The Writer Will See You Now

It’s not an official medical report, and it won’t help doctors treat the patient it’s about, but Dr. Dena Rifkin’s write-up tells a story that the dry clinical language of medicine never could. “There are startling moments that you don’t forget,” it begins, and clearly this was one of them—a night in which a young Rifkin, not even yet an M.D., stumbled out of sleep and into a pa­tient’s room to find him soaked in blood. “The patient looked up at me, and opened his mouth as if to speak,” she writes. “Blood came out instead of words, slick and shiny as an oil spill.”

That patient is long since out of her hands, and it’s too late to help him. But by writing about him, Rifkin may be helping herself—and, in the long run, her future patients. The piece was her submission to a Yale writing workshop for young doctors taught by the medical writer Dr. Abraham Vergh­ese. Rifkin liked the seminar so much she went back for a second round with author Dr. Richard Selzer. And the program’s or­ganizers were even more pleased. As they announced in the October Journal of Gen­eral Internal Medicine, the workshop im­proved not just the doctors’ view of their profession, but also their view of those in their care. Anna Reisman, an assistant pro­fessor of internal medicine at Yale who runs the program, says that learning to write well may have even made them better doctors.

That’s an idea medical schools can appreci­ate—and a growing number of them are putting it into practice. More than 80 percent of American med schools now offer some form of training in literary studies or “nar­rative medicine,” says Dr. Rita Charon, who coined the term and leads the pro­gram at Columbia University. Many med­ical schools, including those at premier universities such as NYU and Dartmouth, even have their own student literary jour­nals. Reisman’s program, a two-and-a-half day discussion group modeled on the Iowa Writers’ Workshop, has thus far enrolled 35 students. She got the idea for it because writing was something she’d been doing all along. “I started keeping a journal on day one of medical school, and it saved me,” she says. “Putting these things on paper makes them real. You can go back to them and there they are, as raw as the day you wrote them.”

She’s certainly not the first to feel that way; William Carlos Williams famously kept a notebook while he was in training, writing essays about his patients after finishing his shifts. For many doctors, however, the standard coping strategy for stressful, and often life-and-death, medical situations is not to explore their feelings, but to bury them. Reisman calls this the “hidden curriculum” of medical training—not one that’s expressly taught, but one that leads to an “erosion of values” as young doctors be­come disillusioned and less empathetic to patients. Charon says that emotional de­tachment eventually can drive doctors out of medicine altogether. “People talk about burnout,” she says. “What that means is that there’s no more room for the self.”