Essays and poems are part of Dr. Richard Panush’s rounds at Saint Barnabas Medical Center. (Aaron Houston for The New York Times)As a health and medical writer, I have been fascinated to learn about the role writing, and reading, can play in medicine and better patient care.
That’s the issue explored by Dr. Pauline Chen in this week’s “Doctor and Patient” column, where she writes about how literary training can be an essential part of medical training.
Dr. Chen writes: “There is now emerging evidence that exposure to literature and writing during residency training can influence how young doctors approach their clinical work.
“‘We’re teaching the humanities to our residents, and it’s making them better doctors,’ said Dr. Richard Panush, a rheumatologist and chairman of the department of medicine at Saint Barnabas Medical Center.
“The idea of combining literature and medicine — or narrative medicine as it is sometimes called — has been part of medical education for over 40 years. Studies have repeatedly shown that such literary training can strengthen and support the compassionate instincts of doctors.”
Click here to read the full column, “Stories in the Service of Making a Better Doctor.” And please join Dr. Chen in the discussion by posting your comments below.
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From 1 to 25 of 107 Comments
While I fully believe in narratives for empathy building, I take issue with who is teaching these stories. It seems to me that medical schools often hire MDs or DOs to teach the courses, when at the very least it should be team-taught with someone with an advanced degree in English or Literature. Failure to hire someone with this specialty negates the importance of education in a specialty area - it implies that anyone can teach literature. This isn’t true any more than it is true that anyone can teach microbio. I hope medical schools don’t fail to acknowledge the importance of experience in learning and teaching the Humanities.
From Pauline Chen: Individuals with advanced degrees in English, Literature, and Writing have been involved with these programs, either directly or in consultation. Dr. Charon, for example, is not only an M.D. and general internist but is also a well-respected literary scholar with a Ph.D. in English. The individual leading the session for the obstetrics and gynecology residents at New York-Presbyterian Hospital was Nellie Hermann, who received her M.F.A. at Columbia, is teaching faculty there and has just published a critically acclaimed novel.
— JeanWorthwhile?….The Humanities?
Well, finally. Literature is, after all, one of the most personal forms of communication. When will a doctor or med student ever have time to listen to the details of a patient’s narrative with the intensity that they read in the main character of E.B. White’s story? Reading reminds us that everyone we encounter has a narrative we may not, and may never, know. In other words, patients are not just walking viruses.
I disagree with the statement that med students should be taught by a Literature of Humanities professor. The purpose of the class is not to teach students analytical reading or comparative literature. The focus is the plot, the characters, the emotions/ideas provoked by the reading, while a Literature professor would certainly focus on the author’s techniques.
— CARlaThanks to Ms. Parker-Pope for bringing to our attention a new and humane addition to the doctor’s tool kit.
Readers who also wish to learn the uses of the humanities for the patient (including writing and the arts as healing instruments) may want to follow links to the great writing teacher Pat Schneider, founder of Amherst Writers and Artists (www.patschneider.com); and to the Sacramento-based program, Sutterwriters, led by Dr. Lawrence Spann (www.sutterwriters.com).
— Tom GoffAs a medical provider, I have long felt a connection to my patients that I recognized did not exist with my colleagues. I was taught, through literature and the keeping of a diary, precisely what CARla stated: every patient has a narrative we usually do not know, and as someone most trusted by the patient, it was part of my duties as a provider to listen to the words of that narrative. Not everyone wants to tell you their story, and that has to be respected. But to better treat the chronically, and severely ill acute persons is to empathize with them on a humanistic level.
I also disagree with it being said that literature or english professors should teach the lessons of narrative medicine. The idea of narrative medicine does not come from understanding the readings of an analytical or comparitive approach. Rather, it is to understand how the story line follows the real life encounters of the physicians - to bridge the disconnect between ’stories’ and life through discussion and example.
— DanielAnything that bridges the gap and encourages understanding between physician and patient is a good thing.
