Writing for Wellness

The Literature: How Reading Fiction Builds Empathy

Much of medical training is spent reading literature. This is mostly in the form of textbooks, primary research articles, or summaries of the most recent literature (UpToDate, etc.). We sit in seminars and absorb facts and spend our free time catching up on the stack of journals we get in the mail (my flights to see my husband are spent reading JAMA andPediatrics in Review). But though we have so little free time and so much to read, it may behoove us to pick up some literary fiction every once in a while.

Empathy and the ability to relate to our patients and colleagues is a crucial part of the practice of medicine, and multiple studies have found a correlation of increased empathy in those that read more literary fiction¹. An increase in empathy scores based on various measures has even found to be inducible after reading literary fiction, but not nonfiction, popular fiction, or science fiction^2-4. Literary fiction, in this case is literature that includes complex characters with nuances that require the reader to search for meaning. This is in contrast to popular fiction, in which the reader to read passively due to the fact that characters conform to expectations, as well as nonfiction, in which the prose very clearly lays out the exposition as opposed to requiring the reader to draw conclusions and make inferences⁴.

Reading literary fiction specifically has also been shown to improve vocabulary, general knowledge, and other verbal abilities and generally make more successful students starting at a young age⁵. But why is this so specific to literary fiction as opposed to anything else? Literary fiction is essentially a simulation of social worlds and contexts^1,5. It allows us to follow the trajectories of human agents we care about and to become invested in their stories, but with none of the risk that comes with social investment in the real world^1,4,6. Just like our relationships in real life, in social encounters we are forced to read between the lines and infer how characters are feeling based on their words and actions^5,7,8. Since we are required to contribute our own voices, we consider our own perspectives within the context of the fictional world and actions⁴. And when the characters do not conform to our expectations of how we think they should behave, it makes us reassess our own expectations and assumptions^5,6. This critical thinking enhances cultural competence, awakens curiosity, and increases empathy and self-awareness^5-7. It also allows us to be more comfortable with uncertainty and ambiguity, two incredibly important characteristics in medicine, because we are experiencing it in such a low risk environment⁷.

In these social worlds, we are transported to situations and circumstances we would never experience otherwise, but we are still able to relate to characters and understand their experiences more fully, which then can be translated to our patients. It reduces the strangeness of others as we imagine ourselves in their shoes⁴. And it presents us with situations that may not have ever taken place but could conceivably occur in the future¹.

I spent much of my time in college, graduate, and medical school reading medical nonfiction, not only because that is what interested me, but because I thought it would help me prepare for life as a physician. One the one hand, The Immortal Life of Henrietta Lacks by Rebecca Skloot does paint a pretty grim and compelling picture of systemic discrimination in the healthcare system in the United States while also proposing ethical questions about medical experimentation and ownership of tissue. However, The Death of Ivan Ilyich by Leo Tolstoy taught me about the pain a man experiences when no one acknowledges his impending death, not because it is explicitly mentioned, but because it can be seen in his words and actions at the end of his life. It stimulated my imagination to feel what he is feeling, just like I need to do with my own patients. Maybe next time I’m on a plane, I will put down my JAMA and pick up a novel.

References

Oatley K. The cognitive science of fiction. WIREs Cogn Sci. 2012;3:425-430. doi: 10.1002/wcs.1185.
Pino MC, Mazza M. The Use of “Literary Fiction” to Promote Mentalizing Ability. PLoS One. 2016;11(8):e0160254. doi: 10.1371/journal.pone.0160254.
Bal PM, Veltkamp M. How Does Fiction Reading Influence Empathy? An Experimental Investigation on the Role of Emotional Transportation. PLoS One. 2013;8(1):e55341. doi: 10.1371/journal.pone.0055341.
Comer Kidd D, Castano E. Reading Literary Fiction Improves Theory of Mind. Science. 2013;342(6156);377-380. doi: 10.1126/science.1239918.
Oatley K. Fiction: Simulation of Social Worlds. Trends Cogn Sci. 2016;20(8):618-628. doi: 10.1016/j.tics.2016.06.002.
Saffran L. What Pauline Doesn’t Know: Using Guided Fiction Writing to Educate Health Professionals about Cultural Competence. J Med Humanit. 2018;39(3):275–283. doi:10.1007/s10912-016-9430-4.
Johnson JM. Finding Time for Fiction. Acad Psychiatry. 2015;39(6):713-715. doi: 10.1007/s40596-015-0341-x.
Seeman MV. The Psychological Uses of Fiction. Psychiatry. 62(1):83-90. doi: 10.1080/00332747.1999.11024855.

