Perspective
Poetic Podcasts
The Importance of the Humanities in Medicine
Literary podcasts attempt to help physicians better understand the human condition so that they can better treat their patients.
By Nancy J. Baker, M.D.
To be effective, physicians must walk in two worlds. The one is generally cognitive and the domain of science: anatomy, pathophysiology, pharmacology, and the like. The other is more breathed than considered and involves the heart: compassion, empathy, relationships, hope. The one is built on the burgeoning body of scientific literature. The other on story, art, and music, and it is often caught rather than taught. We sometimes treat these worlds as if they are separate when, in fact, they both help define who we are as clinicians.
Medical humanities attempts to tie the two together. For more than 20 years, I have lectured to family medicine residents about the relevance of literature and art to our work as physicians. More recently, I have recorded a series of podcasts on the topic to share with my clinician colleagues.
My interest in medical humanities grows out of my personal desire to integrate literature and medicine. That was reflected early in my life when I chose to double-major in biology and English as an undergraduate, a synthesis I pursued during my medical training, nurturing my love of poetry and prose while at the same time honing my skills as a scientist. It also prompted me to take a four-month sabbatical from practice and teaching to study in Oxford, England, in order to become more familiar with European literature.
I’ve found that poems and stories consistently evoke empathy and reinforce my inductive, subjective, interpretive skills. Practicing medicine, on the other hand, requires systematic, objective analysis and deductive reasoning in order to develop appropriate diagnostic and therapeutic care plans. Together, they equip me to address with sensitivity and precision common, as well as complex, clinical scenarios. They also provide me with self-awareness and insight into the lives of my patients.
Medical Practice and the Written Word
Medical educators have long recognized the value of using nonmedical literature to help physicians-in-training better understand and communicate with their patients. Pennsylvania State University College of Medicine and Southern Illinois University School of Medicine became the first medical schools in the United States to have humanities departments in 1967 and 1969, respectively. In 1972, Joanne Trautmann Banks, Ph.D., the matriarch of the literature and medicine movement, was appointed to the Penn State faculty to help familiarize students with literature that dealt with various medical conditions, the overall experience of human suffering, and the experience of being a medical provider. At least seven medical schools now have full-time faculty teaching medical humanities, and the field has its own academic journal, Literature and Medicine. Residency programs across the country have developed similar curricula that use literature, art, theater, film, and music to do the following:
- depict the history of medicine;
- illustrate troublesome ethical and cross-cultural health care
issues;
- help medical trainees develop empathy by allowing them to vicariously experience old age, life with a chronic disease or disability, and death and dying;
- familiarize trainees and faculty with works that can provide simple enjoyment and facilitate relaxation;
reinforce the power of language and imagery as well as the reality of ambiguity and uncertainty in medicine; and
- foster a greater capacity for self-knowledge, reflection, and creativity.
Rita Charon, M.D., who directs the narrative medicine program at Columbia University, believes the goal of medical humanities is for learners “to behold the lives of patients well enough to apprehend their meaning… [Both] literature and medicine follow individual characters or patients from their origins to their destinies.” She says that doctors join their patients on “journeys of living and dying”1 and calls this “narrative knowledge” or “narrative competence.”2 Charon believes familiarity with literature enables learners to exercise keen observation, to perform relentless hypothesis testing, and to listen to and understand a patient’s story from beginning to end.
Medicine in and of itself provides fodder for creative expression. Renowned physician poets and authors such as Anton Chekhov, Oliver Wendell Holmes, William Carlos Williams, Richard Seltzer, and Dannie Abse, to name a few, have written poignant narratives about the “stuff” of their daily professional lives.
