Narrative medicine writing has become increasingly popular among physicians. It is s a good way to tell your patients’ stories, tell your own, or simply blow off steam. An estimated 80% of medical schools teach narrative medicine writing in some form: courses, seminars, workshops, and graduate degree programs.(1) In my experience, having recently enrolled in a graduate-level “certificate” program, one of the basic aims of narrative medicine programs is to teach physicians how to undo an academic style of writing, a style acquired on the path to becoming physicians, especially physicians entering research careers.
Narrative Medicine Defined
Let’s take a step back first and ask, “What is narrative medicine writing?” The best answer comes from Rita Charon, MD, PhD, the Columbia University physician who has defined the movement for the past several decades. At the heart of her mission lies the belief that effective healthcare requires “the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.”(2) Thus, narrative medicine writing emphasizes the humanistic aspects of healthcare, weaving together the stories of patients, their illnesses, and their interactions with the healthcare system.
Charon considers narrative medicine a basic science mandatory for medical practice. Although they are not always called narrative medicine, many endeavors in medical education and practice combine literary works and medicine, as well as the social and behavioral sciences, under this umbrella category. The problem is that many physicians don’t write. They’re either too busy to write, too tired, or too burned out, which is all the more reason to write and ventilate their feelings.
Many doctors feel that writing is a struggle. “They delay. They feel inadequate—even inauthentic,” write psychiatrists Laura Weiss Roberts and John Coverdale,(3) 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.”
Why Write?
A precursor to writing is to ask: “Why write?” There are many reasons other than the obvious one: to get something off your chest. Some of the reasons to write are no doubt in the academic vein, but many are in the narrative. When the two genres are combined, scholarly contribution and professional growth result, according to Weiss and Coverdale. The time will come when you may write, because writing holds the potential for comfort and insight to emerge from difficult or painful experiences. The sidebar lists a dozen reasons why physicians might want to write.
Sidebar: Twelve Reasons Why Physicians Write
Promote the advancement of knowledge
Elevate issues important to the doctor–patient relationship
Seek and share new information
Engage in questions and discussion
Influence the sociopolitical culture
Affiliate with patients and colleagues
Generate and test hypotheses
Deepen understanding of a topic or set of issues
Connect with a wider community of authors
Foster reflection and self-improvement
Inspire greater purpose and meaning in work
Transform values and priorities in one’s field
Adapted from reference 3.
“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 was 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 Versus Narrative Medicine Writing
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 often is 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 uses 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 unaffected is anathema to narrative practice.
I had to unlearn the academic way of thinking and writing to write narratively. In doing so, there was a risk—the risk I would be viewed as a heretic by my colleagues, or at least labeled a “breezy” writer. I felt like an outcast like the one 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.
Finding Your Writer’s Voice
So, how did I find my writer’s voice or, to paraphrase John Fox, the author of Poetic Medicine (Penguin Publishing Group, 1997), how did I find yeast in my words so that my prose became 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 feeling-oriented, nonlinear 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 get past. In the preface to Fox’s book, the New York Times best-selling physician author Rachel Naomi Remen, MD (Kitchen Table Wisdom), 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 pseudoscientific scholars.
I broke free of those literary gatekeepers by reading essays written by physicians and non-physician authors. Many of the latter were from multicultural backgrounds: Black, Latinx, Indigenous, Asian, Middle Eastern, LGBTQIA+—or a combination of those identities—and their perspectives were fresh and personal, their stories intellectual and inspiring. I also learned to craft narratives by participating in innovative writing exercises. The combination of reading—close reading(4)—and writing paved a rewarding path for inquiry, reflection, understanding, and creativity that is ultimately healing.
A Hybrid Writing Style
I did not entirely abandon the academic ethos that had long been ingrained in me, but, rather, I found a balance that allows for more freedom and creativity. I “opened up” to express my inner thoughts and emotions through the written word. I became more adept at, and comfortable with, using plain language, adopting a more conversational tone, and, most importantly, incorporating storytelling elements into my writing.
The multicultural writers 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. A statement from the psychologist Erich Fromm is worth noting in this context: “The quest for certainty blocks the search for meaning. Uncertainty is the very condition to impel man to unfold his powers.”(5)
Kandace Creel Falcón, while pursuing her doctorate degree as a Xicana femme feminist stated it differently: “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 [by the] strong pull of academese…”(6) 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.
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, the other steps considered prerequisite for narrative writing will follow:
Adopting a mindset that values the patient’s story as much as the clinical data;
Listening deeply and empathetically 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; and
Using language that is accessible and relatable to a broad audience.
Conclusion
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.
References
Schiffman R. Listening to patients’ stories. New York Times. February 25, 2021. www.nytimes.com/2021/02/25/well/live/narrative-medicine.html#:~:text=Narrative%20medicine%20is%20now%20taught%20in%20some%20form,enhance%20the%20interactions%20between%20doctors%20and%20their%20patients
Charon R. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001;286:1897-1902. https://doi.org/10.1001/jama.286.15.1897
Roberts LW, Coverdale J. Why write? Acad Med. 2020;95:169-171. https://doi.org/10.1097/ACM.0000000000003072
Charon R, Hermann N, Devlin MJ. Close reading and creative writing in clinical education: teaching attention, representation, and affiliation. Acad Med. 2016;91:345-350. https://doi.org/10.1097/ACM.0000000000000827
Fromm E. Man for Himself: An Inquiry into the Psychology of Ethics. New York: Rinehart, 1947.
Falcón KC. What would Eden say? Reclaiming the personal and grounding story in Chicana feminist (academic) writing. In: Lee SQ, ed. How Dare We! Write: A Multicultural Creative Writing Discourse. Ann Arbor, MI: Modern History Press; 2017:8-15.