm

But,

Margaret Chisolm

you know, I think it's important for people to be aware of their temperament and then get support in when there are these provocations,

Margaret Chisolm

like a brain tumor or,

Margaret Chisolm

you know, a difficult encounter with a patient for a clinician to help them figure out how to think about that feeling and how to act in a way that's going to be adaptive for them in response to that feeling.

Margaret Chisolm

So it's a complicated topic, but I do think it's Important for us to be aware of our temperament, our affective temperament, and also be aware of our feelings and how they might affect our thoughts and our actions.

And, Michael, if I could say just one more thing or maybe two things to reflect on, that is one,

I was on a call and bringing it back to things that we also talk about in Hippocratic Society, which is I was on a call with some psychiatrists going over mutual patients that we have,

and there's a patient who was having a lot of sleep difficulty and is a young patient, and so had been reaching out a lot to me for different medication choices and also to our team as a whole, the neuro oncology team,

and that he, the psychiatrist, looked at the medication list and saw, like, wow, you tried a lot of different medications.

And we were like, yeah, we did. And he was like, yeah, maybe we could, like, involve a psychiatrist, because a psychiatrist oftentimes is better at also, just, like, being okay with the discomfort when a patient, like, reaches out in distress and allowing for a little bit of time to,

like, try things, like rest with them, like, kind of be with them in their discomfort and not react all the time. And I do think that in medicine,

there's a sense in which we want to, like, immediately meet people's needs, too, and sometimes that's not the best thing to do for the patient, actually, in that particular moment and how to find that balance and how to also access, like, our own kind of anxieties there that we're responding to as a.

As an important aspect of, like, forming, I think, that that affectivity. And then the other thing that I was just thinking about as you were talking was,

you know, Meg, one of the conversations we had before this podcast is just the idea that the other day that you brought up about the most important thing between the patient and their therapist is actually the bond itself, rather than perhaps the particular type of therapy even that the patient is getting.

And that, I think, is also an idea that we talk about in the Hippocratic Society, this idea that it's that bond between the clinician and the patient that's important and how can we grow and.

And building that bond with the patient.

And sometimes it might not be even like, the particular things that we say or do, but rather it's like that relationship that is that which is important to the patient sometimes can help us refocus on the fact that we may be, like,

swamped or just distracted by all of the particular things that need to be done,

but that in the end, for the patient, it's that Relationship, that's important.

Margaret Chisolm

Yeah, I mean, I think for patients,

Margaret Chisolm

knowing that their clinician is on their side,

Margaret Chisolm

I think is the most important thing.

Margaret Chisolm

And so, you know, I worked for 10 years in addiction and a lot of those patients had not experienced a clinician who was sort of on their side.

Margaret Chisolm

And they were,

Margaret Chisolm

had experienced a lot of adversarial patient, clinician relationships.

Margaret Chisolm

So I think just knowing that you're on their side now, a patient might not be ready to change or,

Margaret Chisolm

you know, might not be following the recommendations that you might be making,

Margaret Chisolm

but that doesn't mean that you can't have a great relationship with them.

Margaret Chisolm

And you know, I often will say, you know, look, I just don't think you're, you know, like ready to work on this right now. But I'm here for you when you are ready to work on this.

Margaret Chisolm

But I think so often as clinicians we'll get into these sort of battles with our patients rather than focusing on the relationship itself, which is the most important thing, not what the patient's doing or what, you know, you might be saying, but what you're conveying in terms of being there for the patient and,

Margaret Chisolm

you know, being willing to join them where they are.

Yeah, I really love that last point, Dr. Chisolm, because I think it also speaks to why developing the moral imagination is so important.

If it is really that bond that is the most important thing, then how essential it is for us to not let our emotions drive all of our decisions and understand the actual, all the circumstances and the evidence and how we're feeling and how that might affect us.

And so with that in mind, looking forward,

how do we develop our moral imagination in school and work and how do we use art as well to facilitate that?

