This is the second part of a two-part series in which our editor Tessa Roberts-Smorenburg explores the relationship between art and care from a care-ethical perspective. Building on the reflections developed in Part I, she examines several presentations from the international forum The Art of Observation: How Art Improves the Skills of Healthcare Personnel in Rome (November 20-21, 2024) and relates them to questions of observation, uncertainty, and power in contemporary oncology care.

In the first part of this series, it was argued that art can make visible what often remains unseen in contemporary healthcare. Within increasingly complex systems of care, art creates opportunities to attend to vulnerability, ambiguity, and forms of experience that are difficult to articulate within dominant healthcare narratives.

The presentations at the international forum in Rome suggest, however, that the contribution of art extends beyond improving observational skills alone. Art not only helps healthcare professionals observe more carefully, but also invites reflection on the political dimensions of care: on whose experiences become visible, whose voices are heard, and how relations of power shape both perception and practice.

What we notice, and what remains unnoticed, is influenced by professional training, institutional structures, social imaginaries, and relationships of power. These matters strongly resonate with contemporary oncology care. Advances in personalized medicine and diagnostic technologies have created new possibilities for patients while simultaneously increasing uncertainty and complexity in a growing can-do society.

Caregivers are required to navigate expanding treatment options, uncertain prognoses, and difficult questions regarding quality of life. In such contexts, observation is never simply a matter of identifying symptoms. It involves attending to patients, collaborating with colleagues, and reflecting on the institutional environments in which care takes shape.

From a care-ethical perspective, three interconnected themes stood out throughout the conference. First, art teaches us how to observe and tolerate ambiguity while remaining in uncertainty. Second, it demonstrates how prior knowledge shapes what becomes visible and what remains in the background. Third, it reveals that observation is inseparable from questions of power, positioning, representation, and the political dimensions of care.

Across these themes, the importance of interprofessional collaboration repeatedly emerged. Perception is not an individual achievement but a relational practice, shaped through dialogue with patients, families, and colleagues who bring different forms of expertise and experience to the interpretation of complex situations and institutional contexts. Together, these themes offer important insights into the challenges of contemporary oncology practice.

The conference itself opened with a presentations by Professor Vincenza Ferrara (Sapienza University of Rome, Italy), who hosted the conference. In her presentation Art and Training in the Healthcare Area in Italy, she reflected on the growing use of Visual Thinking Strategies (VTS) ((1)) within healthcare education in Italy. According to Ferrara, the method contributes to the development of empathy and helps bridge the distance that can emerge between physician and patient.

At the same time, it strengthens observation and listening skills, supports interprofessional communication, promotes resilience, and helps healthcare professionals cope with stress in increasingly demanding care environments. A similar perspective was presented by Dr. Joel Katz (Dana-Farber Cancer Institute and Harvard Medical School, USA) in his lecture Adapting VTS to Address a Spectrum of Healthcare Competencies and Audiences. Katz demonstrated how Visual Thinking Strategies are integrated into medical education at Harvard-affiliated institutions.

Observing Under Conditions of Uncertainty

Several presentations focused on iconodiagnosis, a field that examines how signs of disease can be identified and interpreted in artistic representations. Italian surgeon Paolo Zamboni demonstrated how paintings can support the recognition of possible disease manifestations through careful observation of posture, facial expression, skin tone, and bodily appearance ((2)).

Similarly, Italian dermatologist Massimo Papi explored in his presentation The Skin Like a Canvas how depictions of the skin can provide insights into health, living conditions, social status, and historical context. Related to this approach, Dutch surgeon Thomas van Gulik presented the ABCD method, a structured art-based observation technique based on Visual Thinking Strategies (VTS). Through the sequential steps of Attention, Behold, Communicate, and Diagnose, participants use artworks to develop observation skills and strengthen diagnostic reasoning ((3)).

At first glance, these approaches appear primarily concerned with improving diagnostic accuracy. From a care-ethical perspective, however, their significance extends beyond identifying disease more precisely. Clinical practice, particularly in oncology, is characterized by uncertainty.

Symptoms may be ambiguous, treatment responses and choices vary considerably between patients, and outcomes often remain difficult to predict. Even when biomedical knowledge is highly sophisticated, there are limits to what can be known with certainty. Moreover, what is perceived and how it is interpreted are shaped not only by clinical expertise, but also by institutional contexts, professional norms, and organizational priorities.

What these educational practices teach, therefore, is not simply how to see more. They teach participants how to remain with what is not yet fully understood. Viewers are encouraged to slow down, suspend immediate judgment, and remain open to multiple interpretations. Rather than treating uncertainty as a problem to be eliminated, art invites healthcare professionals to stay attentive within it.

This lesson is particularly relevant in oncology care, where decisions about treatment frequently involve balancing competing goods: extending life, maintaining quality of life, minimizing suffering, responding to patients’ wishes, and navigating uncertain futures. Observation therefore extends beyond biomedical indicators. Caregivers must also attend to changing hopes, fears, and existential concerns that emerge throughout the illness trajectory. From a care ethical perspective, good observation does not arise from certainty alone. It emerges from the capacity to remain attentive when certainty is unavailable.