The Literature: List of Works in Narrative Medicine

Full Disclosure: I am on vacation this week and spending time with extended family taking naps, eating homemade goodies, taking long walks, and laughing until my belly hurts. As much as I love writing and diving into the literature around narrative medicine, I decided to take a brief break to be as mindful and present as possible during this most precious time. I have also been taking time to sit and read and truly process what I read. I hope many of you have set aside some valuable reading time as well. To that end, I have decided to start a narrative medicine book list on this blog based on my own experience and that of others.

It is linked here: https://writingforwellness.health.blog/narrative-medicine-list-of-works/

I hope to add more to it as time goes on and as I discover more reading material. I would love suggestions of anything all of you have read as well. In the meantime, I wish you a wonderful holiday, and I hope you take some time to take care of yourself this season.

Writing Prompt: Stopping by Woods

It has been snowing this week in Columbus. One of the things I love about growing up and living in the Midwest is the excitement that comes with the arrival of winter. My favorite thing to do is to watch fresh snow fall outside my window as I drink a cup of tea and read a good book. Unfortunately, the hospital calls every day of the year, and I have to step out into the snowy abyss. The snow blows horizontally, my face freezes over, and I spend my day treating patients who want to be in the hospital even less than I do (because who wants to be sick over the holidays?).

I found myself experiencing that familiar feeling of initial enchantment by the snow, the lights, and even the tiny Christmas tree I have put up in my apartment, closely followed by the disappointment that comes from missing out on traditions we have at home. It’s a difficult life we have chosen in medicine, but a fulfilling one, and I found myself distinctly relating to the poem by Robert Frost, “Stopping by Woods on a Snowy Evening.” I would love to hear what all of you think about it as well.

Stopping by Woods on a Snowy Evening
By Robert Frost

Whose woods these are I think I know.
His house is in the village though;
He will not see me stopping here
To watch his woods fill up with snow.

My little horse must think it queer
To stop without a farmhouse near
Between the woods and frozen lake
The darkest evening of the year.

He gives his harness bells a shake
To ask if there is some mistake.
The only other sound's the sweep
Of easy wind and downy flake.

The woods are lovely, dark and deep,
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.

The prompt for this week is this:

“Write about how you feel on a snowy evening.”

You have seven minutes. See you next week.

References:

Frost R. (1995). Stopping by Woods on a Snowy Evening. [online] Poetry Foundation. Available at: https://www.poetryfoundation.org/poems/42891/stopping-by-woods-on-a-snowy-evening Accessed 18 Dec. 2019.

More unedited writing of mine. About fifteen minutes on how I know if I am doing a good job.

I put off responding to this prompt for as long as I could because as much as I know how valuable it is to do this kind of self-assessment, I also know that it can be painful to actually define metrics for yourself to live up to. What if I cannot even meet my own expectations? That’s worse than disappointing someone else.

