Storytelling saved my sanity during the coronavirus pandemic. The lockdown afforded me time to write and share stories about my life and career. I wasn't writing my memoir as much as I was engaged in the practice of narrative medicine writing -- stories about the meaning of illness and opportunities to reflect on the vastness and depth of human experience in the healthcare setting. After I began telling my stories, I discovered the field of narrative medicine has been around since the turn of the century.
Rita Charon, MD, PhD, is widely credited for originating the field of narrative medicine. She inaugurated and teaches in the Master of Science in Narrative Medicine graduate program at Columbia University, where she received her PhD degree in English following her medical degree from Harvard. Charon is also co-author of Principles and Practice of Narrative Medicine and other scholarly works. In her seminal article on narrative medicine, published in the Journal of the American Medical Association in 2001, Charon wrote: "The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others."
Storytelling and writing competencies are taken for granted. But the fact is that few narrative medicine writing programs actually incorporate writing skills as a program goal, including medical schools that have integrated medical humanities into their curricula, which now number well over 100 in the U.S. In the most comprehensive review of narrative medicine writing programs to date, the authors recommend expanding program objectives "to include the development of enhanced writing skills and self-efficacy related to the writing process as measurable learning outcomes."
Laura Roberts, MD, MA, chair of psychiatry at Stanford University and editor-in-chief of Academic Medicine, observed that many gifted physicians "...struggle when it comes to writing. They fret. They delay. They feel inadequate -- even inauthentic. While these colleagues may view teaching and healing as natural capacities, they view writing as anything but."
Perhaps some physicians need tools to write creatively -- tools that can only be obtained through formal education. In my own case, despite my penchant for writing, I realized I had virtually no formal education in writing and English literature. That's why I recently decided to enroll in a narrative medicine writing program at a local university. I'll be taking several graduate-level courses leading to a "certificate" in narrative healthcare. Here is a list of the courses:
Introduction to Narrative Medicine: Narrative as a Form of Knowledge
"A study of readings by narratively trained practitioners as well as writing assignments that move practitioners beyond clinical knowledge into narrative knowledge. Through engagement with literature and writing, students develop comfort with the less-defined areas of care -- the open spaces of provider-patient relationships where ethics, empathy, and the unknown hold more power than heart-rate and x-ray."
Narratives of Illness
"A study of illness narratives in poetry, short fiction, creative nonfiction, and novels. Emphasis on close reading and developing narrative competency and empathy."
Writing & Healing
"A study of narratives by doctors and other care providers. Emphasis on reflective writing skills as students develop their own narratives, addressing presence, complexity, paradox, fatigue, shame, love, listening, and other human facets of care."
One of the features of this program is that classes can be taken in any order. Each class is 3 credit hours given for 2 hours one evening per week. Courses are conducted remotely via zoom. They are spaced out over three semesters and can be completed in about a year. Individuals choosing a more formal course of study leading to a Master of Fine Arts (MFA) in creative writing need to accumulate 36 additional credit hours (a total of 15 three-credit courses), which usually takes several years to complete.
At this stage of my life -- turning 70 with an MBA degree already in tow -- I'm not keen on continuing my education beyond the basic nine-credit certificate program. However, one never knows. There are many enticing "supportive" workshops conducted at this university and courses designed to identify and apply rhetorical theory to various writing genres including poetry and fiction. At a cost of $690 per credit hour -- or a minimum of $2,070 per course -- I'll have to choose wisely should I decide to pursue my training beyond a certificate.
I was impressed that at least one physician, a cardiothoracic surgeon, decided to take the plunge and shell out $31,050 for an MFA degree. He was asked: "Why did you decide to pursue a master's degree in writing?" The physician responded, "Writing has helped me in more ways than I can count. I host a monthly Narrative Healthcare Seminar at our hospital, which is very gratifying. I also think writing is an excellent way for physicians like myself to prevent burnout and to focus on the deeper meaning of what we do and how we can enhance care for our patients." This physician has subsequently retired from practice and now markets himself as an author (six novels) and freelance writer on his LinkedIn profile.
Indeed, the benefits touted by narrative medicine programs, whether geared toward a certificate or master's degree, include enhancing narrative competence, communication, and empathy; detecting and mitigating burnout; fostering reflection with regard to professional identity formation; promoting team-building; and facilitating teaching competencies. Interacting with highly engaged students in the health professions and energetic teachers -- most of whom are accomplished authors and writers in their own right -- creates an esprit de corps, a passion for a life of impact. The learning environment becomes a stimulus for the narrative.
My son is a writer and teaches creative writing at the college level. When he was in graduate school, one of his professors said, "The best advice I can give you is to write every day whether you feel like it or not." The great science fiction writer Isaac Asimov was a compulsive writer. He said his idea of a good time was to go up to his attic and sit at his electric typewriter and bang away. Asimov reasoned: "If my doctor told me I only had 6 months to live, I wouldn't brood. I'd type a little faster."
Arthur Lazarus, MD, MBA, is a member of the Physician Leadership Journal editorial board and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.