Performing Medicine

In 1991, Mary Rockwood Lane, a nurse friend, and I founded Arts in Medicine (AIM) at Shands Hospital, University of Florida’s (UF), a major North American teaching center. Our goal was to bring artists of every kind into the hospital’s wards and clinics, to offer their myriad arts and crafts to patients and their personal and professional caregivers. We held a strong belief, though back then we had no objective data to prove it, that art and art-making could become a powerful healing force for all.

Over the past thirty-four years, AIM has recruited hundreds of visual, literary, and performance artists to work on every one of the hospital’s care units. AIM’s very first artists were Stuart Pimsler and Suzanne Costello of the Stuart Pimsler Dance & Theater (SPDT), who performed in the hospital atrium to a group of patients and their personal and professional caregivers. SPDT has since worked with professional caregivers throughout North America, offering innovative theatre exercises for creative expression and self-care.¹ Fast growing and compelling evidence—subjective rather than objective—led us in 1995 to create the Center for Arts Medicine, which has gone on to become a leader in the arts medicine movement.²

Medicine is a performance art, whether conducted in the operating theatre or at the bedside. The word theatre derives from the Greek theatron, meaning simply a place for viewing. Historically, it was a public amphitheater where surgeons performed before an audience of physicians and medical students, who were there to learn, and the lay public, packed in like sardines and present simply for entertainment ³.

The Agnew Clinic by Thomas Eakins

Commissioned to honor Dr. David Agnew at University of Pennsylvania, 1889

Hospitals offer a marvellous setting for live theatre against a background of emergency rooms, operating theatres, triage areas and intensive care unit—countless dramas that unfold constantly as caregivers and their recipients interact physically, verbally, and emotionally. Every encounter is an embodied performance in human care.

A child first awoke my awareness of caring as performance. On my first day of pediatric internship in the mid-sixties, I opened the door of the babies and toddlers ward and a three-year-old advanced fearlessly on me, arms stretched upwards. The message couldn’t be clearer. I dropped to a clumsy kneel and he clambered into my arms, pressing his bib—coated with ice cream, or spaghetti, or was it rice pudding?—against my brand new shirt and tie. I hugged him right back, savoring the momentary bliss. Soon after this encounter, a teenage patient with advanced cancer scolded me, “Lighten up, Doc—we don’t need serious doctors around here!” It brought to my mind the mediaeval performances of Venetian plague doctors during the epidemic of Yersinia Pestis—the Black Death. They donned bird-beaks stuffed with dried flowers and spices and toiles cirees to visit the sick, looking to all the world like commedia dell’arte performers. Were they deliberately trying to lighten this desperate situation?

Plague doctor, Marseille, about 1720

Wellcome Collection (Public Domain)

As I gradually learned the art and science of my job as a pediatric oncologist, my callow prods and pokes seasoned into more deft and loving attention. It certainly wasn’t in my job description to sit on my young patients’ beds at close of day, to hear their stories and to share some of my own. But I sensed my simple presence served a purpose. I began trying on a new persona at each bedside, adapting my tone of voice, posture, actions, many times in a working day. My deepening intimacy with those teens and toddlers freed me from the nanosecond culture of deadlines and scut lists and precise dogma of biomedical science. As I listened, rapt, to their stories, often attended by free-flowing tears, I dared to believe my wordless attention, through eyes, ears, and hands, offered them a measure of healing.  

The writer Anatole Broyard, in Intoxicated by My Illness, described living with advanced prostate cancer ⁴. Hooked up to intravenous and urinary catheters, he felt “an irresistible desire to make jokes,” crying out for “a witty doctor who could appreciate the comedy as well as the tragedy of my illness.” So I tried lightening things up for my patients and myself: to staunch their snuffles, I would very slowly withdraw from my trouser pocket my three-foot-by-three-foot Union Jack handkerchief.

Sidney Homan was a UF professor of theatre who worked with young patients on the Shands psychiatric unit, teaching them how to perform: how to move, hold each other’s attention, pick up on visual and verbal cues, and breathe like babies through their bellies. I watched him play his favorite game with sixteen-year-old Linda* as the doctor and Sid as her patient.

