The Artistry of Medicine

The Artistry of Medicine

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Medical maverick Professor Roger Kneebone discusses the power of performance and how doctors can harness artistic talent in their work.

What do surgeons have in common with close-up magicians, puppeteers and tailors? A lot, if you ask Professor Roger Kneebone. The unassuming former doctor has devoted the last 15 years of his career to academia, researching how the seemingly incompatible worlds of science and the arts overlap and what can be learned from their similarities.

We meet in a bustling common room at Imperial College’s South Kensington campus, though Kneebone is not a lifelong denizen of prestigious academic institutions. He began his career as a trauma surgeon in war zones in southern Africa, before spending 17 years as a GP in Wiltshire. His work developing a national training programme for GPs caught the eye of Lord Darzi, who invited Kneebone to join his research programme at Imperial in 2003.

“I’ve always been interested in education and I became increasingly interested in looking at the skills of surgery that experts don’t even know they have,” Kneebone says of his move to academia. He now leads a Master’s in Surgical Education, encouraging surgeons in training to engage with the humanities and social sciences.

But it is in his role as director of the Centre for Performance Science that Kneebone carries out his most innovative cross-disciplinary work. The centre, which is a joint venture between Imperial and the Royal College of Music, researches the art of performance, and Kneebone is looking at how professional performers can teach doctors valuable skills.

Surgery, he explains, is not something that can be learned from a textbook. While theoretical knowledge is vital in medicine, procedures can only be carried out with the help of human performance. “We tend to think of medicine as an applied science and we think of surgery in terms of skills – manual skills particularly – but those only make sense if there is performance,” he says. “It’s through performance that patients experience care.”

And who better to teach performance than performers themselves? Kneebone’s idea is to bring doctors and scientists together with experts in a range of different artistic fields. Most involve not only intricate manual skills, but also an element of performance or narrative.

Orthopaedic surgeons team up with stone carvers to discuss the safe and effective use of sharp tools on hard materials. Chefs and chemists exchange tips on weighing and measuring according to exact instructions. Other collaborations have involved practitioners in fields as obscure as lacemaking and puppetry. It is hoped students will learn from these unorthodox experts, and can do so away from the stressful and intimidating environment of the laboratory or the operating theatre.

These partnerships will, Kneebone hopes, become a key part of medical training. Aside from practical skills, it can also help doctors to deal with the psychological elements performance, such as anxiety and recovery. “It’s not enough to read about it; you’ve got to experience it,” he says.

In addition, Kneebone believes a focus on performance could lead to a more personalised form of medical care, one he describes as “bespoke”. He has collaborated with Savile Row tailor Joshua Byrne for almost a decade, and frequently uses this profession as an analogy. A tailor, Kneebone explains, does not merely present the customer with a prescribed list of options. Instead, he works carefully to understand what the customer needs and adapts his product accordingly.

This, says Kneebone, is what doctors should aim for. “The whole process of bespoke is to work out what somebody wants and to guide them to a solution that’s best for them,” he says. “It’s not about limiting choice, but shaping choice and aligning it to the needs and wishes of an individual person.”

He compares medical practice to the idea of the ‘workmanship of risk’, a term coined by furniture designer David Pye in 1968. Pye talks about ‘risk’ not in the usual meaning of exposure to danger – an unhelpful term for medical practitioners – but rather in the sense of uncertainty. Unlike identical products churned out on a factory production line, handcrafted objects will each emerge unique, and the creator can never be entirely certain what the finished product will look like. This, says Kneebone, is similar to clinical practice.

“Every patient is unique and every clinician is unique and every manifestation of every illness is unique,” he explains. “You can’t say for certain how it’s going to work out.”

Rather than viewing this uncertainty as a negative, Kneebone sees it as the key to good care, especially for patients with chronic conditions that require long-term treatment. The bedrock, he says, is a doctor-patient relationship founded on trust and integrity. Beyond this, the care process should be tailored to the individual.

But Kneebone’s ideas are not without their obstacles. First, he must challenge the scepticism many doctors feel towards performance. “They feel wary of performance or feel it somehow diminishes the value of what they do or is somehow inauthentic,” he says. “But I think that’s a misreading of what performance is about.”

Moreover, his concept of the bespoke grants the patient greater agency in their treatment, challenging traditional power dynamics. It also raises questions of how these idealistic concepts could be realised in an already strained health service.

Kneebone is unfazed by these concerns, however, saying his ideas could be implemented without too much disruption and, crucially, without large investments of time and money. “I think it’s often a question of reframing what is already there rather than changing things radically,” he says.

Aside from his work on performance, Kneebone leads the Centre for Engagement and Simulation Science at Chelsea and Westminster Hospital, where he is developing new forms of simulation to provide student doctors with realistic experience of procedures and operations.

Too many simulations, Kneebone says, fail to recreate the stresses and complications of real life, and he wants to focus on human experience as well as purely technical skill. Pairing anatomical models with actors, for example, more effectively recreates the challenge of interacting with a patient while carrying out invasive procedures. He has also pioneered an inflatable operating theatre that creates a convincing environment without the need for expensive equipment.

Simulation also allows Kneebone to invite people from outside the world of medicine to experience a taste of the operating theatre, without the need to let them loose on real patients. This, it seems, is where his work on simulation and performance meet.

“If you think about surgery as performance then it makes sense not only to look at what performers outside surgery do, but also to invite those performers in to see what surgeons do,” he says. “You can’t really do that except by simulation.”

For Kneebone, the scientific and artistic hub of South Kensington, packed with world-class institutions, is the ideal location for his work. “It’s a fantastic opportunity to look at what experts in these institutions have in common, rather than what separates them,” he says.

Ultimately, linking seemingly unrelated professions is at the heart of Kneebone’s work. As a former doctor, his research is focused on improving the skills of surgeons and medical staff. But his ideas resonate beyond the world of medicine, and you can’t help but think about how they could be applied to your own profession. After all, performance, in whatever form it may take, is a skill we all need.

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