(I do hope the lab-coated doctors don’t loom over their patients quite as overwhelmingly as in the photo!)
— Carol AnneRe: Carla - If the literature were taught by someone in comparative literature, that may be the case, but it has been my experience that those that have not been educated in English or literature fail to see the layers of meaning. Teaching literature doesn’t entail some feel-good seminar where the only question to be asked of students is “What did you think of this?”
— JeanMuch of what is taught in medical humanities courses is literature that is about being a patient, or about disease states, not simply literature written by physicians. In order to ensure students are taught in an educationally sound, academic environment, the course should be under the direction of someone with that specialty. Otherwise what you have is a glorified book club.
It is a very interesting question that you have raised about the best way to teach these skills to doctors and doctors-in-training.
The Narrative Medicine program at Columbia consists of a faculty composed of doctors and other health care providers, as well as others with advanced training in the humanities, like Nellie Hermann, the novelist and MA in Creative Writing who is teaching the narrative workshops for our OB/GYN residents.
Teaching how to use literature to help bridge the gap between patients and their providers requires the expertise of people who understand BOTH the humanities and the experience of doctors and patients, which is why this field represents such an exciting new dimension of medicine.
— Abigail Ford“How wonderful that you want to help young cancer patients.” That is how most people respond when I tell them my book Everything Changes: The Insider’s Guide To Cancer In Your 20’s and 30’s, is about to be published. My intention in writing this book is not just to help patients, but so doctors too can better understand our interior worlds. Even when asked about our personal lives by the most caring of doctors, patients – especially young ones, are sometimes too shy or embarrassed to reveal the raw honesty of our true experiences. Literature is a poignant bridge for reaching across the doctor-patient gap.
— Kairol RosenthalI read with great interest the article “Combining Literature and Medicine”
— keiichi kamekuraI am not a doctor, but I can treat patients by Okada Purification Therapy(MOA International ).
As one of the therapists I have been exploring any good
way to treat patients when I treat them.
I have never heard of this combining literature and medicine in Japan.
I would like to try this tool in my treatment , so I want to study this much more.
-keiichi
I am a medical student with a literature background from undergrad. I wholeheartedly agree with the purpose of these programs, but the reality is this: the things one must learn in the med school — anatomy, physiology, pathology, immunology, microbiology, etc. — are simply too time-consuming to allow more than a cursory study of literature in some kind of throwaway class. Those students who are interested in it will explore further, but the vast majority won’t find it useless and will just resent it.
— The ScrivenerOnce upon a time ( that is how fairy tales begin) premedical students that I knew at Columbia College wanted a broad based liberal arts education before entering medical (trade) school. Those MD’s who had superior liberal arts training (similar to Dr. Chen’s at Harvard) maintain their interest in non medical matters such as Literature , Art and Science to a far greater extent, I would imagine, than those who prepared with narrower technological emphasis or attended International medical schools which started in the medical sciences right from the onset.
In my personal experience, I have found the liberal arts trained physicians to be in general, more empathetic and intuitive physicians. The writing sample in the MCAT as well as the interviews are wise requirements needed to help identify medical school candidates who posses the ability to express themselves in more ways than mere recalling formulas and equations.
— Harvey Lefkowitz, MDI am glad to see this topic highlighted. During my medical education I was fortunate to have the opportunity to take a literature and medicine class taught by Audrey Shafer (http://bioethics.stanford.edu/profiles/bioethics/faculty/Audrey_Shafer/), and later on to participate in a writing workshop at Yale (http://residency.med.yale.edu/writer.html). I would argue that, since medical school, I have found pathology and poetry to be of equal importance in sustaining me as a physician.
— Dr. D. RifkinI continue to write and to find insight and solace for myself and those I teach and care for using the skills I learned in those sessions. I see narrative medicine as a kind of ‘applied literature’ — a way to understand the human experience of patients and of caregivers.
