Category Archives: Creativity in Healthcare

A Journal for Nurses…

Posted on February 4, 2010 | 1 Comment
 

Throughout this blog, I write about integrating creativity and the arts into patient care...into healthcare systems...include a few  Creative Interventions for you to try on your own and with your patients...and promote the use of Creative Interventions with healthcare professionals.

Well, here's another healthcare professional promoting creativity in the form of writing/journaling designed for nurses.  'A Daybook for Beginning Nurses' is geared towards new nurses. Each day begins with an inspirational quote or saying from seasoned nurses and famous personalities across the globe.  Even though the title reads '...for beginning nurses', I think it's good for nurses at all levels.  We all need and want to be inspired, and this inspires us to be grateful.

Here’s a couple quotes from the book…

“Nursing is not for everyone.  It takes a very strong, intelligent, and compassionate person to take on the ills of the world with passion and purpose, and work to maintain the health and well-being of the planet.  No wonder we’re exhausted at the end of the day!” ~donna cardillo, author of this book

And another…

“Once a nurse, always a nurse.  No matter where you go or what you do, you can never truly get out of nursing.  It’s like the Mafia.  You know too much.” ~deb gaudlin

 A little information on the author, Donna Cardillo.  She is a nurse and author of the popular “Dear Donna” column in Nursing Spectrum and NurseWeek.  She is also a motivational speaker, workshop leader, author, columnist, and consultant, as well as a daily contributor to Nurse.com.  Donna has written numerous books including Your 1st Year as a Nurse (Random House) and The ULTIMATE Career Guide for Nurses.  She has been a featured health care coach for the Los Angelos Times.  She has written for Imprint, the journal of the National Student Nurses Association (NSNA), and has served as keynote speaker for NSNA national conferences.  Donna is a frequent guest on radio and TV, including NBC’s “TODAY” show. 

Below are a few topics Donna talks about during her motivational and educational conferences:

  • Techniques for assertive behavior/communication
  • How nurses have already changed the face of healthcare
  • How to be a nursing advocate
  • Strategies for elevating the profession to new heights
  • What they already have going for them

Visit Donna’s website at www.Nurse-Power.net

You can buy “A Daybook for Beginning Nurses” at amazon.com or nursingknowledge.org. You might just find out you know one of the many nurses, like moi, quoted in the book :)   Now, go and buy the book for yourself, a colleague and/or friend!

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‘Art By Nurses’ by Lynda McLeod

Posted on January 20, 2010 | 4 Comments

Creative Interventions are not just for patients…they should be experienced by healthcare professionals too.  Caring for the sick is demanding work, and at times, thankless.  Health professionals need a repieve to rejevenuate themselves, and engaging in creative activities does exactly this.  Self-care principles and theory applies not only to patients and their families, but to healthcare professionals as well.  Who benefits?  Everyone that healthcare professionals interacts with – nurses, doctors, ancillary nursing personnel, social workers, OT, PT, managers and executive staff,  academicians, etc.   By experiencing and expanding your own definition of creativity, it will ultimately benefit you, your patients and everyone else. 

Lynda McLeod of Victoria, British Columbia has applied these self-care principles into action.  This week, I invited Lynda to talk about her background in nursing and interest in the arts.  Lynda is a  nurse educator, artist and founder of ‘Art By Nurses’, an online gallery of artwork for sale created by nurse-artists. 

With no further ado, here’s Lynda…

“Since the beginning of my nursing practice I have always used art as a reflective process to help me make sense of the experiences I encounter as a nurse. In fact, I attribute the process of art as the only reason I am still involved in nursing. Being a highly sensitive, creative, person, I found some of my nursing experiences, mainly bearing witness, difficult to unravel.

As an effort to maintain balance and meaning I connect with nature and my family by going on long canoe and kayaking trips along the west coast of BC. The meditative act of painting these moments became my vehicle to transcend the sorrow and arrive at another plane of understanding. I have no formal art education in technique, color or brushwork; instead, I draw on my passion for nursing and the transformational relationships formed while teaching the next generation of registered nurses

I started the web site company based on a belief that many nurses engage in the meditative process of art in order to make meaning of the experiences they encounter as healers. By creating art and sharing their artistic visions, nurses work to maintain their health and support each other in a very rewarding, yet demanding profession.

