Another Kind of Page Calls Future Doctors

It’s a story that’s all too familiar for many physicians. Dealing with the constant physical and emotional stress of caring for sick and suffering patients, they face a choice: Stand unguarded against the force of all of that stress and heartbreak, or retreat behind a coldly clinical barrier. Physicians are often victims of “secondary trauma,” says UAB psychiatrist Fred Griffin, M.D. Over time, the intense experiences of modern medicine can lodge like foreign objects in a doctor’s psyche.

Like all human beings, physicians respond by seeking relief. “Some retreat into a position of singular objectivity,” Griffin says. “It’s a position of safety, but one that may deaden the physician emotionally and impoverish the doctor-patient relationship.” The defensive process begins even before the physician is a physician. “When I teach medical students,” notes Griffin, “I can already observe them gradually move from seeing patients as people to viewing them as diagnoses.”

Twenty-five years ago, Columbia University internist Rita Charon, M.D., Ph.D., made the same observation about herself. Drawing on her literary training (she earned a doctorate in English from Columbia, specializing in Henry James), Charon began hosting discussion groups where doctors and medical students could read the writing of physician-authors, then talk—and write—about their own most traumatic cases. Charon coined the term “narrative medicine” for this literary catharsis. Two years ago, Griffin and pulmonologist Waid Shelton, M.D., brought the movement to UAB.

In their narrative medicine discussion group, UAB physicians and medical students do not trade theories about Moby Dick; instead, they read authors who themselves have made a living in medical practice, such as pediatrician/poet William Carlos Williams. These writers speak honestly of their patients and the emotions they provoke, pouring out their helplessness, fear, frustration, and rage. Their ability to use words to translate clinical experiences into human emotions allows others to identify and process their own similar reactions.

Turning memories into narratives allows physician-authors to discover feelings they may have ignored, says Griffin. In some cases, the mere act of admitting these feelings serves as an epiphany.

For Charon, who came to UAB in March as an Alpha Omega Alpha visiting professor, self-realization is the goal of narrative medicine. Speaking at medical grand rounds, she explained: “This is why we write—not to report things, but to undergo them. And by representing what we undergo, we can see it whole.”

Griffin says transforming case histories into narratives allows a physician to see himself or herself as a fellow human being, not just a technician of modern medicine. He believes this is vastly important, not only to short-term effectiveness, but also to longevity in a doctor’s career.

“When the emotion experienced is not sufficiently processed, some doctors may become burned out or leave medical practice early,” Griffin says. “And we all can agree that’s not good for patients.”

— Steve Dupont