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In this episode, we talk to Claire Unis. She reflects on her experiences as a pediatrician and how small moments of contentment and satisfaction, like seeing a healthy baby or a budding tree, led her to realize the importance of an aesthetic appreciation in her practice. She shares the story of a newborn patient whose appearance led her to suspect a serious condition and how her medical training and experience allows her to recognize when something is awry just by looking at a patient. As trained scientists, physicians also have a trained aesthetic appreciation and the ability to recognize when something is wrong.

Claire Unis is a pediatrician and author of Balance, Pedal, Breathe: A Journey Through Medical School.

She shares her story and discusses her KevinMD article, “Aesthetics and the physician’s eye.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have Claire Unis. She’s a pediatrician, and her KevinMD article is titled “Aesthetics and the physician’s eye.” Claire, welcome to the show.

Claire Unis: Thank you so much for having me, Kevin. It’s really a delight to be here.

Kevin Pho: We’ll get to the article in a little bit. First off, briefly share your story and journey to where you are today.

Claire Unis: Sure. So I am a pediatrician, but I’m also an author. When I was in medical school, I realized that the changes we go through as we learn to become physicians, as we learn to take care of patients, were really so transformative and so difficult to explain to people that I really wanted to write about them, and I knew I needed to write about them in the moment.

So I actually took a little bit of time off during medical school, and I got my master of fine arts in creative writing while I was in medical school so that I could write about the process of becoming a doctor. That project has finally been published, just in April of this last year. It’s called Balance, Pedal, Breathe: A Journey Through Medical School.

Kevin Pho: So you actually got that fine arts degree in creative writing while you were in medical school. Not many physicians do that. Tell me some of the things that you’ve learned through that journey.

Claire Unis: Well, I learned quite a number of things, but one is that it’s really important to honor your creativity and to recognize what you need, what your soul needs, at the time that it’s needed. At that juncture, I really needed some reassurance that I still had my creative abilities, that I could hone them, and that I hadn’t completely given myself over to the process of becoming a doctor.

My dad loves to say, “Medicine is a jealous mistress.” That may be a dated expression, but the idea is that you can absolutely be consumed and obsessed with medicine and lose sight of who you are otherwise.

Kevin Pho: Now, why is it that the journey to become a physician stamps the creativity out of a lot of prospective doctors?

Claire Unis: Oh, isn’t that a great question? I think part of it was that process of trying to fit yourself into a mold of someone you may not naturally feel like you are, right? We put on that white coat, and all of a sudden we are privy to people’s stories, and we are touching them in a way we would never normally be able to touch a stranger, right? So you’re holding this new responsibility and this new identity before you’re really even sure that’s what you want or have earned. I think that process of changing is so acute and so all-consuming that it’s easy to feel like all of you is changing into this new persona that you’re still getting to know. Does that make sense?

And then of course, we all know once we’re in medicine that the amount of time that we can give to people is really bottomless. It’s such a wonderful feeling to be needed, to give care, and to feel like what you’re doing is important that it’s fairly easy to give ourselves over to that process entirely and feel like that is the sum total of who we are.

Kevin Pho: Now, during medical training, you actually took the time and effort to get a degree in creative writing. That’s not something a lot of medical students would do. Tell me some of the questions that you asked yourself as you were coming to this decision.

Claire Unis: I think the main question was whether there would be any negative consequences for slowing down my medical education to do this, and I really couldn’t see any. I didn’t follow a completely traditional path to begin with. I had taken a year off after medical school, and not to do research or anything that’s supposed to be useful for getting into medical school. I actually moved to the Eastern Sierra and waitressed and rock climbed and decided to do absolutely nothing responsible during that year. So I was not a stranger to taking a little bit of time off, and I felt that it helped me be sure of my next steps and be sure that I was going the direction I wanted to go.

Of course, while I was in graduate school for creative writing, I had moments of wondering whether I needed to take an even bigger step off the path toward becoming a doctor. And yet writing about the process, I think, if anything, confirmed my commitment to continuing on.

