Sir Isaac Newton dedicated as much, if not more, of his time to the study of alchemy than he did to the natural order of the universe, but most of his work as an alchemist remained unpublished until long after his death when a metal chest full of his belongings was auctioned in 1936. The great man of science, the first of the Age of Reason, was simultaneously the last of the magicians.
To think that Newton may have thought more about levity than gravity seems absurd. It also explains why he couldn’t or didn’t publish much of his research; he would have needed a different physics and a different calculus to explain his findings. His peers would have thought him crazy, as if the apple that befell him did some brain damage.
Perhaps it is best that we keep some things to ourselves as personal secrets never to be shared, lest we are considered extremists, completely out of step with the times, or simply misunderstood. However, I suspect that the great majority of physicians have within them relevant literary contributions that they’ve been holding back, maybe written yet fearfully tucked away in a drawer.
Most physicians keep their thoughts and stories to themselves. Doctors feel they may be judged or criticized for their writing. Some believe they lack sufficient talent to be writers, while others insist they don’t have the time to write. These are all excuses used by physicians who aspire to be narrative writers – excuses not to write. My advice to them is please do not let your great-great-great-grandchildren discover your unpublished ideas or manuscripts and sell them at auction. The time to write and publish is now. The question is: Why aren’t you writing?
Writing is not rocket science. All of us have had to write narratives of some sort since grade school. Believe me, if I can do it, so can you. The reason I say this is because my fourth-grade writing assignment was to compose and illustrate a short fiction piece about Halloween. I remember writing about monsters and ghosts and clumsily outlining them and coloring them with crayons. I wanted the piece to be scary, so I chose a cemetery as the backdrop. The creatures were eyeing the candy of the trick-or-treaters in the cemetery – literally eying the candy. I drew them with big eyes, long before I became fascinated by psychiatry (schizophrenic patients will often draw eyes because they can constantly feel like they are being watched). My fatal flaw was not that the plot was ill-conceived – why should people be trick-or-treating in a cemetery? – or that my artistic ability was nil. Rather, in the story, I spelled the word “human being” incorrectly, writing “bean” instead of “being.”
Now that word processing programs have spell check, spelling should not be a problem for anyone, although you still have to proofread your work because even in my example, “bean” may not have been detected as an improper spelling. Otherwise, the mechanics I aimed for in my fourth-grade story still apply: write to foster empathy and active listening and engage the audience in your narrative.
Here are some other basic principles you should consider when incorporating narrative medicine writing into your daily practice.
Pay attention to the patient’s story, not just their symptoms. This includes their emotional state, their living conditions and lived experiences, their fears, and their hopes.
When taking patient histories, don’t begin with, “What brings you here today?” Instead, ask, “What do you think I should know about your condition (or situation)?” Delve deeper than just the medical facts. Ask about their personal lives, their experiences with their illness, and how it affects their daily routines.
Keep a journal close by to write about your experiences and those of your patients or give yourself prompts and reminders to reflect upon later. Ponder patient interactions, your decisions, and your emotions. This can help you process your experiences and gain insights.
Read narratives and memoirs by other health care professionals. This can provide you with new perspectives and help you understand the value of narrative medicine. Practice close reading, i.e., looking at both what the text says (its content) and how the text says what it says – through imagery, figurative language, motif, and so on.
Consider participating in workshops or courses on narrative medicine. This can provide you with certain skills and knowledge to incorporate narrative medicine into your practice.
Encourage your team to share their experiences and reflections. This can foster empathy, improve communication, and promote a better understanding of patients.
Encourage your patients to share their stories. This can be in the form of verbal narratives, written stories, or even art and music. This can help you understand their experience better and provide more personalized care.
Narrative medicine is not just about storytelling. It’s about using narratives to improve health care delivery and promote healing. It requires practice and patience, but the rewards can be significant.
One of the greatest compliments paid to me was by a prominent psychiatrist, and his remarks were about my writing. I had asked the psychiatrist to write the lead chapter for a book I was editing, and it was already under contract with a publisher. The psychiatrist was late in submitting his chapter, and on top of that, his manuscript was poorly written. I did a major revision of his chapter, staying true to his points but improving the flow, grammar, and syntax and inserting scientific references to bolster its credibility.
I mailed the new and improved manuscript to the psychiatrist for his approval. Several days later, he called me.
“Art,” he said, “You’re an alchemist.”
“How do you mean,” I asked.
“You know how to turn shit into gold!”
Newton may have been onto something after all.
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.