I supposed that doing a good job in medicine for me comes down to a few main things:

Taking good care of my patients
Taking good care of myself
Taking good care of my colleagues

That is incredibly nebulous and annoying. What does it mean to take good care of all of these groups? For my patients, I think it entails:

Listening and being present with each of them, even while being efficient (it IS possible!)
Taking time to read and learn medicine (a more big-picture type of presence)
Showing compassion
Taking ownership and initiative for their care
Having the confidence to trust myself
Having the humility to ask for help when I need to

For myself, a lot of the same applies:

Listening, being self-aware, showing compassion
Reading, paying attention, and learning from all of my experiences to take full advantage of my time in residency
Taking ownership and initiative to help me learn and grow as a physician, and having faith in myself and my newly developed abilities
Not feeling shame for needing to ask for help, whether that is for someone to talk me through a difficult management strategy or for a safe space to vent or cry

For my colleagues, it’s amazing how much all of this is exactly the same, at least in my mind:

Paying attention to how my colleagues are doing and offering them support when they look like they need it
Providing a safe space for us to work without judgement or shame
Taking ownership of my patients, their conditions, their documentation, their orders, everything I can, so that I can provide a safe transition to the next team and not burden my colleagues
Not being afraid to ask for help early on when I require less support instead of waiting until I am debilitated

It seems like a few main themes emerged from this for me to generally be a good physician:

Providing a safe space for all of us to be human, to make mistakes, to ask for help
Not being afraid to take advantage of that safe space
Working as hard as I can to do the best that I can and to learn from my mistakes and from others
Being present, supportive, and compassionate and asking for help when I find myself unable to do those things

Seem like some good goals to me. They’ll probably change as I go through residency and think about this some more, but it seems like a reasonable starting point. I’d love to hear what many of you have thought about!

The Literature: The Benefits of Narrative Medicine for Residents

The practice of medicine is a beautiful confluence of art and science, where we interpret a patient’s clinical data within the context of their personal narrative and use all of the information to provide the best care possible. That sounds nice, but most residents hear that and laugh at the thought of having enough time to connect for so long with one patient. With increasing requirements for efficiency, a devastating diagnosis for a family turns into a one-liner. Let’s say you have a three-year-old patient named Jack whose favorite color is blue, who loves police cars and playing in the mud, and whose parents are crushed by his diagnosis of leukemia. You admit him, and for efficiency’s sake, your signout on him reads something like this: “3yo previously healthy M who presents with new onset leukemia, WBC 400k, high risk for tumor lysis syndrome so q6h labs, allopurinol, 1.5xMIVF, sedated LP, bone marrow biopsy, and port placement scheduled for today.” Your team knows exactly what to do about the leukemia, but they know nothing about Jack or his family.

In a practical sense, if you are just covering an inpatient service overnight, this doesn’t necessarily matter. In our hospital, you could be managing 30-40 patients, many of them tenuous (especially during the winter for pediatrics residents #thanksRSV), and your job is, to put it bluntly, to make sure they don’t die. But what if something bad does happen? What if the child is transferred to the PICU, what if they go into renal failure from tumor lysis and need dialysis, what if your infant with bronchiolitis goes into respiratory failure? Not only do you need to have a discussion with the family and help them process what is going on, but you also need to be able to cope with difficult circumstances as a human being. In addition, as human beings, the depersonalization we apply to increase efficiency promotes burnout and limits both the patient’s healing and our own¹.

Residency programs at Children’s Hospital of Philadelphia², Columbia University³, Louisiana State University⁴, Temple University⁵, University of Virginia⁶, Kaiser Vontana Medical Center¹, and Vanderbilt University⁷ have looked at incorporating narrative medicine into clinical training in order to promote resident wellness as well as effectiveness. They have worked with pediatric, surgical, neurology, and internal medicine residents as well as others. These initiatives have ranged from one to two one-hour sessions to a 12-session series throughout the year. Most of them follow the general narrative medicine framework that involves reading a short piece, reflecting on it personally and as a group, and then writing a self-reflective piece. Others have incorporated long writing exercises even culminating in essay contests.

