Many doctors feel that writing is a struggle. "They delay. They feel inadequate -- even inauthentic," psychiatrists Laura Weiss Roberts, MD, MA, and John Coverdale, MD, MEd, who are editor-in-chief and associate editor, respectively, of Academic Medicine. Roberts and Coverdale continue: "While these colleagues may view teaching and healing as natural capacities, they view writing as anything but."
"How should I write?" I asked a mentor when I was a medical resident. He replied, "Art, just write what you want to say." Indeed, a fellow student in my narrative medicine writing class reminded me that the definition of a writer is "someone who writes."
Still, there has been a slight hitch: I wasn't trained in the narrative. My mentor was a well-published physician researcher trained in the scientific method, and that's how I learned to write -- scientifically and technically, without jargon, adhering to the no nonsense "instructions for authors" in the likes of JAMA and its sister specialty journals. (To their credit, JAMA and other major medical journals now consider narratives and poetry for publication.)
Academic writing primarily focuses on the objective presentation of facts and data in a structured, formal manner. Its emphasis on empirical evidence, research, and statistical data is often used to advance medical science and share new knowledge. It involves a clear, concise, and formal style of writing that adheres strictly to specific formats and standards. The language is technical, the tone is impersonal, the expectation is precision and accuracy, and the primary goal is to inform, educate, and persuade based on facts and figures.
In contrast, narrative medicine writing is a form of reflective writing that centers on the experiences of patients and clinicians. It utilizes storytelling to explore the emotional, psychological, and social aspects of healthcare. The language is more personal, descriptive, and emotive, focusing on the human experience rather than just the clinical facts. The goal is to foster empathy, compassion, and a deeper understanding of the patient's perspective, thereby enhancing patient care and the overall healthcare experience.
Doctors often find their inspiration in narrative medicine because the discipline guides them in the art of empathic listening and allows them to be more responsive to their patients' needs. Medical training has the opposite effect. Openness and beneficence are suppressed by conditioning, forcing students to sacrifice compassion in the name of intellectual clarity. Declaring that physicians must remain dispassionate and detached from their emotions to ensure patient care is anathema to narrative practice.
I have had to unlearn the academic way of thinking and writing to write narratively. In doing so, there is a risk that I will be viewed as a heretic by my colleagues, or at least labeled as a "breezy" writer. Sometimes I feel like an outcast depicted in a surreal scene in the Field of Dreams, where Terence Mann (James Earl Jones) sprays Ray Kinsella (Kevin Costner) with an insecticide mist, exclaiming, "Out! Back to the sixties! Back! There's no place for you here in the future!" You could substitute "academia" for "the future" and understand my predicament.
So, how am I finding my writer's voice? Or, to paraphrase John Fox, the author of Poetic Medicine, am I finding yeast in my words so that my prose will become like "fresh bread on the table," leavened with experience, resilience, and intuitive understanding? I'll answer in a moment, but first let me tell you about Fox.
Fox is an educator and a certified poetry therapist who believes he has been "called" to poetry as a form of healing. He claims that poetry is a "natural medicine." Fox likes the feelings-oriented, non-linear logic of poetry because it allows for paradox and even celebrates it. After all, isn't the presence of paradox ubiquitous in medicine: joy and woe; pain and comfort; sadness and exaltation?
Unfortunately, the poetry of my youth has left a sour taste that I cannot cleanse. In the preface to Fox's book, the New York Times best-selling physician author Rachel Naomi Remen, MD, observes: "Much of the old poetry was pretentious and erudite, full of references to mythology or the ancient Greeks, poetry whose words I could not easily understand." My sentiment exactly!
I understand that modern poetry is different. Nevertheless, I have turned to other sources and forms of writing to help me unleash my inner self on paper, specifically to break free from an academic climate that is increasingly insular, and often reflects the narrow-minded vision of clinical investigators, grant-writers, and pseudo-scientific scholars. I am breaking free of those literary gatekeepers by reading essays written by physicians and non-physician authors from multicultural perspectives and backgrounds: Black, Latinx, Indigenous, Asian, Middle Eastern, LGBTQIA+ -- or a combination of those identities -- and by participating in writing exercises.
The multicultural writers have reminded me that institutions, particularly academic centers with their strict rules, formats, and expectations, can feel stifling and limit individual expression, in essence impeding learning by teaching exclusively to scientific analyses and objective understandings, neglecting the creative, spiritual, and cognitive dimensions underlying practice.
Stated differently by while pursuing her doctorate degree as a Xicana femme feminist: "The PhD track is supposed to discipline you. During my time as a graduate student the process tried to beat me out of my writing...Soon I could no longer recognize myself in my pages. I had been disciplined." Falcón's personal battle was to push against the forces of the academy that sought to minimize and invalidate her perspective. Her triumph over academic tyranny prevented her from becoming lost in her own stories.
I, too, believe that breaking free of the academic gatekeepers is the first -- and most important -- step in bridging the gap between academic writing and narrative medicine writing. Once unchained, other steps considered prerequisite for narrative writing seem to quickly follow:
- Adopting a mindset that values the patient's story as much as the clinical data
- Listening deeply and empathically to capture the nuances of the patient's experiences
- Weaving the patients' experiences -- hope, fears, emotions, and aspirations -- into a coherent, engaging narrative that captures the reader's attention and evokes empathy
- Employing narrative techniques such as scene-setting, character development, and plot construction
- Using language that is accessible and relatable to a broad audience
The transition from academic writing to narrative medicine writing is a challenging but rewarding journey that requires a profound and fundamental change in mindset, approach, and style. Making the transition requires a commitment to use writing as a tool to enhance healthcare by finding a voice and giving voice to our patients' stories.
Arthur Lazarus, MD, MBA, is a member of the editorial board of the American Association for Physician Leadership and an adjunct professor of psychiatry in the Lewis Katz School of Medicine at Temple University in Philadelphia. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.