ArtbyNurses.com brings nurses together using art. We share the healing qualities of art with the wider community to spotlight our profession, illustrate the benefits of art as a self-care process and celebrate our artistic talents.

We encourage nurses to join Art by Nurse to sell their art in a virtual gallery. A percentage from each sale is automatically deposited into an Art Fund for Nurses. Registered nurses can apply for funds to use art as a strategy in maintaining balance and meaning in their lives as healers. Retaining healthy nurses in the midst of a nursing shortage is the ultimate goal of Art by Nurses.

Support your colleagues and join Art by Nurses as an artist or an associate member.”  ~lynda mcleod

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Don’t forget to visit Lynda at her website ‘Art By Nurses’

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Is it Art Therapy?

Posted on December 13, 2009 | 3 Comments

When I conduct the Creativity Workshops in healthcare environments, someone never fails to ask me if I’m an art therapist - I am a Registered Nurse and artist.  People automatically assume, and understandbly so, one must be an art therapist when working or helping patients wih art.  As an artist and nurse, I want to introduce the idea and concept of what the arts can do for patients.  Engaging in the creative process, the arts, is healing and should be integrated into healing environments – into hospitals, outpatient treatment centers, doctors’ offices, the VA, residental centers, long-term care facilities (nursing homes), home care, and hospices.

When you engage in a creativity activity, aka the creative process, you become your own therapist.  The therapy (which you facilitate) is to access that space that is intuitive, invisible, intangible, healing, and brings you comfort and pleasure by creating a tangible object.  It can be a painting (in my case), a beautiful garden, poetry, a book or journal, a crafted piece of work, a short story, playing music, singing, helping others, drumming – the medium is not important.  Whatever you are experiencing or feeling will manifest outwardly in your creative project.  Now, this is not to say art therapy is not necessary…it may be for certain individuals who need individualized professional counseling. 

So, the question of “Is it art therapy?” still remains unanswered.  The answer is “yes”, but not in the traditional sense of the title ‘art therapy.’  The nurse/artist/social worker/physician/creativity facilitator is an advocate of creativity by facilitating and encouraging art-making… the patient is her/his own therapist by willingly engaging in the creative process…the therapy is the actual art-making itself.

From review of the literature, incorporating creativity into nursing’s framework of care is more practical, versatile and non-threatening over other therapeutic models, i.e., therapy.  In nursing terms, creative activities can be referred to as “creative nursing interventions.”  Traditional psychotherapy may not provide the best approach to working with patients, because most patients do not view themselves as needing psychotherapy.  Engaging in the creative process is what facilitates healing at the spiritual, emotional, cognitive and physical levels.  In fact, many patients may feel threatened if an arts program is referred to as art therapy.  Rather, patients want to gain a sense of control of an unfamiliar environment. (1)

 

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“Narrative Medicine: Healing the Healer” – an interactive Creativity Workshop for Healthcare Professionals

Posted on November 6, 2009 | 2 Comments

Back in September, September 3 to be exact, Bob Climko, MD, MBA  and I facilitated a Creativity Workshop titled “Narrative Medicine: Healing the Healer” for healthcare professionals.  This 3rd annual conference held by Georgia School for Addiction Studies titled ‘Keys to Change: Prevention, Treatment and Recovery’ could not have been more appropiate as our world adapts to changing paradigms in current economic, leadership, social and personal transformations in vision, mission and attitudes.

In healthcare, change is also occurring, albeit slowly.  But positive change, no matter the pace, is good.  Historically, Nightingalethe medical model – a world of scientific and technological breakthroughs to ‘cure’ human conditions – prevailed.  And the ‘art’ of healing the sick, utilitzing nature and the arts, and honoring human dignity - lost.  However, there is a stirring in healthcare to provide services that are truly patient centered and to focus on multi-dimensional healing.  And the concept of integrating nature, creativity and the arts in healthcare are a couple of these services.   Other terms for these ‘newer’ services are: complementary therapies, integrative medicine, alternative therapies, etc.  But, these therapies are not new…they existed since Hippocrates2the beginning of time.  Both Hippocrates and Florence Nightingale believed in treating patients as multi-dimensional beings by addressing the physical, intellectual, spiritual and emotional realms.  They believed in the benefits of nature, lighting and the arts as important components to the healing process.