Success of the programs depended on making them available for residents to participate in, as in they took place during protected time, it wasn’t a significant time commitment, and while a few were mandatory, many were simply encouraged with support from the residency program director. Generally, from survey results, residents derived the following benefits from their sessions:

Connecting with the patient allowed them to gather more information and generate fresh hypotheses, therefore improving patient care^3,8
They had a safe space to self-reflect and explore with peers, building camaraderie and professional connections^2-5
They had a creative outlet as well as an outlet for their stress and a way to express it that they did not have before^3-5
They improved communication skills, especially listening skills^4,6-8
They were better able to appreciate and accept ambiguity in medicine^2,6
They were able to reflect on their own behavior and that of others to identify negative and positive role models and be more intentional about their personal growth^1,8
They were able to find meaning in the patients’ narratives as well as their own by reflecting on their own illness experiences^2,7

Almost all of this data has been collected via qualitative surveys in small groups (with a maximum of a few dozen study participants), so there is still much to be done to further investigate the effects of narrative medicine and having an outlet to write on the wellness and effectiveness of residents. However, it is promising to see that it is possible to make time for creative expression within a busy residency program, and both the trainees and patients benefit.

References

Johna S, Dehal A. The power of reflective writing: narrative medicine and medical education. Perm J. 2013;17(4):84–85. doi:10.7812/TPP/13-043.
Diorio C, Nowaczyk M. Half As Sad: A Plea for Narrative Medicine in Pediatric Residency Training. Pediatrics. 2019;143(1): e20183109. DOI: https://doi.org/10.1542/peds.2018-3109.
Charon R, Hermann N, Devlin MJ. Close Reading and Creative Writing in Clinical Education. Academic Medicine. 2016;91(3):345–350. doi: 10.1097/ACM.0000000000000827.
Wesley T, Hamer D, Karam G. Implementing a Narrative Medicine Curriculum During the Internship Year: An Internal Medicine Residency Program Experience. Perm J. 2018;22:17-187. doi:10.7812/TPP/17-187.
Rosenberg N, Vitez M. Jamaica Kincaid’s “Girl” and the Challenge of Growing Up in Medical Training. JAMA.2019;322(13):1238–1239. doi:https://doi.org/10.1001/jama.2019.14003.
Harrison MB, Chiota-McCollum N. Education Research: An arts-based curriculum for neurology residents. Neurology. 2019;92(8):e879-e883. doi: 10.1212/WNL.0000000000006961.
Pearson AP, McTigue MP, Tarpley JL. Narrative medicine in surgical education. J Surg Educ. 2008;65(2):99-100. doi: 10.1016/j.jsurg.2007.11.008.
Koo K. The Value of Reflection in Urological Trianing: An Introduction to the AUA Residents and Fellows Committee Essay Contest. J Urol. 2018;200(2):253. doi: 10.1016/j.juro.2018.03.114.

Writing Prompt: How Am I Doing?

A running theme here is how difficult it is to practice medicine. Something that I have struggled with in residency is the ability to determine if I am functioning well as an intern. We have no grades to earn and formal evaluations can range from extremely critical to glowing within the same week. It is hard to know what milestones we should be meeting without external feedback. By far the most formative feedback is that which we receive by observing our superiors and peers. Essentially, we compare ourselves to our co-interns (even though we know that’s unhealthy) because we don’t know how else to know if we’re doing a good job. And we internalize and overanalyze every interaction we have with our seniors and attendings. If Dr. X made a face during my presentation, clearly I am doing a terrible job (or she smelled the vomit in the room next door). I have definitely found my mood and ability to cope in residency change week by week depending on my supervisors.

In my discussions with a few of my co-interns, what helps us the most is developing an internal sense of milestones to meet. I don’t mean the goals we have on our Career Development Plans (I will find more opportunities to read the primary literature! I will finish all of my tasks before signout even with a full patient list! I will be efficient!). Rather, it’s important to ask ourselves, “What does it mean to me to be a good doctor?” What values do we have as human beings that we want to uphold that are based on our own goals and aspirations, not just the long-held expectations of what a resident “should” do?

This is a really hard question. This is a really important question, and I think it might benefit us to dive into it, even for a short period of time.

The prompt for this week is this:

“How do I know that I am doing a good job?”

You have seven minutes (or as much time as you want). See you next week.

More unedited writing of mine. Seven minutes on my best possible day.