Learning How Knowledge Shapes Seeing

Questions of observation and interpretation were explored further in the presentation Meaningful Engagement: Using Art to Improve Observational Skills in Health Care by dr. Veronica White (Princeton University Art Museum, USA). White discussed two paintings by the Neapolitan painter Carlo Coppola depicting the plague outbreak in Naples in 1656.

The first, The Pestilence of 1656 ((4)), positions the viewer close to suffering. Its relatively intimate scale invites careful attention to individual bodies, gestures, and expressions. Viewers encounter those who are ill and dying at close range. His second painting Market Square during the plague of 1656, completed several years later, depicts the same epidemic from a different perspective ((5)). Here the viewer encounters a broader social landscape. The eye is guided across a crowded marketplace filled with victims, while religious symbolism appears in the background. Although the subject matter remains the same, the position of the observer has changed.

The comparison reveals that perception is never neutral. The position from which we observe, shapes what becomes visible. Certain elements move into the foreground while others recede into the background. As White noted, art historians compare visual elements across artworks in much the same way that clinicians compare symptoms across patients. In both cases, interpretation is guided by prior knowledge.

Looking more slowly reveals how composition and color guide attention. Particularly striking is Coppola’s use of visual language borrowed from battlefield painting. Disease is framed almost as a military catastrophe, shaping how suffering is perceived and understood. The painting tells a story not only about illness but also about society’s apparent inability to care adequately for the sick and the dead. Bodies lie exposed in the mud, some uncovered, blending into the earth itself. The image confronts the viewer with collective vulnerability and social disruption.

For a care ethicist, such observations raise broader questions. How do we represent illness and suffering? What becomes visible, and what remains outside the frame? What language do we use to make sense of disease? These questions remain highly relevant in contemporary oncology care. Clinicians now have access to technologies that reveal increasingly detailed biological processes.

Yet the expansion of biomedical knowledge can also narrow the field of attention. Biomarkers, scans, treatment protocols, and measurable outcomes become highly visible, while uncertainty, grief, vulnerability, and hope may become less apparent. Knowledge shapes perception by influencing what becomes visible and what remains in the background. Art therefore offers more than a tool for sharpening observational skills. It creates opportunities to reflect on the frameworks through which observation takes place. It teaches us to ask not only what we see, but also why we see it in a particular way.

The Framing of Narrative and Meaning

Questions of interpretation emerged again in the ArtMD project, presented by Professor Christine Bentley (Missouri Southern State University, USA) in collaboration with Dr. Joel Katz (Dana-Farber Cancer Institute and Harvard Medical School, USA).

The project approaches artworks simultaneously from medical and art historical perspectives, for example through the analysis of André Brouillet’s A Clinical Lesson at the Salpêtrière (1887) ((6)), a painting that depicts neurologist Jean-Martin Charcot demonstrating a patient before an audience of physicians and students and highlights the central role of observation in medical practice.

Medical observers focus on pathology, symptoms, treatment, and disease manifestations. Art historians attend to context, symbolism, artistic style, and cultural meaning. Looking at the same artwork, observers often arrive at different interpretations because they bring different forms of knowledge to the encounter.

From a care-ethical perspective, this is an important lesson. Every perception is embedded within a framework of meaning. Professional expertise makes certain things visible, but it can also leave other dimensions of experience outside the frame. This dynamic is easily recognizable within oncology practice. Alongside the biomedical narrative of diagnosis and treatment, there are organizational narratives shaped by protocols, pathways, and quality indicators.

At the same time, patients and families tell stories about loss, changing identities, disrupted futures, hope, and everyday life. These narratives do not always align. Art reminds us that meaning is never fixed. It encourages caregivers to recognize the coexistence of different perspectives and to remain attentive to experiences that challenge dominant interpretations.

Within Structures of Inclusion and Exclusion

Questions of power became particularly visible in the presentation Making the Invisible Visible: Art, Identity, and Hierarchies of Power by PhD candidates Kerri Davidson and Hana Ghoneima (Yale School of Medicine, USA). The presenters compared artworks depicting similar themes while emerging from very different historical contexts.

One example was French painter Paul Gauguin’s Parau Parau (1892) ((7)), a work produced within a colonial context and shaped by a European gaze. In discussions with students, questions emerged about colonialism, representation, and the continuing influence of historical power relations on contemporary interpretation. The central question was simple yet profound: Who gets to tell the story?

From a care-ethical perspective, this question extends directly into healthcare. Patients are continuously represented through diagnoses, reports, categories, and professional narratives. Such descriptions are necessary, yet they are never neutral. They shape how patients are perceived and how others subsequently relate to them. Within oncology care, where patients often move through complex treatment trajectories involving multiple professionals and departments, institutional narratives can become particularly powerful.

Patients may come to be known primarily through diagnoses, treatment histories, or prognostic categories before their own voices enter the encounter. The contemporary American artist Kehinde Wiley The Call (2019) ((8)) offers an illuminating contrast. Rather than determining how his subjects should be represented, he actively involves them in shaping their own image. Representation becomes a collaborative process rather than a unilateral act.

