Tuesday, November 18, 2008

Want to be a better Doctor? Read Literature.

Last month the NY Times had an article about what is called Narrative Medicine.
While it has long been understood that clinical practice influenced the youthful writing of doctor-authors like Chekhov and William Carlos Williams, there is now emerging evidence that exposure to literature and writing during residency training can influence how young doctors approach their clinical work. By bringing short stories, poems and essays into hospital wards and medical schools, educators hope to encourage fresh thinking and help break down the wall between doctors and patients.
This is probably a challenge for residents and medical students because they already have a heavy load of reading, but it might also be a relief to them. I remember being a law student and having no time to read anything that wasn't related to my classes. So one semester I signed up for an elective seminar: "Law and Literature". It was so nice to be reading a novel or a play and I didn't have to feel guilty about it.
The idea of combining literature and medicine — or narrative medicine as it is sometimes called — has played a part in medical education for over 40 years. Studies have repeatedly shown that such literary training can strengthen and support the compassionate instincts of doctors.

Dr. Rita Charon and her colleagues at the program in narrative medicine at Columbia University’s College of Physicians and Surgeons found, for example, that narrative medicine training offered doctors opportunities to practice skills in empathy. Doctors exposed to literary works were more willing to adopt another person’s perspective, even after as few as three or four one-hour workshops.
This makes sense to me. If I can put myself in someone else's shoes I naturally become more empathetic. But to put yourself in someone's shoes requires a lot of information about that person. In literature that information is fed to you, so understanding and empathy is easier, at least for me. Then when I find myself in a situation with a live person, I can remember what it was like to stand in the fictional shoes of someone similar and I find myself being more empathetic.
Dr. Ramesh Guthikonda, a second-year resident at Saint Barnabas, spoke about a poem called “When You Come Into My Room,” by Stephen A. Schmidt. In the poem, published in The Journal of the American Medical Association, a man struggling with chronic illness lists all that he believes a doctor meeting him should know:

“When you come into my hospital room, you need to know the facts of my life

that there is information not contained in my hospital chart

that I am 40 years married, with four children and four grandchildren....

that I love earthy sensuous life, beauty, travel, eating, drinking J&B scotch, the theater, opera, the Chicago Symphony, movies, all kinds, water skiing, tennis, running, walking, camping...

that I am chronically ill, and am seeking healing, not cure.”

The poem so affected Dr. Guthikonda that he began regularly asking his patients about their hobbies and families, and he enrolled in a Spanish class so he could learn to better pronounce their names. “My rapport with patients, especially with my Hispanic patients, was not up to the mark,” he said. “I never asked about the patients’ lives, about who they are. I am much more sensitive to those issues now.”

The best doctor I ever had was a woman who had the ability to focus all of her attention on me the entire time she was in the room and make me believe that she was interested in anything I had to say. She always asked follow up questions if I mentioned something that I was noticing about myself and she would often bring it up up during the next visit. Unfortunately she left private practice to become an administrator at the VA hospital. I've always wondered if her skill was natural or if it could be taught. It never occurred to me to ask her if she read literature.