I used to write about my best possible day all the time as a teenager. It usually involved very specific people and activities that I tried to optimize to yield the highest level of enjoyment. But now as I think about it, I find it hard to pick anything specific to do on my best day. Even though I have been on the night shift in the hospital this past week when it has been extremely busy, I found myself experiencing little bouts of euphoria and generally being very content. These feelings occurred in the following circumstances:

When I connected deeply with a patient or parents or was able to offer them reassurance
When I made a mistake and instead of spiraling, I worked on using it to make myself better
When I was able to support my colleagues when they needed it

I also was able to spend the weekend with my husband who lives in another state, and we attended our medical staff Christmas Party. I remember dancing with all of my co-residents and feeling so happy that we were all so free and joyous. I remember feeling content when some of my co-residents came up to me and commented on how glad they were that I was doing this work. I was thrilled that my co-residents were all so excited to meet my husband, forging those connections. And even just spending time with my husband doing nothing and building our relationship brought me joy.

So it seems that my best possible day consists of being with people I love and living my values. No matter what the specific activities, that is how I can live my best life.

The Literature: What Is Narrative Medicine?

When starting this blog, I was asked by many people, “but what exactly is narrative medicine?” I thought that after a month devoted to the concept in medical school, I should be able to answer that question; however all I could ever muster up were some vague musings on telling our stories to help us connect to one another as human beings, especially in the context of the physician-patient relationship.

Thankfully, Dr. Rita Charon and the Division of Narrative Medicine in the Department of Medical Humanities and Ethics at Columbia University have done this work for me. As it turns out, I was mostly right, but there are some further nuances to it. The concept that is central to narrative medicine is narrative competence. Narrative competence is essentially the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Narrative medicine then takes narrative competence and incorporates it into the practice of medicine¹.

Narrative medicine requires two participants: a teller of the story (or a writer) and a listener (or a reader). This way, it facilitates a communion between the two involved parties, which in turn forges connection. In the context of a therapeutic relationship, the patient gives account of themselves and the clinician receives it^1,2. Though it can be applied to any of the following relationships (and others): physician-patient, physician-self, physician-physician, and physician-society¹.

Dr. Charon has detailed how incorporating narrative medicine has improved her clinical practice. She has found that inviting patients to tell her a story about their lives and what is more important to them has strengthened the therapeutic relationship and made them more willing and open to share^1,3. Just as we are taught in medical school to begin with open-ended questions to gather the most data about a patient’s illness, doing so also allows us to tease out the patient’s fears, hopes, and worries. In doing so, we are better able to extend empathy to our patients and they are more willing to open up to us, thereby allowing us to gather more information and better focus our differential diagnoses and care^1,3.

Not only do our patients benefit, but we as clinicians do as well. Physicians are submerged in pain and suffering on a daily basis and despite the focus several decades ago on detachment, that is less the goal now. In diving into our own emotional responses to patients and their journeys as well as our own, we are better able to weather the tides of illness and maintain our own courage, faith in love in the face of tragedies. Stories are also the way that we learn; clinical education and residency essentially focuses on experiential learning of the stories of disease processes over and over again¹. Yes, the data is very important, but it is within the context of the patient’s whole narrative that we are able to help them. A transaminitis can be due to 1000 different circumstances; it is the story that helps us make sense of it.

How do we build narrative competence? Through practice. The Division of Narrative Medicine at Columbia University recommends reading literature, writing about that literature, and reflecting on all of it². So that is what we will do.

References

Charon R. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA.2001;286(15):1897–1902. doi:https://doi.org/10.1001/jama.286.15.1897
(2019). About Narrative Medicine. [online] Columbia Narrative Medicine. Available at: https://www.narrativemedicine.org/about-narrative-medicine/ [Accessed 9 Dec. 2019].
Charon, R. Dr. Rita Charon: Honoring the stories of illness. Presented at TEDxAtlanta; September 13, 2011; Atlanta, GA. https://www.youtube.com/watch?time_continue=279&v=24kHX2HtU3o&feature=emb_title. Accessed Dec 9, 2019.