I’m a huge fan of narrative medicine, but sometimes have trouble finding good narrative medical writers. Atul Gawande is of course the leader of the field right now, near as I can tell, with Oliver Sachs and Jerome Groopman in the mix as well.
Does anyone know where to find good lists of material or authors? The Columbia program referenced above has a good bibliography. Anything else people are familiar with?
Thanks, and thank you for teaching me that there is indeed a name for this vein of writing I enjoy so much!
— R CarterI am a graduate of an osteopathic medical school
— “DocP”who is in her first year of internship. In this day and
age of managed care and hospitals wanting
patients to be admitted and discharged quickly, where
does one have the time to listen to a patient’s life
story? I think this concept of narrative medicine is
great in theory, but not practical in the current
climate of medicine today where we are trained
to see 1 patient every 15 minutes.
Thank you for Dr.Chen’s article and the chance to comment. As an oncologist and a writer I have found that the opportunity to write about my experiences, even if only for myself, but when possible shared through publication and story telling, has greatly enriched my work as a physician. Sometimes immediately, sometimes from a great distance in time, I can relive incredibly poignant moments and comprehend their meaning in much more profound ways than is allowed in my average too busy day. Seeing and reviewing my own description of what happened takes me to a deeper level of understanding when I did a good job and when I failed. Being a writer and a reader unquestionably makes me a better doctor and teacher in the training hospital where I work.
— Kathleen Ogle, MDEach patient has a unique story. Each patient want to tell that story. Doctors are privileged in that they are allowed to ask for those stories. But rarely do they ask - because of time constraints.
Many writers have been physicians. What connects these two professions is the human story. We all want to hear that story, and we all want to tell our story.
Alexa Fleckenstein M.D., physician, author.
— Alexa Fleckenstein M.D.Great piece. I love seeing Rachel Remen’s “Kitchen Table Wisdom” in the photos. My wife and I participated in a faculty seminar led by Dr. Remen on teaching a course she started at UCSF called “The Healer’s Art,” now taught at more than 60 medical schools worldwide.
Her own narrative is compelling; the way she captures the stories of her patients and their families is a blessing.
Her life and work would be a great topic for a profile in Health.
— John Schumann, MDAs an ER doc and writer, Instructor in Narrative Medicine at Columbia with Rita Charon, I have found that being able to write down even a snippet or two of the never ending stories that unfold before me in the ER (and that, obviously, I become totally involved in as the physician taking care of the patient) has helped me tremendously in dealing with the intense emotional highs and lows that are so much a part of the job.
As Rita says, when you write about something it allows you to subsequently stand outside the experience, walk around it, see it from many other points of view.
Being involved in Narrative Medicine has given me tremendous compassion for my patients and has, whenever I can wrench a few free minutes to just talk and interact with them, allowed me to learn so much more about them, understand how they see themselves and how they see their illness in terms of their self-told life stories.
In terms of the issue of who is best qualified to teach this:
— Ken WI must say that working in a group with Rita, as we all read our stories and poems, to be able to have the insights of her literary expertise, is astonishing. The more experienced the literary (and medical) background of one who runs a program in Narrative Medicine the richer and more nuanced the connections all involved will make, whether they be psychic, medical, creative. The places a group can go are endless.
I couldn’t help but wonder about the photograph illustrating the article. How did the patient, surrounded by a crowd of observing physicians, one of them reading to her, feel? Did she feel cared for as a person or placed in the role of a theatrical prop?
— Eben SpinozaCroatian Journal for Public Health, has a regular feature on „Literature and Health.“ Our Journal is on Internet, open to everyone, including Dr Chen and YOU (Google: hcjz), in line with our beleif in a global moral community, health for all and averyone. We promote the idea that global connection should inclede health, that every country should have a health journal, and health should link to literature as well as to science. We have already published beautiful works on peace tolerance, facing poverty and other works. We support, practice and invite cooperation in work on health and literature, health and challenge of goodness in this one world, of many countries and billions of homes and wonderful people.