Margaret Chisolm

Well, you know, just the word imagination is, you know, interesting to me because it conveys this idea of curiosity and wonder and inquiry. And so that's sort of my main aim in doing the arts based work,

Margaret Chisolm

museum based teaching, is to cultivate this sense of wonder and inquiry in health professionals, physicians,

Margaret Chisolm

future doctors,

Margaret Chisolm

whether it's about themselves or about their patients.

Margaret Chisolm

I think to be a great doctor you really have to be open and curious and really,

Margaret Chisolm

you know, in a kind of mode of inquiry to understand your patients. Right. It's like, oh, I really,

Margaret Chisolm

I might not agree with what they're doing,

Margaret Chisolm

but I'm really trying to understand where they're coming from. Like what, what's motivating them,

Margaret Chisolm

you know, what, what do they value? What are they valuing?

Margaret Chisolm

That's, you know, causing Them to,

Margaret Chisolm

like,

Margaret Chisolm

make these decisions. I think rather than getting into, you know, struggles with patients or having a judgmental attitude towards patients, I think it's just so much more interesting and productive to have this stance of wonder and inquiry, you know, what's going on.

Margaret Chisolm

Help me understand this. You know, I really want to kind of understand your thinking. What are you thinking about this and what's going on in. In your. In your mind?

Margaret Chisolm

And how are you thinking about these topics? I mean, to me, that's the most interesting thing. Right. Because that's really connecting with somebody on a. On a really deep level.

Margaret Chisolm

And that doesn't mean by trying to understand somebody that you're necessarily condoning their behavior. So lots of times I think learners will think, well, I can't empathize with that person because I think they've, you know, done X, Y or Z.

Margaret Chisolm

That sets them apart in some way and remarks them as a bad person or whatever.

Margaret Chisolm

But,

Margaret Chisolm

I mean, empathy really means just trying to understand,

Margaret Chisolm

you know, where somebody was coming from or is coming from. So doesn't mean you condone what they're doing. But I think in order to help people, the first step is trying to understand what.

Margaret Chisolm

Who they are as people and what motivates them and what experiences they've had that have led them to this point.

Margaret Chisolm

Yeah.

And it also makes me think about this idea of, you know, imagination and creativity, both the idea of the fact that they're encountering. Encountering a mystery.

So the fact that we are not the final word on all of these decisions,

though we may have some answers based on medicine of, like, what is a good path forward?

The reality is, I think as a good clinician, we would be integrating that which we think is a good health decision,

but with that particular person's circumstances and where they're at. Right. And I feel like also imagination and creativity is seeing a particular situation from a new light or a different angle or perhaps like an aspect of that thing that we hadn't seen before.

And what you were saying, Meg, of approaching our clinical encounters in a way in which we are not just approaching it from the typical aspect of trying to get the patient to agree to a particular treatment plan, but rather approaching it from an angle of like.

Yeah, what. What is, like, happening in this patient's, like, whole life?

What are aspects of the patient's decision making in life that I haven't seen yet that I might need to look at with, like, a slightly different lens or a slightly different angle or perhaps under a slightly different light in order to be able to understand that person better.

And I feel like that can help us move away from sometimes what we even experience in friendships or sometimes making people like our pet projects like our friends if we want them to be a certain way or even in like marriage.

Right. Want somebody to be a certain way, or kids wanting them to be a certain way, but rather seeing the person behind that and having a detachment, I would say, of like, what you want from them, but rather trying to approach each person from trying to like, understand them more.

And it seems to me that love primarily consists in understanding the other and that all of this, the idea of the moral, imagination, creativity, helps us to be able to foster those things and therefore also can inform the way that we approach our patients.

Margaret Chisolm

Yeah, absolutely. I mean,

Margaret Chisolm

one of the things that the arts based work does is really help us appreciate multiple perspectives.

Margaret Chisolm

So I think appreciating the perspective or beginning to understand and appreciate the perspective of the patient is important.

Margaret Chisolm

It reminds me of,

Margaret Chisolm

you know, this idea that is from Al Anon, actually about giving people, allowing people the dignity of living their own life. Right.