Writing Prompt: The Best Possible Day

Atul Gawande is one of my favorite medical writers. His oeuvre is a great place to begin when you are interested in exploring narrative medicine because it is thoughtful and thought-provoking, but still very accessible to the modern reader. He is the author of several books, including Being Mortal: Medicine and What Matters in the End, from which this essay is adapted.

In “The Best Possible Day,” he writes about the death of a close family friend. He describes experiences very familiar to many of us as physicians, the feeling of helplessness and hopelessness when someone is given a terminal diagnosis. The story, which I highly encourage you to read, ends with the friend living out her “best possible day” as she learns to accept her death and makes the most of the last 6 weeks of her life.

The prompt for this week is this:

“Write about your best possible day.”

You have 7 minutes. See you next week.

References:

Gawande, A. (2014). The Best Possible Day. [online] New York Times. Available at: https://www.nytimes.com/2014/10/05/opinion/sunday/the-best-possible-day.html %5BAccessed 27 Nov. 2019].

For those of you who would like to see my writing from last week, here it is in its unedited glory. Seven minutes on why I am grateful to practice medicine.

Gratitude in Pediatrics

Each new baby’s
fingers and toes
Curling around my index finger,
Proof of their neuronal maturity,
A reflex.

But to me, it’s a handshake,
A hello.
Accompanied by a reflexive smile.
Because why not pretend it’s just for me?
And keep it in my pocket
Saved for a rainy day.

To watch a child grow
Is to witness a miracle.
To see myself,
A patient,
A student
Learn is to witness
That highest achievement of humanity.

And to share it,
Well,
Like a nursing mother,
But without the milk,
I feel the oxytocin.

For I nourish with knowledge,
With gentleness,
With space.
And what a blessing
To have the nourishment to give
In the first place.

And to be surrounded
By those with their own gifts,
Nourishing me as well.

The Literature: A Brief History of Physician-Authors

A phrase I have heard uttered by many medical trainees (including myself) is “I don’t have time to write.” Many of us have histories as amateur essayists and poets with a thirst for literature that we have since abandoned since starting our medical education. The time and emotional demands in medicine seem to preclude us from devoting the time necessary to read and write for pleasure and contemplation instead of to satisfy the needs of billers and insurance companies. But physicians have worked concurrently as authors for centuries.

In the Middle Ages, Maimonides¹ was and continues to be one of the leading Jewish philosophers of all time. But he was also a physician, writing about a number of disease and their treatments, as we do today in the peer-reviewed literature. This tradition has continued through the 21^st century, with many authors actually remembered more for their writing than for being physicians. John Keats, who lived for a brief 25 years in the 18^th century, is remembered for being one of the greatest poets of the English language. But he finished medical school before giving up the practice of medicine to write. Anton Chekhov also died young, but in that time was an accomplished playwright and essayist all while having a prolific career as a doctor².

Modern physician-authors also include those recognizable for their medical degree (Atul Gawande, Paul Kalanithi, Abraham Verghese, Oliver Sacks)³ in addition to those primarily known for their writing prowess. Michael Crichton, author of Jurassic Park, Congo, and other books was an immunologist. Khaled Hosseini, who wrote The Kite Runner and A Thousand Splendid Suns is an Afghan-born American physician².

There are numerous examples of physician who have become successful authors, but why do doctors make good writers? Some say³ that as physicians, we are uniquely tuned into the stories of our patients, that we have to be good storytellers to understand and navigate the complexity of our patients’ experiences. We are intimately attuned to living and dying since we experience mortality on regular basis. We are also characters in thousands of patients’ stories every year, and we influence these stories as often as we record them. As physicians, we are trained to be detail-oriented and develop acute observation skills which can benefit us in our writing. And writing also benefits us as physicians, as it can teach us about empathetic care and help us understand the humanity of our patients⁴.