— Dr Slobodan LangThis approach fascinates me, because I have witnessed the power of the written word to reach the human heart.
My mother was a legendary high school English teacher in my hometown, and then a legendary literature and creative writing professor in a nearby University town.
I remember countless occasions when, while eating in a restaurant or stopping to fill up on gas, someone approached her and said something like, “You probably don’t remember me, but you changed my life forever.”
These revelations didn’t necessarily come from budding scholars and future writers, but rather from her less likely fans, who discovered the transformative emotional value of great literature and creative self-expression.
But here’s the rub. It may not be so easy to transfer the emotions touched by academic exercises, to the grueling routine of cranking patients in and out of the office.
Again, recalling my wonder at my mother’s academic life, I was often flabbergasted at the callousness of her colleagues and the great writers who came through the campus on seminars. I remember pondering , “How could someone, who must be so sensitive, be so cruel?”
It’s not so much a doubt as it is a question, because I’m excited about the idea.
I enjoy Dr. Chen’s articles on the subject of empathy in medicine, and I hope they keep coming. It’s a subject vital for health care, and also, vital for our society. How do we go from a country where “liberal” is the “L” word, to one in which we care as much about the elderly, the homeless, and the people with no health insurance, as we do about people (ourselves?) who can’t afford luxuries in a bad economy?
We all need more compassion. Let’s discover how to find it, and then how to use it.
— WesleyI was always thankful that I did my psychiatry clerkship at one of the community hospitals rather than the lofty medical center. One of the better aspects of the community program was a seminar that was purely from the literary standpoint. We read and discussed short stories, passages, poems written by those in the throes of various psychiatric states - severe depression, psychosis, mania, others. That probably brought home much more so than any patient exposure that could be otherwise garnered during that limited time span.
That seminar series likely played a great role in my ability to express empathy and non-judgment regardless of a person’s condition. (I’m an internist.)
This era of EMRs and documenting to bullet points has eroded the humanity of medicine. I recall attendings who lamented at the coldness of the presentations - “45 year old white male presenting with….” as opposed to “45 year old unlicensed plumber, single father of 2 who noted …”
— susanFor several years I participated in a fiction writing program that deeply affected me. The instructor was an amazing professor at Northwestern. Through his guidance in terms of how we both read and wrote stories, I learned to curb my impatience and judgments, slow down, and pay attention to what people were doing and saying, and then think about what it all meant. When studying literature, you are studying people. Not a bad skill for a doctor to develop.
I am sure I know which Lorrie Moore story was likely studied when mentioned above–she wrote a brilliant one about a child with leukemia called “People Like That Are the Only People Here.” With the classic phrase, “Peed Onk” (for pediatric oncology). And these lines, which still give me a painful smile:
“The oncologist shrugs. What casual gestures these doctors are permitted!”
— Francois“gently touching their patients…” I hate that. I have my boundaries, you know. Being a patient equals a million indignities; I don’t want more of the same. Be gentle when you insert that thing into my vein, otherwise, hands off!
I agree that the courses shold be taught by specialists in the field. The people who imagine a Literature professional would do something worse than a lay person do not have a clear understanding of what literary analysis entails.
It never fails to amuse me when people of limited scope discover the wonders of Literature. Duh!
This article reminds me of another on Urban Literature (code for black pulp). Maybe medical narrative will get physicians to read, who knows?
Still in medieaval times, universities required that every student first take Liberal Arts, to provide them with the necessary fundaments. Today, we have university graduates who may be apt in their profession, but I would hesitate to call them educated.
— SusannaWe read Dr. Chen’s article, “Stories in Service of Making a Better Doctor,” and this comments section, “Combining Literature and Medicine,” with interest and enthusiasm. At University of Alaska Anchorage we are developing a community outreach Web resource—LitSite Alaska. One of the areas of focus is Narrative and Healing. < http://www.litsite.org/index.cfmsection=Narrative-and-Healing >.
— Ronald Spatz, MFA
We invite physicians to contribute their personal narratives.