Active participation in creativity and the arts by patients, families, staff, healthcare professionals and the larger commUNITY encourages collaboration, harmony, tolerance of differing opinions and viewpoints, acceptance, acknowledges and appreciates the creative process, flexibility and patience.

music-notes1writing-colorpaintbrushes

Now, back to ”Healing the Healer”  Creativity Workshop!

Purpose of the Workshop:

1. The use of the written word and art activity as healing interventions.  Through careful listening to one another’s stories through the written and spoken word, and process of art making and presentation, healthcare professionals (healers) may begin to reconnect with their own healing spirit.

2. To introduce, promote and utilize the concept of integrating creativity and the arts into clincal practice.

Description of the Workshop:

Two arts activites, writing and art-making, were chosen for participants (18 healthcare professionals) to tell and show why they chose to enter healing professions for their careers. The writing portion was  conducted by Bob Climko, MD, MBA and the art-making by Marti Hand, RN, MPA, Artist.  Writing, as explained by Dr. Climko, was the third ear.  Creating art accesses the soul and heart regions of the body.

Savannh

(Healthcare professionals creating their masks during “Healing the Healer” workshop)

Outcome:

The healing professionals wrote poignant stories of particular clients/patients who they treated and left a lasting impression – these were the reasons why participants entered the professions they did.

In the art making activity, the instructions were to create masks representing their reasons to become healthcare professionals.  Interestingly, there was not a single person who followed the guidelines!  Rather, all the masks created represented their current physical, psychological, spiritual and emotional states.  Most participants explained their masks, and then told the story behind the masks…something I believe would not have happened without the art-making piece.

Active  participation in the creative process enhances collaboration, harmony, tolerance, acceptance, flexibility, and in this case - catharsis.

GSAS-mask

(Example of mask created by “Healing the Healer” participant)

By implementing creativity and the arts in healthcare systems, patients, families, staff, healthcare professionals and local communities all benefit:

Art-making

Writing

Music

Dance

Humor

Laughing Clubs

Art exhibits with work created by patients, families, staff and healthcare professionals

Drumming circles

Indoor and outdoor gardens

Art at the bedside for patients and families

drummusic-notes1singing

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Turning Swords to Paintbrushes, and Warriors to Painters…

Posted on October 30, 2009 | Leave a comment

          paintbrushes1

On October 12, 2009, the New York Times published an article titled ”Turning Swords to Pens, and Warriors to Writers.”  The story summarizes an effort organized by the Writers Guild of America in mentoring wounded U.S. military veterans to write their stories.  The writing workshop received support from the Wounded Warrior Project, and the National Endowment for the Arts Operation Homecoming.  Below is a summary of the article, some information on traumatic brain injury (TBI),traumatic brain injury and my recommendation to offer painting  and the visual arts as a healing modality for self-expression of the horrors and psychic wounds of war.

Here’s are few veterans’ responses on the writing workshop…

  • One veteran struggled to find what exactly it was that he wanted to say.
  • Another said “…there’s something in my heart…I feel like it’s a calling to write.”
  • Yet, another veteran’s real reason for attending the writing workshop was to sharpen her writing skills for a historical compilation of her family history, and the role America plays in their lives.

Writing offers veterans an avenue for expressing personal stories and experiences of combat, and is a fine medium for those capable and desiring to write.  However,  for veterans with traumatic brain severe-nerve-damageinjuries, writing may not be the best arts modality to offer due to nerve damage or loss of neural connections within the brain. This loss of neural connections may lead to many of the symptoms associated with brain injuries. Depending on the location,  severity, and rapidness of treatment for traumatic brain injuries, there may be difficulties with the following (in relationship to writing).

  • Inability to focus on task
  • Difficulty with problem solving
  • Inability to express language (Broca’s Aphasia)
  • Slower thinking
  • Inability to attend to more than one object at a time
  • Inability to name an object (Anomia)
  • Inability to locate the words for writing (Agraphia)
  • Problems with reading (Alexia)
  • Inability to focus visual attention
  • Difficulties with eye and hand coordination

 (Source: Brain Injury Association of America www.biasusa.org)

To learn more about the other myriad symptoms associated with traumatic brain injuries in the military, visit the link below – DHCC.

According to DHCC  (Deployment Health Clinical Center) , the website states that early mild TBI symptoms may appear subtle, but they can lead to significant, life-long impairment in an individual’s ability to function physically, cognitively and emotionally.  Btw, DHCC is located at Walter Reed Army Medical Center in Washington, DC.

