The Artful Doctor


Before you reach the articles on anti-coagulation therapy, or echinacea use among children with respiratory infections, or antidepressant-associated sexual dysfunction, you will always see the art.

It might be a Van Gogh or a Vermeer or a Cassatt. It might depict the Madonna or tulips or a boxing match.

But each week, as you look at the cover of The Journal of the American Medical Association (JAMA), you might feel - just for a moment - like you're peeking through the window of a museum of fine art.

"I consider that the heart of JAMA," Dr. Catherine D. DeAngelis, the editor, said of the artwork adorning its covers.

That might sound odd, given that JAMA brings its nearly 600,000 subscribers some of the world's most current and most promising research on topics ranging from hormone replacement therapy to the development of a cancer vaccine.

But the art - along with a one-page essay about the work, the artist and the era in which it was created - is designed to put physicians in touch with the part of their practice that has nothing to do with scalpels or CT scans.

"If medicine were strictly science, you could teach a computer and let the computer do it - probably better than the human mind," said DeAngelis. "The thing that makes a physician a physician, or a nurse a nurse, or a clinician a clinician, is the personal aspect - the aspect that has more to do with the art."

For years, JAMA covers displayed what many scientific journals do today: a table of contents. But on April 20, 1964, in an issue on continuing medical education, JAMA abandoned tradition and ran a reproduction of St. Jerome in His Study by Jan van Eyck.

"I remember, we stood there after we saw the first issue, and it was just like, 'Is the world going to end? Is this heresy?' " said Dr. M. Therese Southgate, who has chosen the cover art for 30 years. But, she said, "It worked."

The idea came from JAMA's editor at the time, Dr. John H. Talbott, an art aficionado and collector whose research took him from South America to the South Pacific. He believed the cover art should somehow reflect the contents.

Now, however, Southgate often chooses works that have nothing to do with medicine. Most are paintings, though she sometimes picks sculptures or mixed-media collages. Her favorite artist is the French post-impressionist Paul Cezanne, whom she calls the "greatest that ever lived."

When Southgate became keeper of the cover in 1974, she was petrified by her lack of knowledge about art. So she became a student of it - just as she had been a student of medicine at what is now the Medical College of Wisconsin. She read books, went to lectures and befriended curators at the renowned Art Institute of Chicago.

"I went over there and haunted it," said Southgate, 75, who never practiced medicine after her residency. "I was so terrified of putting something on the cover that would have some meaning that I had missed."

She reminds people that she's a self-trained amateur art historian, but she is as professional an amateur as they come. By 1996, she had chosen art for more than 1,000 covers and written more than 500 essays. She lost count after that.

A surgeon told her how a patient who liked art but who wasn't recovering well perked up after he gave her a copy of JAMA. A schoolteacher from a small Pennsylvania town wrote that one of her students - the son of a physician - brought JAMA covers to art class because there was no museum nearby.

Covers depicting nudes invariably prompt complaints, as do Picassos - in part, Southgate thinks, because some find his work demeaning to women.

A few years ago, Jocalyn P. Clark, a University of Toronto doctoral student, examined a year of JAMA and wrote an article in the British Medical Journal called "Babes and boobs? Analysis of JAMA cover art."

Clark said that many of the women were portrayed in stereotyped domestic or sexualized roles. "It would be of benefit to see a more thoughtful and balanced representation of women on the front page, reflecting growing scientific coverage of and concern with women's health and social issues," she wrote.

Southgate, for her part, didn't think the discussion worthy of her covers, and didn't appreciate the article's title - even if it was offered in jest.

One of Southgate's most talked-about covers was blank, save for JAMA's name and the date. Called "A Cover Without Art," it first ran in 1996 in an AIDS/HIV theme issue. Southgate got the idea from New York-based artists who commemorate World AIDS Day as a "Day Without Art," when some museums drape cloths over certain works. The stark white cover has run three times since on AIDS issues.

Southgate, who can no longer look at artwork anywhere without wondering whether it might make a good cover, is asked repeatedly to explain the link between art and medicine.

"To put it into words is difficult, yet when one looks at the paintings, one knows, intuitively perhaps, that the visual arts have everything to do with medicine," she wrote in The Art of JAMA II, the second of two coffee-table books of covers and essays. "In a sense it is medicine that unites art and science. Art and medicine exist in a relationship as intimate and as necessary as that between the human body and spirit."

She wants physicians - who examine their patients much the way painters examine their subjects - to revel in the images, rather than just study the science inside. "My first hope is that it enhances their life a little, and then my hope is that automatically, that is passed on [in] their care of patients," she said.

The art cover continues in another journal edited by the son of the man who began it at JAMA. Dr. John A. Talbott, a University of Maryland School of Medicine psychiatry professor, uses American artwork on the cover of Psychiatric Services, which he has edited for 23 years. Like his father, Talbott believes physicians should be more than just caregivers in white coats.

"If they're gong to live a rich life and be stable and good and good clinicians and good teachers, they really have to be more than just glued to a CAT scan," he said.

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