GPs play a crucial role in mitigating the effects of the climate change crisis. The impact of health care on the environment is increasingly clear, and the link between planetary health and patient health is now widely acknowledged. The Royal College of General Practitioners has updated the GP curriculum to recognise the impact on both doctors and patients. Furthermore, the development of a UK Education for Sustainable Healthcare curriculum formalises the need for medical students to understand these issues. Despite these pressing concerns, medical school curricula often leave students ill-prepared to manage the health consequences of climate change.
Current educational approaches typically rely on workshops and scenario-based clinical skills sessions. However, it remains to be seen whether these approaches are the most useful means of educating medical students, some of whom may question the relevance of planetary health to medicine or the existence of climate change itself. A more innovative approach that accentuates the various perspectives of students, patients, and society may complement more conventional teaching methods.
Pieter Bruegel the Elder, Landscape with the Fall of Icarus, c.1560. Image in public domain.
Art offers one such innovative approach. The use of art in medical education is increasingly recognised as improving student empathy, reflection, and acceptance of ambiguity. These are desirable attributes in the modern GP, who may encounter a multiplicity of patient truths and the variegated expertise of postmodern society. Paintings such as Fildes’ The Doctor and Munch’s The Sick Child are already utilised in medical education.
Bruegel’s Landscape with the Fall of Icarus is a potential addition to this collection. The well-known story of Icarus offers a clear analogy to climate change, and its lessons of hubris, dismissal, and lack of self-awareness are also applicable to doctors. In the painting, Icarus, having flown too close to the sun, is partially submerged in the sea. Notably, his extraordinary flight and fall is almost hidden, surrounded by the indifference of the everyday ordinary. In the foreground, a ploughman whips his horse, a fisherman waits for his catch, and a shepherd is lost in a daydream. The painting is associated with the proverb that ‘No plough stops for a dying man’. This lost concern challenges medical students who may be accustomed to viewing the patient in isolation, prompting them to consider the complex interplay between the individual and wider society. The GP is ideally situated to convey a holistic approach to care that encompasses a planet-conscious approach. The painting also lends itself to discussions of other medically relevant themes, such as the interdependent relationship between planetary and human health, food systems, biodiversity, flooding, and heatwaves.
You do not need expertise in planetary health or art to use Landscape with the Fall of Icarus to stimulate conversations about the impact of climate change on health. In Walter Tevis’s novel, The Man Who Fell to Earth, the protagonist describes Bruegel’s painting as something that ‘he had once loved but was now merely used to.’ Similarly, Auden’s poem about the painting observes ‘how everything turns away, quite leisurely from the disaster’, and how we continue calmly on. This everyday indifference to the extraordinary is a key lesson for medical students, encouraging authentic reflection during their clinical placements and interactions with experienced colleagues. Using art can help students connect a patient’s condition to the broader impacts of planetary health. For instance, when assessing a child with asthma, prescribing medication during a heatwave, explaining mercury bioaccumulation in fish to a pregnant patient, or navigating the ultra-processed food options in the local takeaway. GPs should encourage students to examine this remarkable situation, even if others decide it is easier to look away.