Photography and the Education of a Doctor

A stethoscope, a blood pressure cuff and a few other tools are all pediatrician John Moses needs to obtain basic information about the health of his patients. But when he wants to go beyond the clinical setting and find out more about their health issues -- the whys and wherefores of teen pregnancy, for example - he puts the medical instruments down and picks up a camera.

That's what he did as a young doctor embarking on his career in Henderson. He wanted to know more about the pregnant teens who came into his office. So camera in hand, he stepped out of his world and into theirs.

What he learned is that young women get pregnant for myriad reasons, and few of those reasons have anything to do with what he could dispense - birth control pills, condoms and other contraceptives.

Janie, for example, was 16 or 17, and she had two children. "She was unapologetic about why she became pregnant," he said. She had an alcoholic mother and an abusive step-father, so "she got pregnant and had her kids at a very young age in order to have a family that she could feel good about."

That's not, he said, "what a teenager would necessarily walk into a pediatrician's office and announce at a check-up. So now when I see teens in the clinic, my agenda hasn't really changed. I still want them to be healthy and make good decisions for themselves and not get pregnant, or at least delay childbearing until they get older, but I'm just more open to the range of possibilities from their point of view."

Moses, who published photographs of teen mothers in a book called "The Youngest Parents," said he learned through taking their pictures to look not only for vital signs, but also for signs of depression, poor academic performance, and a family history of teen pregnancy. And he now asks them if they've had sex, if they need birth control, and if they want to get pregnant. "It's not a question I used to ask," he said.

Moses left Henderson in the late 80s to work at Duke Children's Hospital and Health Center, where he works as a general pediatrician. He also teaches two courses at Duke's Center for Documentary Studies, one called Medicine and the Vision of Documentary Photography and another called Children and the Experience of Illness.

Listen to a podcast from Dr. John Moses on "Enhancing My Medical Education Through Photography." The podcast was produced by the Center for Documentary Studies.

The children's class looks at illness through the eyes of pediatric patients. Undergraduate students show young patients how to use a camera, and the results, Moses noted, are often revealing.

"Many of the pictures...are not photographs that I would take or a photographer looking at childhood illness would make," he said. "Maybe a photographer would photograph the IV poll e, but they probably wouldn't call it ‘My Buddy.' "

One teenage patient who spent months of her life attached to an IV drip did just that; another took a picture of his father sitting on a sofa and called it "My Dad and Jerry," with Jerry being the child's imaginary friend; and a third focused the camera on his shoes and their Nike logo, not because of his affinity for the brand name, but because of his affinity for the Greek goddess of victory, Nike.

Two of the children -- the one who dubbed her IV pole her buddy and the one who put his faith in Nike -- had cancer and have passed away. The young boy who photographed his imaginary friend had an eye disease and is alive and well.

Moses has also used his camera to capture the work of primary care practitioners - generalists who year in and year out keep tabs on the overall wellbeing of their patients, the ones for whom the relationship between doctor and patient is, or should be, a top priority.

Moses travelled from Maine to California taking pictures of general practitioners in a range of settings; all, he said, were inspirational in how they approached their craft. One stood out, and that was Dr. Donald Moore, who at the time had been practicing family medicine for 49 years in Coats, N.C.

"I was reminded of the basic importance of the doctor-patient relationship when I went out to photograph Dr. Moore," Moses said. "(He) had it in his bones how to build trust and develop a good relationship with his patients."

Moore "had good communication skills, which don't have to be all that complicated. Listening is important. Sitting down can make all the difference."

Many of the primary care photos appeared in a book called Big Doctoring in America: Profiles in Primary Care, which came out in 2001. Since then Moses has taken on a new project, this one focused on gunshot victims.

"I got the idea as a result of one of my patients coming in with a gunshot wound, an 8-year old boy," he said. "He was shot right between the eyes and the bullet miraculously lodged in the skull. It did not penetrate the brain." The bullet was ultimately removed and the boy was fine.

Moses knew the boy from one of Duke's pediatric clinics, and his shooting inspired Moses to learn more about why it happened, so he now uses his camera to explore the lives of young gunshot victims. Like his other projects, he's motivated by one fundamental truth: "There is a lot to look at beyond the clinic," he said, "and that's certainly true with gun violence."