In a New England Journal of Medicine article on TBI in the military, it  Iraq-Soldiers-PTSD15dec04reported 56%  of those diagnosed with TBI are considered moderate or severe, and 44% mild!  Also, some symptoms of TBI overlap with those of post-traumatic stress disorder (PSTD).  Those in the military are usually young and healthy, and have a good chance to recover from TBI.  However, they have been hurt in terrible ways which may complicate and affect their recovery outcome. (1)

Use paintbrushes rather than pens…

Given the cognitive, visual and motor coordination problems veterans paintbrushesexperience as a result of TBI, writing may not be the best avenue for self-expression.  Painting (and the visual arts) as a creative intervention is a much better choice of medium.  Why?

  • With writing, there is a tendency for  internal editing and censoring of the written word, and this is by those of us without brain injuries!  Imagine the frusration of veterans suffering from mild to moderate  symptoms of  TBI.
  • Writing requires fine eye – hand coordination. Painting, on the other hand,  involves more gross motor coordination.
  • Painting requires less cognitive and visual perfection or acuity.  For example, Claude Monet painted despite his progressing blindness.

Claude Monet water lilies

(Claude Monet, water lilies, 1840-1926)

  • Painting utilizes imagery rather than words to express psychological and emotional states.
  • In painting, there is no right or wrong methods, techniques or colors to convey meaning and thoughts.  Writing requires concentrated effort, exactness and command of the written language.
  • Paintbrush handles can be adapted for those unable to hold thin paintbrushes.
  • There is less internal editing with painting.

 Note: email me for the references.

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Try this simple Creative Intervention…

Posted on October 23, 2009 | 2 Comments

music-notes1I’d like to introduce and describe a short and simple Creative Intervention to try on your own.  I developed this CI (Creative Intervention) for use in my Creativity Workshops. 

The goal is to visualize the music you hear and transfer these images onto paper.  It will take about 10 minutes to complete the music-notes1exercise, but may be longer depending on how much time is devoted to your drawing; the musical piece is 5:25 minutes long.

But first, read the short list of instructions and then go for it! 

A few Instructions:

1. The music selected for this particular Creative Intervention is Beethoven’s Pathetique Movement 2 by Freddy Kempf.  I chose Freddy beethovenKempf’s version over other artists for his expressiveness and sensitivity in interpeting this piece.

The link below is to a youtube video.  The goal is to listen with your eyes closed. No peeking to watch Freddy during this exercise; you can watch him later!

Note: It’s important to be in an quiet environment for you to benefit from this exercise.  So, close your office door or wait for better time.

2. Gather your supplies: white paper and drawing/coloring tools in different colors (crayons, colored pencils or markers).  Anything you crayonscan draw with is fine, but make sure you have different colors.

3. Listen to the selected piece by clicking on the link. Remember- keep your eyes closed during the entire musical piece.  The goal is to shut out outside visual images and noises, and focus on you.

While you’re listening, picture how the music would look if you could see it.  What are the colors and shapes you see?  Are there lines?  Is it abstract?  What are the rhythms, the melodies and mood(s) you see?  How does the music make you feel?  Are there words or just colors or images? Don’t worry about drawing anything you may not recognize – that’s not important to this exercise.  Remember, there is no right or wrong way of doing this exercise - just your way.

music-notes1

      Are you ready to begin?

Increase the volume on your computer to mid-way – Beethoven’s Pathetique Movement 2 is very soft in certain sections.

CLOSE YOUR EYES and listen for the entire duration.  Click the youtube link below and listen to Freddy Kempf’s version Beethoven’s of Pathetique Movement 2.   According to music interpretation,  Pathetique in its entirety is not a sad song piece.   Beethoven wrote this when he found out he was losing his hearing. The first movement is depicting the rage and sorrow he felt. The  second movement (the youtube video below) is depicting the comfort he receives.  The third movement is almost a testament of joy.


Now, draw what you ’saw’ when your eyes were closed.  When you’re finished, look at your drawing for a few minutes.  Don’t be critical about it – it is what it is.  Try this exercise with your favorite musical pieces – rock, alternative, classical, pop, etc.  Compare the 2nd, 3rd drawing with the first.