As to the difficulty in balancing the two fields, having a prolific career as a writer is not for every physician. But the 20^thcentury American pediatrician and poet, William Carlos Williams, described writing and medicine as “two parts of a whole.”

“As a writer I have never felt that medicine interfered with me but rather that it was my very food and drink, the very thing that made it possible for me to write. Was I not interested in men? There the thing was, right in front of me.”⁵

Not all of us would like to prioritize writing, but for those of us who do, we have centuries of role models to look to for inspiration. And for me, that makes it even a little less intimidating to start.

References:

Seeskin, K. (2017). Maimonides. [online] The Stanford Encyclopedia of Philosophy(Spring 2017 Edition), Edward N. Zalta (ed.). Available at: https://plato.stanford.edu/archives/spr2017/entries/maimonides/[Accessed 2 Dec. 2019].
Banerjee, A. (2014). 10 medically-trained authors whose books all doctors should read. [online] OUPblog. Available at: https://blog.oup.com/2014/12/author-doctor-reading-list/ [Accessed 2 Dec. 2019].
Beck, D. (2016). Cover Story: The Physician-Writer: Good doctors are good storytellers; some make it a second career. [online] American College of Cardiology. Available at: https://www.acc.org/latest-in-cardiology/articles/2016/06/10/11/12/cover-story [Accessed 2 Dec. 2019].
Verghese A. The Physician as Storyteller. Ann Intern Med. 2001;135:1012–1017. doi: https://doi.org/10.7326/0003-4819-135-11-200112040-00028
Wagner LW. William Carlos Williams: Poet-Physician of Rutherford. JAMA. 1968;204(1):15–20. doi:https://doi.org/10.1001/jama.1968.03140140017004

Why Narrative Medicine?

Medical training is HARD. Let us count some of the ways in which it can be difficult:

We work long hours
We are exposed to an onslaught of information that we are supposed to retain
We are constantly being pulled in a million different directions
We have to somehow build rapport with a patient and their family and provide exceptional care in a 15 minute time slot
We pay witness to some of the most difficult times in a patient’s life
We experience death and loss and suffering
We feel helpless in the face of socioeconomic disparities and injustice in the healthcare system

The list goes on. But for me, at least, finally becoming a pediatrician was the culmination of a 25 year journey (and the beginning of a new several decade one). Despite all of the difficulties, it is AMAZING. Here are some of the great parts of my job:

Human beings, especially children, are super cool, and it can be incredibly rewarding to connect with them and their parents
Learning new skills helps us build confidence in ourselves
We get to solve complicated puzzles every day
We have the privilege of watching our patients grow and evolve and the satisfaction of knowing we played even the tiniest part in that
We get to work in highly-skilled teams with people we respect and admire
We develop lasting and fulfilling relationships with our co-trainees
Babies are cute (I am a pediatrician, after all)

Some days, it can be difficult to move past the bad and appreciate the good. Some days, it can be difficult to process everything we see throughout the course of a shift, a week, a year. This is where Narrative Medicine comes in. In her seminal work introducing narrative medicine to the medical community¹, Rita Charon, MD, PhD, remarks,

“With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care.”

So here’s my goal: that medical trainees (and others who would like to join) come on this journey with me to explore narrative medicine in an accessible way that is not time-prohibitive. I will typically approach this in the following way:

On Mondays, I’ll dive deeper into the world of narrative medicine, starting with an introduction into the concept, the components, the data behind its benefits, and different examples we can look to for inspiration and communion.
On Thursdays, I’ll offer a short writing prompt that can be done in 7 minutes. This is time that we can take for ourselves to process on our own and develop “narrative competence.” I will post my own response to the prompt the next week.
I will continue the conversation (with some diversions) on Twitter @NimishaBajaj2

Thank you all for joining me on my adventure. For this week, the writing prompt is early due to Thanksgiving. It is a twist on a classic:

“Why am I grateful to practice medicine?”

You have 7 minutes. See you next week.

References:

Charon R. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA.2001;286(15):1897–1902. doi:https://doi.org/10.1001/jama.286.15.1897