In his essay “The Practice” from his autobiography, Williams wrote:
It’s the humdrum, day-in, day-out, everyday work that is the real satisfaction of the practice of medicine. … The actual calling on people, at all times and under all conditions, the coming to grips with the intimate conditions of their lives, when they were being born, when they were dying, watching them die, watching them get well when they were ill, has always absorbed me.3
Williams published his first collection of poetry in 1917 when he was 34 years old. Robert Pinsky, former U.S. Poet Laureate, celebrates Williams’ ability to speak plainly in his poems, yet not plainly. He refers to his remarkable ability to juxtapose “… elevation against directness, candor against enigma, the ordinary against the strange.”4 No doubt Williams’ experience as a general practitioner, caring for hundreds, if not thousands, of patients during his 40-year career in Rutherford, New Jersey, contributed to his extraordinary ability to observe and describe the simple joys, profound sorrows, and often perilous plights of humankind. He addresses many of these subjects in stories such as “The Use of Force” and “A Night in June.”3
Richard Selzer, M.D., a retired general surgeon and Yale University faculty member, is a prolific contemporary writer. He admits that his writing is a direct outgrowth of his passion for language. He also acknowledges his love of storytelling. Like Williams, he routinely woke in the early morning hours to write essays and stories prior to his busy work days. He says he uses as much of the English language as possible. “Perhaps it has to do with those decades of restraining the scalpel. Now, when it’s the pen my fingers ride, I’m apt to give it full rein.”5 He continues:
I have used both humor and the grotesque as instruments of illumination, and recognize in myself both the aghast, lidless witness to horror and the storyteller bent on captivating the reader. … When the subject is that of the human body, how it’s made, how it works, and what goes wrong with it, I have kept faith with the factual. In all other matters, I’ve committed the gentle treason of poetry and betrayed mere fact in search of truth, the real real that lies just beneath the real.5
Poetic Podcasts
Even though as physicians we often have little time to read nonmedical literature, we are responsible for our continuing education and professional development. Recognizing this, in September of 2007, Dan Johnson, a member of the HealthPartners Institute for Medical Education staff, suggested doing a series of five- to seven-minute podcasts using poetry to address the affective domain of patient care. In addition to providing new insights, he hoped the series would offer respite, enjoyment, and perhaps even inspiration for physicians, whom he often saw as encumbered by the volume and complexity of their daily work. Dan and I began to tape poems with which I’ve become familiar during my career as a clinician and family medicine residency faculty member and that I believe illustrate important aspects of the doctor-patient relationship. Many, though not all, of the works are by physician-writers.
Each podcast consists of a brief introduction, followed by my reading of the poem, and then a brief dialogue between Dan and me regarding its relevance to the experience of illness and the nature of the doctor-patient relationship. Between December 2007 and January 2008, Dan sent out eight weekly podcasts as email attachments to approximately 100 family physicians in HealthPartners Medical Group. I made the podcasts available to faculty and resident colleagues at the University of Minnesota. Physicians also can access the poems online at www.fresheyesime.com. (The website averages approximately 150 hits per month.) At this time, health care providers do not receive CME credits for listening to the podcasts. They are simply for enjoyment and enrichment.
One of the poems used in a podcast was “S.W.” by Rafael Campo. Campo is an internist in New York City who primarily cares for patients with AIDS. The poem describes an emergency physician caring for a patient at the end of the day:
Extending from her left ear down her jaw,
The lac was seven centimeters long.
She told me that she slipped and struck her face
Against the kitchen floor. The floor was wet
Because she had been mopping it. I guessed
She’d had to wait for many hours since
The clock read nearly midnight; who mops floors
So late? Her little girl kept screaming in
Her husband’s thick, impatient arms: he knocked
Three times, each time to ask when we’d be done.
I infiltrated first with lidocaine.
She barely winced, and didn’t start to cry
Until the sixteenth stitch went in and we
Were almost through. I thought my handiwork
Was admirable. I yawned, then offered her
Instructions on the care of wounds. She left.6
After the reading, I discussed the difficulty of providing care to those who’ve experienced intimate interpersonal violence, our uncertainty as to whether or not the physician recognized the injury as abuse-related, the impact of seeing this patient so late in the day, as well as the meaning of the yawn at the end. Is the physician uncaring and dispassionate, or simply exhausted at the end of a long night’s shift?
In February 2008, Dan and I began recording a series of short stories and essays, which we recently began distributing to members of the HealthPartners Medical Group and other interested parties. Eventually, we plan to read and discuss original poetry and prose by physician-writers within our community and to invite patients to discuss how they believe physicians’ familiarity with nonmedical literature can affect the care they receive. The goal of this initiative is to continue to use literature to foster empathy in physicians.
In sum, nonmedical literature, as well as film, theater, music, and visual art can provide medical trainees, as well as busy, practicing physicians with professional insights and personal enjoyment. The HealthPartners podcasts are one example of how a new technology can help us preserve our passion for our work as healers. MM
Nancy Baker is an assistant professor of family medicine and community health at the University of Minnesota. She is a faculty physician in the Fairview University Family Medicine Residency program, and she practices at Smiley’s Clinic in Minneapolis.
References
1. Charon R. Reading, writing, and doctoring: literature and medicine. Am J Med Sci. 2000;319(5):285-91.
2. Charon R. Literature and medicine: contributions to clinical practice. Ann Intern Med. 1995;122(8):599-606.
3. Williams WC. The Doctors Stories. New York: New Directions, 1983.
4. Pinsky R. William Carlos Williams: selected poems. New York: New Directions, 2004.
5. Selzer R. The Doctor Stories. New York: Picador, 1998.
6. Belli A, Coulehan J eds. Blood and Bone: Poems by Physicians. Iowa City: Iowa City Press, 1998.