This offers an important lesson for healthcare. Good care requires more than observing another person. It requires creating space for that person’s own interpretation of their situation. Observation is therefore fundamentally relational. At the same time, these examples remind us that care is not automatically good or romantic. Care can support and empower, but it can also exclude, categorize, silence, or overlook. Through engagement with art, participants experience how power operates within practices of observation and interpretation, making visible dynamics that might otherwise remain hidden within institutional life.

Relearning How to Perceive

Taken together, the presentations in Rome reveal a broader contribution of art to healthcare than is often assumed. Art trains observational precision, but it also cultivates reflexivity. It teaches healthcare professionals to become aware of how uncertainty, prior knowledge, institutional structures, and power relations shape perception.

In doing so, it encourages forms of attentiveness that remain open to complexity rather than reducing it too quickly. Throughout the presentations discussed here, art repeatedly functioned as a practice of making the invisible visible while simultaneously drawing attention to the conditions under which visibility is produced. Sometimes by revealing subtle clinical signs, sometimes by exposing the assumptions that shape observation, and sometimes by drawing attention to voices and experiences that remain marginalized within dominant healthcare narratives.

For oncology practice, this may be particularly valuable. As diagnostic and therapeutic possibilities continue to expand, there is a growing need to safeguard ways of perceiving that remain attentive to the relational and political dimensions of illness. Patients are more than biological bodies, and care involves more than clinical interventions. From a care ethical perspective, perhaps this is the most valuable lesson offered by the intersection of art and care. The examples discussed throughout this article demonstrate that art offers more than a method for teaching observation.

Together, they illustrate how art can help caregivers remain attentive to complexity, vulnerability, ambiguity, questions of meaning, and relationships of power within healthcare practice. Art does not eliminate uncertainty. Rather, it teaches us to remain attentive within it, together with patients, colleagues, and others involved in care.

At the same time, an important question remains to what extent such forms of awareness can be sustained within healthcare systems that are themselves shaped by strong organizational, technological, and economic pressures. While this question remains underexplored, it highlights the importance of continuing to examine how insights gained through arts-based approaches can be translated into everyday healthcare practice.

Follow-up symposium

The conversations initiated at the Rome forum continue to evolve internationally. A follow-up symposium, Bridging Visual Arts & Healthcare: Impact, Innovation, Research, will take place at the Center for Visual Arts in Healthcare at Brigham and Women’s Hospital in Boston (USA) in 23-25 September 2026 ((9)). The symposium will bring together healthcare professionals, educators, artists, and researchers to further explore the contributions of visual arts to healthcare education and practice.

Tessa Roberts-Smorenburg will contribute to this symposium as a panelist in the session Interprofessional Teambuilding, where she will present a project developed at the Netherlands Cancer Institute. In this sense, the questions raised in Rome remain open, inviting continued reflection on how art can help us perceive, respond, and care within increasingly complex healthcare environments.’

Notes
((1)) Visual Thinking Strategies (VTS) is an arts-based educational method developed by cognitive psychologist Abigail Housen and museum educator Philip Yenawine in the late 1980s and early 1990s. The method emerged from Housen’s research into aesthetic development, which examined how people construct meaning when looking at works of art. Using facilitated group discussions built around open-ended questions such as “What’s going on in this picture?” and “What do you see that makes you say that?”, VTS aims to strengthen observation, evidence-based reasoning, listening skills, critical thinking, and collaborative meaning-making. Originally developed for museums and schools, VTS is now widely used in healthcare education to foster observation, communication, reflection, and tolerance for ambiguity.
Yenawine, P. (2013). Visual thinking strategies: Using art to deepen learning across school disciplines. Harvard Education Press.

((2)) Van Gulik, T. M. (2026). Which illness is depicted in Caravaggio’s Sick Bacchus? Journal of Education and Medical Humanities Perspectives, Article 101276.

((3)) Van Gulik, T. M., Bult, S., & De Ruiter, P. (2024). Evaluation of the ABCD-method in art-based observational training of medical students and surgical residents in the museum. International Journal of Surgical Education. Advance online publication.

((4)) Carlo Coppola (Italian, active ca. 1635–1672), The Pestilence of 1656. [Oil on canvas], 76 × 99 cm, 96.8 × 119.7 × 5.4 cm (frame). Museum purchase, Caroline G. Mather Fund (y1963-36).

((5)) Market Square during the plague of 1656, Naples, by Carlo Coppola (active 1640-1660), [Oil on canvas], 130×180 cm. Detail. Plague of 1656, Italy, 17th century.

((6)) A clinical lesson at the Salpêtrière by André Brouillet (1887). [Oil on canvas]. Université Paris Cité, Paris, France.

((7)) Parau Parau. Whispered Words by Paul Gauguin (1892), [Oil on canvas], Yale University Art Gallery

((8)) Wiley, K. (2019). Tahiti series. The Call. Oil on linen]. Kehinde Wiley Studio.

((9)) Center for Visual Arts in Healthcare. (n.d.). Symposium information. Brigham & Women’s Hospital.