Writing and Telling Our Clinical Stories to Improve the Art of Medicine

Why do doctors and nurses write stories? And why tell them to a group of unfamiliar colleagues? People write to learn from their experiences, to express the meaning of their life's work. Although we remember our stories, we may not understand them until we write them on paper, move them out into the world.

Origin of Spirit Section

In this issue we publish a large collection of original stories, poems, and essays by Kaiser Permanente doctors and nurses, written either during the five Narrative Medicine conferences and workshops The Permanente Journal (TPJ) sponsored in 2004–5, or the TPJ Portland and Oakland quarterly writing groups in 2005. Barry Lopez, an Oregon naturalist, wrote in his Native American tale, Crow and Weasel, “The stories people tell have a way of taking care of them. If stories come to you, care for them. And learn to give them away where they are needed. Sometimes a person needs a story more than food to stay alive. That is why we put these stories in each other's memory. This is how people care for themselves.”¹

Relevance of Stories

Reading and writing stories of clinical encounters with patients or colleagues can improve the diagnostic and communication components of physicians' and nurses' clinical competence. Physicians and nurses encounter many dilemmas in their practice: moral, ethical, legal, social, human rights, religious, economic, and personal values. Stories can help with understanding and finding solutions, to integrate and organize complicated situations, and to clear the mind. Writing stories can also positively impact physician mental and spiritual health. Writing is a powerful tool to discover meaning and to promote self-understanding, and because psychological conflicts are linked to specific changes in our bodies, narrative writing can be of therapeutic value to physicians.²

“Sometimes a person needs a story more than food to stay alive.”

Physician Authors on Writing

Kate Scannell, MD, internist with The Permanente Medical Group and author of “The Death of the Good Doctor,” keynotes our writing workshops. She wrote in Annals of Internal Medicine, “Writing and speaking about doctoring can save your life. By this I do not mean that they can prolong life, but, rather, that they can prove deeply enlivening. Giving language to what we witness lifts into personal and, sometimes, public consciousness the otherwise unarticulated existential dimensions of experience that permeate our work—whether we name them or not. Consciously narrating these accounts illuminates more of our collective lives as patients and physicians, expanding our felt understanding of human frailty, compassion, strength, love, fear, hatred, and ill will.”³

Abraham Verghese, MD, MFA, a New York Times best-selling author and practicing internist, gave the keynote address at our first writing conference. He wrote in Annals of Internal Medicine, “A sense for the stories unfolding before us will perhaps allow us to be more conscious of bringing people to the epiphanies that their stories require … [W]e will remember the voice of the patient, even though it is the voice of medicine that we record in the chart. … We should be not just ‘doctors for adults’¹ but also ministers of healing, storytellers, storymakers, and players in the greatest drama of all: the story of our patients' lives as well as our own.”⁴

Spirit: The Permanente Literary & Arts Journal

TPJ has produced three supplements thus far: Weight Management, HealthConnect, and Evidence-Based Medicine. From this issue we will produce a fourth, somewhat different one. We will collect the stories, poems, essays, published in this section, with a spiritual symposium, commentary, other new stories, and art into an annual periodical, called “Spirit: The Permanente Literary & Arts Journal.” When published in Summer, 2006, it will be our second book. The first book, published in 2005, was Soul of the Healer: The Art & Stories of The Permanente Journal: The First Seven Years. Motivated by our readers' comments, we created this book to bring together our art and stories they say are so beautiful and uplifting.

The editors hope you enjoy reading your colleagues' never-before-told stories and poems, and that they bring you health. Write and tell us one of your stories, and please attend one of our writing groups, or tell us of your interest in starting your own.

Commentary

Restoring Our Humanity: Our Intention to Heal

Fred Griffin, MD

Fred Griffin, MD, is a psychiatrist and a professor at the University of Alabama School of Medicine. Dr Griffin has written extensively on literature in medicine, the use of writing in psychoanalysis, and the physician-patient relationship. He presented to and attended the TPJ writing workshop in Atlanta, Georgia in October 2005.

Being a doctor can be such a lonely place to inhabit. Our task-oriented approaches to patient care can all too often reduce us to feeling more like two-dimensional characters in someone else's story than three- and four-dimensional people in our own meaningful lives. Never has there been a time in the history of medicine when physicians have had a greater need to find meaning in what they do. When we translate clinical experience into written narratives, we bring to life the physician-patient relationships in which we live. The act of writing helps us to restore our own humanity, and the act of seeing ourselves with our patients on the written page reminds us of what led most of us into medicine in the first place. These stories both humanize the physician-patient encounter and make physicians feel more like the human beings they are than the “human-doings” they sometimes become. And it is only through being more fully human ourselves that we may convey convincingly to patients our intention to heal.