Creative Interventions are not just for patients…

Creative Interventions should be experienced by all healthcare professionals, not just patients.  Who will benefit?  Nurses, doctors, ancillary nursing personnel, social workers, OT, PT, healthcare managers and executive staff, and academicians.  By experiencing and expanding your own definition of creativity, it will ultimately benefit your patients and your daily interactions with others.

 mhand_stem-cell-garden_sm(stem cell garden, Marti Hand 2008)

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Drawings by patients with lupus…

Posted on October 9, 2009 | Leave a comment

A comment  received on the post “Drawing as a diagnostic tool in lupus patients” expressed interest in seeing some drawings created by lupus patients who participated in the research study (by Katarzyna Nowicka-Sauer).  Below is the reader’s comment:

“It would be interesting to see some of the drawings by the lupus patients! It would take me a bit to figure out how to draw my illness!!! Interesting concept really.”

In response to the comment, below are 3 drawings and their stories taken from the research article (1)…

lupus pt drawing 1

 

 

“My illness had…still has…many faces: In the beginning I used to cry a lot, I was young and my appearance was the most important thing.  I was angry, sad…These teeth represent the horrible pain I used to suffer.  Now I accept my disease… Nevertheless, sometimes these stages come back.” (JJ, 44)

 

 

 

 lupus pt drawing 2

 

 

 

“Lupus has attached many parts of my body.  Sometimes it’s hard to bear it, especially during flares… It’s also a fear: What will happen next?” (BG, 50)

 

 

 

 

 

lupus pt drawing 3

 

 

 

“My illness is like a monster which sometimes bites, but it still has “human shape’ because I hope it will be ‘humane’ for me.”  (CR, 52)

 

 

 

 

 

 

According to the researcher, ‘drawing is an unconventional task that makes the patients think about their disease in a different way, far from medical view.  It makes them concentrate on ‘feeling’ and ‘experiencing’ the disease … Although we are used to verbalizing our thoughts and feelings, sometimes, it can be easier to express them in the visual way…”

Note: email me if you want the bibliography

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Your Body as Healer…

Posted on October 2, 2009 | Leave a comment

An article titled “Miracle Survivors,” in Forbes (March 2, 2009), portrays stories of people who have spontaneous remissions from several different types of cancers. Explanations by the medical community range from “…a complete mystery,” “divine intervention,” or “the immune system.”  With regard to the latter explanation, our bodies have all the necessary elements to heal itself. 

Everyone knows who Deepak Chopra  is…here is his explanation and understanding of spontaneous remission taken from intentblog: 

“Essentially remission is based on our understanding of the science of self-repair. Our bodies have learned to heal themselves over millions of years of mhand_bodymindsoulemotionevolutionary time. Our bodies are the best pharmacies in nature. They make antibodies, sleeping pills, tranquilizers, immunomodulators, and anti-cancer drugs in the precise dose at the precise time and for the right taget organ; and all the instructions come in the packaging! The “packaging” is your own inner self - the ultimate and supreme genius which mirrors the wisdom of the universe.  Cognition or thinking, moods, feelings and emotions, behavior, social interactions, personal relationships, environment, diet, and the inner world of consciousness including attention and intentionality all influence the biology of healing.”

Now, back to the Forbes article…

It states that “spontaneous remissions are among the rarest and most mysterious events in medicine, with only several hundred cases that can be considered well documented.”  In 1993, two authors for the Institute of Noetic Sciences, created a database of  medically reported cases of spontaneous remission in the world from more than 3,500 references.  This data shows the ability of our bodies to heal itself is not such a rare event. 

Btw, the authors defined spontaneous remission as “the disappearance, complete or incomplete, of a disease or cancer without medical treatment or treatment that is considered inadequate to produce the resulting  disappearance of disease symptoms or tumor.” 

Activate the body’s self-healing properties with Creative Interventions in Patient Care:

  • Art-making
  • Writing
  • Music
  • Dance
  • Humor
  • Laughing Clubs
  • Art Exhibits with artwork created by patients, families, professional staff
  • Indoor and outdoor gardens
  • Art at the bedside
  • Limitless possibilities

 MHand_cycleswritingpaintpalette1flower-butterfly

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Some Messages for Contemporary Medicine…

Posted on September 27, 2009 | 3 Comments

A little humor for the day by Groucho Marx:

 ”I never forget a face, but in your case, I’ll be glad to make an exception.”