Margaret Chisolm

And I think that's really an important message for medicine is that,

Margaret Chisolm

you know, we might think we know what's best based on whatever our experiences, our knowledge.

Margaret Chisolm

But,

Margaret Chisolm

you know, there's a certain dignity that I think patients deserve,

Margaret Chisolm

which is,

Margaret Chisolm

you know, the dignity of making their own decisions, of having,

Margaret Chisolm

you know, that freedom.

Margaret Chisolm

I think sometimes we lose sight of that. Even the most sort of enlightened medical student I've had,

Margaret Chisolm

you know, say,

Margaret Chisolm

oh, this patient has, you know, has.

Margaret Chisolm

Is drug dependent,

Margaret Chisolm

you know, heroin dependent. They're pregnant with their eighth child, and, you know, why don't they just, you know,

Margaret Chisolm

tie their tubes or something? And I'm like, what?

Margaret Chisolm

You know, people have the freedom to,

Margaret Chisolm

you know, make choices that they decide to make and not be forced to,

Margaret Chisolm

you know, act in a certain way just because you think from your enlightened perspective that it's the right thing to do.

Margaret Chisolm

I think we have to remind our students that all our patients deserve our respect and the dignity to live their life as they see fit to live it. And sometimes that may mean that they're doing things that we don't think are in their best interest.

Margaret Chisolm

But that's part of what it means to be free as a person.

Thank you both for that. I'm very struck by that last point, especially the idea of freedom and loving other people's freedom,

I think is incredibly beautiful and a wonderful takeaway for students and doctors as just one final ending Point I'd like to ask each of you, is there a specific piece of art or literature or music that you find particularly beautiful or that you think could be particularly helpful for students and doctors to reflect on to develop their own moral imagination?

Margaret Chisolm

Oh, there's so many.

Margaret Chisolm

I think it's on my mind. Is the Raymond Carver short story A Small Good Thing?

Margaret Chisolm

So it's one of my favorite short stories. We read it with every group of students in our Longitudinal Scholars Program in Human Flourishing.

Margaret Chisolm

I think it's just such a beautiful depiction of human relationships and what can go wrong in those relationships and also how,

Margaret Chisolm

despite differences,

Margaret Chisolm

what can go right in those relationships. I love that, that short story.

Even though I am not practicing very often, Slash maybe haven't touched the cello in the past three months in some part of my life. That was like very important to me and still is.

But as you were just saying that, it just made me think about my favorite cello piece, which is actually,

I would say, not very traditional.

It's a piece called Julio.

And I really love it because it. In some ways there's this kind of parts that are legato that uses the string in a very traditional way.

And then in other parts you're actually like strumming it like a guitar and plucking it.

And at other times you're like using the other side of the bow even. I mean, there's like all this thing, all these things that you do with the cello that you don't like, traditionally do,

but it's also a short piece. It's like only three and a half minutes to four minutes, I guess, if you play it through.

And it just reminds me of in a certain sense, like how music allows me to step into perhaps this role that I normally don't step into. I would say I'm overall a kind of a cautious,

risk averse person.

I guess a lot of people in medicine are and have a temperament where I would say I'm more perhaps on the reserve side.

And in this piece I get to enter it and explore these aspects that are still there, that are still a part of me that where there is some spontaneity, perhaps in a more controlled manner than other people, but some, some of that and,

and it's. And being able to access those things through this medium of music that allows me to just like have fun.

And I feel like that that is one of the core aspects of a lot of the things that we were discussing here. The idea of wonder and perhaps part of the moral imagination is also like fun like being able to we encounter things in a way that just like gives us delight and joy in a very simple way and how that allows us to get back in touch with perhaps our more childlike approach to curiosity,

to the world,

to others and in that way helps us to always see things with this new perspective, different perspective or trying to see things from different lenses or perspectives.

Well, thank you both. I'm very excited to check those out. I think that's a wonderful note to end on.

I think this was an incredibly fruitful discussion and thank you again. And we'll see you all next time on the Hippocratic Society podcast.

Margaret Chisolm

Thank you.

Thanks, Michael.

Thank you very much for joining and reflecting with us today.

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