Sid (grimacing): “I don’t feel so good, Doc.”

Linda (grasping her stethoscope): “Okay, so where does it hurt?”

Sid (making dreadful faces): “All over!”

Linda (light bulb): “Hmm—better get the shot box!”

Sid (cringing): “Oh, no, not the shot box!”

As they stood toe-to-toe fighting their word/gesture battle, Sid was tapping into Linda’s self-awareness, freeing her from the crusted-over place she had been stuck in, which no amount of psychotherapy seemed able to pierce.

Sid (relaxing): “So how’re you doing?”

Linda (grinning): “Just great! I’m gettin’ into this—this breathin’ with my belly.”

AIM went on to introduce Playback Theatre ⁵, with amateur actors performing patients’ stories through drama, guided imagery, and music. Many reported feeling validated and “restoried” by these encounters. Dramatic performance is a form of caring used in many disciplines, including youth, disability and criminal justice, as well as to improve health professionals’ self-care and their communication skills with patients ^6,7.

A psychology graduate student, Daniel Shapiro, approached me to help him with his dissertation. He had recruited forty women who met objective criteria for being at increased risk for breast cancer. Dan asked me to play the role of a doctor describing the results of a mammogram which showed equivocal results, so was likely to create a tense and ambiguous situation⁸. He used this analogue methodology, because manipulating interactions between real patients and physicians would have been impractical and unethical. He divided the women randomly into two groups; one watched a videotape of me showing the affect and speech of an extremely anxious doctor presenting these equivocal mammogram results. The second group of women watched a video in which I played an empathetic and completely calm doctor while setting forth identical information about the equivocal mammogram.

Those watching the “worried” tape showed significantly greater anxiety on all statistical measures, had significantly less recall and understanding, and perceived the medical situation as significantly more severe, when compared with those watching the “non-worried” videotape. Patients’ full understanding about their health is critical to their health outcomes, so it is vital that they receive consistently accurate medical information. But Dan’s research shows that physician affect plays a substantial role in patient emotional and cognitive reactions to medical information.

The actress Katherine Hepburn once said; “I’m scared all the time. I just act as if I’m not!” I taught several generations of medical students performance skills by having them take turns to play the parts of doctor and patient. I used the following prompt:

“If you have to go into a patient’s room with bad news, what do you do with your body? Do you open the door confidently, or tentatively? How fast do you walk across the room? Do you sit before opening your mouth to speak? How close do you sit? How do you interact with any family members who are present?”

Many students were initially awkward and embarrassed to act out roles with their peers, but with practice they quickly overcame their self-consciousness. They came to recognize that every patient interaction is a performance, and that—as for actors—practice builds self-confidence and communication skills. It’s no accident that we use the word art to describe both creating works of beauty  and offering skilled and compassionate care.

All the world’s a stage,

And all the men and women merely players;

They have their exits and their entrances

From “As You Like It” by William Shakespeare

References

1. Graham-Pole, J. Illness and the Art of Creative Self-Expression. Clydesdale, Nova Scotia: HARP, The People’s Press, 2022.

2. Pimsler, S. The Choreography of Care. Clydesdale, Nova Scotia: HARP, The People’s Press, 2021.

3. Fitzharris, L. The Butchering Art. Scientific American / Farrar, Straus and Giroux, 2017.

4. Broyard, A. Intoxicated by my Illness. New York: Penguin Random House, 1993.

5. Patterson, P. Centre for Playback Theatre: www.playbackcentre.org, 2006.

6. Fisher, A. and Thompson, J. (eds). Performing Care: New Perspectives on Socially Engaged Performance. Manchester, UK: Manchester United Press, 2020.

7. Bouchard, G. and Mermikides, A. (eds). The Routledge Companion to Performance and Medicine. Abingdon, Oxfordshire, UK: 2025.

8. Shapiro, D. The Effect of Varied Physician Affect on Recall, Anxiety, and Perceptions in Women at Risk for Breast Cancer: An Analogue Study. Health Psychology. 1992;1: 61-66.

*Not her real name