I recently read an article written by two physicians in Greece titled, “The Modern Hippocratic Tradition: Some Messages for Contemporary Medicine.”  The article provides background information on Hippocrates and his major achievements in medicine, namely, modern medical practice of attributing disease to natural causes, and treating based on observations, reasoning, and experience.  However, Hippocrates believed and treated his clientele as psychosomatic entities, a holistic medical approach, unlike modern medicine practice which is very depersonalizing and singularly focused on treating the body – not the whole person.

There are many fine points on the state of current medicine (undesireable) and the need for the medical establishment (and healthcare in general) to return to and embrace the basic philosophy and principles of Hippocrates.  Here, I will mention a few by putting the points in quotation marks.  But, read the entire article which you will find interesting.  Source: Marketos S, MD and Skiadas P, MD.  The Modern Hippocratic Tradition: Some Messages for Contemporary Medicine. Spine 1999;24(11):1159-1163.

“…In our times, there is a tendency to forget that the patient must occupy the center of our attention, and in forgetting this principle, physicians have almost lost control of their profession.  The innovation that Hippocrates introduced to medicine was the holistic approach to the patient…he considered and treated the patient as a psychosomatic entity and not as a mere sum of organs…”

“He believed that the human body acts as a whole, so that when an organ is ill, the whole body is being afflicted.”

Hippocrates had a strong faith in nature’s healing power.  He observed the course of  the disease, trying not to interfere with nature.  This attitude should not be explained as a passive stand toward the healing process, but as a respect for nature’s power to cure.  One of his principles is, “Merely give nature a chance, and most of the diseases will cure themselves.”

“Interest has shifted from clinical evaluation of the patients to the assessment and interpetation of sophisticated procedures. In many cases, the efficacy of advanced medical means is being overestimated.  Apart from the fact that exaggerated trust in technology can lead sometimes to inevitable mistakes, this attitude tends to alienate physicians from their target, namely the patient.”

“…the fragmentation of medical science has created a type of physician who regards the patient as a disordered mechanism rather than a psychosomatic entity…”

Hippocrates believed ,”the physician must assist nature, which is the physician of the diseases.”  The natural environment is constantly and rapidly being degradated through contamination of water and food, accumulation of chemicals, nuclear pollution, and the spread of radiation.  The consequences of these environmental changes are apparent already.  Cancer and cardiovascular disease affect a great percentage of Western countries.  This undeniable reality prompts us to rediscover the principles regarding healthful behavior, the quality of life, and the healing power of nature.”

“…biomedical technology has ignored the psychosociologic aspect, treating the patient more or less as a disease and not a unique human entity.  Depersonalization of the patient and a lost sense of his or her individuality can be confronted by keeping the Hippocratic humanistic values in perfect balance with progress in technology.”

“…medicine more than ever senses the need to combine the concepts of humanistic values and the Hippocratic messages with the techonoloic ‘imperative’ (power).  This bond is necessary to the improvement of medicine in the future because, currently, the enormous biomedical technology so far has contributed little to the traditionally human fields of psychosomatic and functional disturbances, posing new dilemmas and threatening scientific problems.”

So, what do YOU think about all this…?

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Posted in -Creative Nursing Interventions, Creativity in Healthcare

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Connecting paintings to patient care

Posted on July 17, 2009 | Leave a comment

At Dartmouth Medical School, a pilot program developed by Dr. Joseph O’Donnell has medical students studying paintings to help sharpen their observational and diagnostic skills.  The medical school collaborates with Hood Museum of Art to assist students to examine paintings, discuss what they (students) have seen, and challenge they to “support their points with visual evidence.”

wassily-kandinsky-solid-green                                      (Wassily Kandinsky 1866-1944, ‘solid green’)

One might ask how examining art is helpful in diagnosing illness and disease in patients.  According to the article, “if a couple of distinctive details in a painting are overlooked, you might arrive at an inaccurate interpretation – very similar to patient diagnosing.”  To read the article, click here.

I’d like to comment on a few points.  First of all, I love that the healthcare industry sees the value in utilizing and incorporating the arts in medical and listeningnursing education.  By applying the same critical observation skills one uses in examining paintings (or any object) to assessing patients, the healthcare practitioner will pick up more of the subtleties regarding a patient’s condition.  However, making an accurate diagnosis is  arrived at carefully listening to a patient’s story of the events leading up her/him seeking medical help, and asking the right questions.

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