The Task of the Physician-Writer, Medicine-Literature [Seminar 3]

Reflection questions used to inform the resident-led discussion with our guest faculty, Dr. Brian Christman:

How does being a writer impact your practice of medicine?
How does being a physician inpact your practice of writing?
How do you decide which patients or cases to write about?
Do you ever blend multiple patients together?
Have you ever co-written a poem with a patient about that patient?
Where do you draw your inspiration? Literature, movies, other poets?
Have you made any missteps with your writing?
Do you keep a journal?

A few selected quotes for discussion:

“To receive the creative speech of the other is to synchronize one’s very existence with theirs: what a challenge this offers to the notion of the clinician as disembodied mind, treating a body dissociated from the personhood of the patient.” (92, PPNM)

“In narrative medicine we explore the implications of attending to speech as an essentially creative act, investigating the ways in which our work opens the possibilities of creative speech, providing opportunities to break through the sedimentations of ‘ordinary’ speech so that we might think, create, express, and therefore know the meaning of our own experience, while attending to the meaning of the other’s.” (92)

“The medical meeting is the ‘gradual fusion of two horizons—the patient’s perspective of unhomelikeness, and the doctor’s perspective of medical expertise and mission to help. The meeting of the two horizons as the inter-nesting of interpretations means that both parties must come to see things from the other party’s point of view in order to reach a new, more productive understanding.” (100)

Physician-writers may use the specialised knowledge medicine represents, but more significantly, they have access, as “privileged observers and participants”, to people and situations to which other writers, let alone ordinary people, may never be exposed.” Doctors may daily witness pain, suffering, joy, and transcendence- matters at the heart of human experience. They are often privy to the most vulnerable and intimate moments of their patients’ lives, with medicine becoming “a window to look at the human endeavor. It happens to be one that puts the doctor within twelve inches of every patient he sees, if he listens to him with a stethoscope-puts them very close physically, and puts them very close emotionally if he or she is that kind of physician. That’s the only reason why this window is a variegated and interesting one, because it has so much humanity in it”

“Interpretation in clinical settings takes place when the physician listens to the patient’s story of illness, filters it through a knowledge of similar cases, and returns the now-interpreted story to the patient to check its validity: “This requires a capacity oimagine illness or injury from the patient’s perspective and an awareness of the impossibility of identifying with the patient’s experience: a kind of listening with the third ear-an awareness of setting and significance and an alertness to narrative possibility”

“The sound of story is the dominant sound of our lives”

Readings

Keats, John. “Letter to George and Thomas Keats” 28 December 1817 [Negative Capability]
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Chekhov, Anton. “Letter to Alexander Chekhov” 10 May 1886 [Objectivity]
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McLellan, Faith. “Literature and medicine: physician-writers” Lancet. 349:564-67, (1997).
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Charon, Rita et al. “Dualism and Its Discontents II: Philosophical Tinctures” Principles and Practice of Narrative Medicine. Oxford Univ Press, 2017.
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From Doctors’ Stories to Doctors’ Stories, and Back Again [AMA Journal Ethics]
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Rousseau, G.S. “Literature and Medicine: Towards a Simultaneity of Theory and Practice” Literature and Medicine, 5:152-181(1986).
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