Kevin Pho: Now, for those physicians and medical students interested in adding a little bit of writing to their daily life or their professional life, what kind of advice do you have for them?

Claire Unis: That’s a wonderful question. At one point I actually had, and this is the old paper book calendars, where you have this little rectangle of space to write on for each day. That was all I could muster during a lot of my medical school training: I could write a few sentences at the end of the day. But it allowed me to hang on to some really important, poignant moments that I could then go back and write about more in future times.

So if you can commit to any kind of journaling, even just a few sentences at the end of the day, it really does quite a lot to help you feel like you are holding on to those emotional moments or those processing experiences that you can then go back and write about more later, if you are someone who enjoys writing. I think many other people have talked about things like a gratitude journal at the end of the day, which can be a really helpful way to reconnect with purpose as well. But for me, my writing was about, “OK, how am I going to remember this so that I can really recreate the experience?”

And then of course, there has to be some time somewhere where you really do commit and say, “OK, this is my writing time.” I currently have a couple of blocks of time every week that are writing time, and I will go back and say, “OK, what is it that I’ve been meaning to explore more?”

The other advice that I have is free write first. Don’t put constraints on yourself. Don’t say, “OK, I’m going to sit down and write my KevinMD article right now.” I sit down and I free write for a while before I figure, “OK, that’s the nugget that I need to develop.” More often, what happens as I write is that the topic goes in a completely different direction than I thought it would, and there’s a lot of self-discovery that happens if you give yourself permission to write total junk first and then hone it later.

Kevin Pho: All right, let’s talk about your KevinMD article. It’s titled “Aesthetics and the physician’s eye.” Now tell me, how did this article come about?

Claire Unis: That’s a great question. I was noticing, and this is often how it is, you go through your day and you realize that just small things make you happy. I can feel that when I look at a tree that’s budding, or I can feel that when I see a baby who’s totally healthy, or little small things. I was finding that I was actually deriving little bits of contentment and satisfaction from these moments, and I was also noticing about myself that my vision will snag on something that’s awry.

It led me to reflect that just shortly after residency, I had seen a baby for follow-up who was a newborn, and something just didn’t look right about this baby. I sent them into the hospital to be admitted, and the baby turned out to have HSV encephalitis. The mom asked me later, because I went to visit them in the hospital, and she said, “How did you know?” I didn’t have a great answer, except that our experience teaches us to recognize sick.

This is almost 20 years ago now, but as we go through our practice, we really recognize, when we look at patients, what sick looks like. We know what is problematic in a rash or what isn’t, for example, or we see an injured arm and we have a sense just from looking whether something is injured. So I think the article was really intended to honor the fact that as trained scientists, we also are trained to have that aesthetic appreciation and recognize when something’s awry.

Kevin Pho: How long did it take you to hone that sense? Because I totally get what you’re saying. Just by opening the door and looking at a patient for the first time, experienced physicians know which patients are sick. Or, just coming out of residency, how long would you say it took you to really, I wouldn’t say master it, but really be comfortable with it?

Claire Unis: Well, with that first patient, it was my first year out of residency. So I feel that my residency prepared me pretty well to recognize what sick looks like, and that’s a really important point, because as physicians, we really have quite a bit of training by the time we are allowed to practice. I don’t know if that’s true of everyone, but I think that if we have a residency in which we are seeing enough sick patients, we really do get to recognize what sick looks like.

Now, honing the finer points, I think that’s a gradual process. We are all learning and growing every day, hopefully. That’s one of the wonderful things about medicine as well, right? We talk about how it can be all-consuming; that’s because we’re never done learning either. So I would say that’s probably still an evolving situation, depending on what illness we’re talking about.

Kevin Pho: So take us into your world of pediatrics. Give us some examples of some of the things that you would see. What are some of these aesthetic tip-offs that would clue you into whether this patient needs more attention, whether this patient is sick? In your world of pediatrics, what would be some examples of that, other than the one that you told in your story?

