The Diagnostic Image: A Way of Seeing

By: Braeden Sagehorn

The first thing anyone does when looking at a painting is simply seeing. At first you might acknowledge the colors, then the shapes, maybe even the medium—pastels or watercolors; maybe you move a little closer to see the brush strokes, tracing where they went, until finally piecing it all together. In fact, it’s quite like looking at a photo. You see the object of the camera, its relation to the background, its depth, sharpness, the angle etc. Every inch informing you about the piece the minute your eyes lay upon it. The beauty of all this lies directly in sight's automaticity. Unless you consciously close your eyes, you’re forever fated to take in that piece of art, and that of the world around you.

Sight is also the first tool utilized by any physician when seeing a patient. As they enter the room you can watch their gait, how they speak, how they sit—mountains of information merely from seeing. Sight is made even more important in the context of pediatric visits where oftentimes the child can’t even clearly communicate how they feel (or perhaps communicate at all). Sight then places itself high on the shelf in terms of essential physician tools. Unless of course you’re Dr. Time Cordes, the second blind person ever accepted into medical school, but for this essay, we’ll be dealing with the majority seeing population of physicians. Here we will be discussing the role of the diagnostic image in this relationship between physicians and seeing.

From the X-ray to the MRI, the diagnostic image plays a pivotal role in patient care. From the minute the image is captured, treatment can be adjusted, diagnoses made, or speculation confirmed. Much like a pro-photographer, an adept physician can effectively see the image instead of merely looking at it. In fact, ‘to look’, etymologically coming from Old English, means to simply gaze or spy. Seeing, however, meant when one became aware of the object of their sight. Instead of simply looking at the image, a physician must become aware of what they’re seeing (you know, part of the reason you study so much in the first place). Just as the camera enhanced our ability to become aware, so too did diagnostic imaging devices; except the only difference being the purely informational use of the image. And then not just the informational aspect, but also the fierce immediacy of acquiring the image.

This immediacy, and availability, allows us to see the world around us effortlessly. At a moment's notice you can see a picture of war-torn eastern Ukraine and become knowledgeable about the true devastation of the region. Suddenly the photo opens a door to witnessing the actual lived realities of an entire world of people. However, this easy ability to become knowledgeable tends to be more problematic than you’d think. For thinkers like Sontag, the question then becomes what one does with said knowledge. Sontag saw the dilemma of a conflation of knowledge with action. For example with Ukraine, knowing about the war doesn’t mean you’re actively doing something to help them. Therefore, the photo grants a certain passivity to its viewer. Except in the case of medicine. Here the photo is viewed, knowledge attained, and then followed by action. The passivity of the photo here is swiftly evaded. And I know what you’re thinking, “that seems kind of obvious, you see something, and then do something about it. That’s literally your job”. And well, yes, that’s the point. Medicine allows you to break the mold that most photos have on people by being able to do something about what it is you’re seeing. How many other jobs get to do that? You get to see something that’s actively going on with someone, and then fix it. It’s cool. Which is exactly why I’m writing about it. Think about that the next time you see a photo of a disaster; try to imagine what you can do to help those people in that moment. Not much, right? This exception that medicine holds is precisely why we get so in touch with others' mortality.

Speaking of mortality, its relationship with the image starts the moment the subject, the setting, become frozen forever in time. This is what Barthes would call the noeme, or the essence, of the photo: what-has-been. Picture a time when you saw a photo of a relative when they were younger. As you begin to take in the image you realize that, unknown to them in that moment, everything about their life transpires. Then suddenly a cascade of emotion emerges bound together tightly by melancholy. This melancholy, this pathos, is what Sontag describes as a sharing of the person’s mortality, of their humanity; at last, you become aware of the photo, you finally see it. The photo before you certifies that which has existed, a testament to its fleeting moment. As for the physician, another dynamic is introduced. Not only then does the scan show what-has-been, but what-is-now. The scan before them, of the broken arm or the tumor, currently exists within the patient; it exists within the present. Now the photo’s essence of what-has-been, evoking the melancholy of a past suffering, elicits a new kind of urgency as the suffering extends into the present. This tension that emerges then can only be repaired through the action of the physician. Through this action, the essence of the diagnostic image returns to that of the photo: what-has-been. This very confliction is what brings physicians even closer to a person’s mortality. It’s part of the reason many of us become doctors in the first place. We saw a photo, realized that it was showing us something that was currently affecting that person right now, and then felt compelled to want to do something about it. The aspect of the image evoking what-is-now pushed us towards wanting to act.

To look at a picture, of any kind, is to come face-to-face with a reality that has existed. Whether it be from a camera or an imaging device, it tells us something important about our interactions with each other. The photo impresses upon us the reality of death; the death of a moment that will never return, the mortality of the subject within its frame, and the death of innocence. For the physician, this face-to-face with the reality of death is coupled with an acute awareness of a present that necessitates action. Therefore, to be a physician, to be a dentist, is to pursue a field that grants one the opportunity for an entirely new, way of seeing.

Further reading if interested

• On Photography by Susan Sontag

• Camera Lucida by Roland Barthes