Claire Unis: I remember having an attending who would call it the “smile sign.” If you walk in the room and the baby’s smiling and delighted at you, they’re probably not very sick. That may or may not be true, but I think there is quite a bit of truth to it. If you cannot engage a child with you, if they don’t have that little spark of interest, then that’s a very concerning sign. So I think that’s probably top of my list.

And then of course, one of the beautiful things about pediatrics is we’re dealing with all different ages of people, so it depends what we’re talking about. Another one would be injuries. I see a lot of knee pain for various reasons; maybe it’s just an area of interest. I think it doesn’t take very long to figure out which ones we really need to worry about and which ones we don’t. Some of it is the physical appearance, the swelling, but a lot of it is in how that patient may be moving, even just from the table or when you start to examine them.

Kevin Pho: Now, for the things that are not physical in nature, we read about how a lot of teenagers are going through a lot of behavioral health and emotional issues, and I’m sure that you see that a lot in your clinic. Take us into your exam room. What are some of the things that would make you ask the questions and suspect that something may be going on beneath the surface from a behavioral health standpoint?

Claire Unis: That’s a great question. We often will see complaints that are not anxiety or depression right up front but turn out to be exactly that. In a younger child, anxiety often will present as behavior problems. The child will absolutely, completely lose it and tantrum in situations where it’s not appropriate, and we have to take a step back and ask ourselves, “OK, what would provoke such a strong reaction?” We have to recognize that often there are sensory factors at play that we didn’t notice, or that there may be anxiety, which there may be a family history of as well. So we’re always keeping in mind, when there’s a behavioral complaint, that there is usually some emotional component underlying it, or of course, there may be a physical component as well.

Not uncommonly, I will get the complaint that a teenager is having attention problems. They can’t focus in school. That’s a common one. You start to see real problems academically, and the underlying problem may absolutely be depression, but no one thought to ask that necessarily early. So especially since this pandemic started, I think we really have to have our antenna up for that.

I will also say there’s an interesting phenomenon: I get a lot of kids coming in, usually my young teens, complaining of anxiety. I think there’s a lot of discussion among them about anxiety, and sometimes we have to take a step back and go the other way and say, “OK, well, wait a second. Anxiety can actually be a positive, right? There are actually ways in which anxiety can serve you well.” We don’t want to overfocus on that as well. There’s really no shortcut for getting to know your patients and their circumstances.

Kevin Pho: What would be some examples where anxiety could be a positive?

Claire Unis: Oh, so for example, when you are getting ready to do a presentation or getting ready to take an exam, you may feel pretty anxious about your performance, right? That anxiety, in an ideal situation, is going to drive you to study for that exam or drive you to prepare for that presentation or that performance, if we’re talking about theater or dance or song or whatever it might be. So in some situations, anxiety is very adaptive, right? I think all of us who’ve gone through medical school certainly remember that anxiety, even just sometimes meeting a patient for the first time or needing to present that patient. But it does heighten your focus and help you to perform your best in an ideal situation.

Kevin Pho: We’re talking to Claire Unis. She’s a pediatrician. Her KevinMD article is titled “Aesthetics and the physician’s eye.” Claire, what are some of your take-home messages that you want to leave with the KevinMD audience?

Claire Unis: Thank you for asking. I really find that one of my great pleasures right now is helping physicians express their creativity. I think that in many cases, physicians believe that they don’t have the ability to write or express themselves creatively. They may not have tried for many years, and yet we have so many stories and so many experiences that can weigh us down if we don’t give them words, give them wings.

So I guess my take-home is that I hope that anyone in this audience will take the time to express themselves. Don’t grade yourself. Don’t evaluate whether this is good writing or not, but let yourself speak on that page. You will be surprised by the things that come out and the self-discovery that happens as a result.

Kevin Pho: Claire, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Claire Unis: A pleasure. Thank you so much for having me, Kevin.