By Kristina Fiore
Two weeks ago, MedPage Today published a story on narrative medicine, for which I interviewed Lee Gutkind, who is credited with being the godfather of creative nonfiction. Gutkind has published several books on medicine, spanning topics from organ transplantation and childhood mental illness to life inside a children’s hospital. He also has encouraged writing among clinicians, publishing several anthologies of stories from all voices in healthcare. The following is an excerpt of the conversation that I had with Gutkind.
You’ve written a
lot about medicine and technology, but you’re also interested in getting
doctors and other medical professionals interested in writing as well. Why is
that?
Physicians really like to talk about literature and they
read much more than lots of people would realize, and much more than the other
people. The second thing is that a physician’s life is very similar to a writer’s
life — the intense isolation, the practice, the feeling of being alone so
often even though there are all kinds of people around you, and, especially
with surgeons, the method, the craft you have to use in order to become
successful. The third thing is that there are so many complicated things for
the everyday, intelligent patient to understand and appreciate and digest, and
as technology advances, it becomes more complicated, so the best way for us to
know about it is through story. And so I thought this is kind of a mission for
me. Since Many Sleepless Nights, there have been four books and four or five
anthologies that focus on the world of medicine and my magazine Creative Nonfiction
has had two or three special issues focusing on medicine, all narrative medicine.
The mission to me is to take the mud of medicine — mud being what other people
might look at it as — and make it clear and understandable through story.
So the idea when
physicians focus on story is to enhance empathy and understanding.
That is absolutely the case and the more that doctors become
aware of the importance of narrative or story, it would seem to me the more
they become interested in listening to the patient story. I know there is a lot
of pressure for doctors to rush through seeing patients, since the average
patient visit is about 12 minutes. But it’s hard to hear a patient story and
understand and digest it in such a short period of time. And I know diagnosis
has a lot to do with patient story and finding out what the symptoms are. So
all of that makes narrative medicine or story-oriented medicine something to
work on and help develop.
It seems the push
into narrative medicine is gaining acceptance. Why at this time, why now, are
more doctors becoming open to this movement?
I’m not positive that it’s becoming an explosion of
awareness, I think it’s coming slowly but also carefully and I think it’s
because this isn’t only happening in medicine, but is happening in science and
history and law. All you have to do is turn on the TV and according to every
commentator, every politician has to have a narrative, every corporation has
one, everyone has a narrative these days. We’re all becoming much more aware
that there’s more to life than, ‘just the facts ma’am,’ since story adds a
three-dimensional perspective that we all value. I think the fact that it
happened in medicine triggered it happening in other areas.
Are today’s narrative
movements directly connected to the rise of narrative nonfiction and the new
journalism?
I say there are linkages between the two, but there was a
modest movement when the new journalism emerged – writers like Gay Talese,
Truman Capote, Norman Mailer, Tom Wolfe, that was the New Journalism. There was
very little medicine and science written in narrative form then. But gradually
more people, specifically two different groups, got involved in the narrative
movement. One is that other writers like the poet Diane Ackerman would cross
the line from what they considered to be literature into what people were
calling journalism or nonfiction, and increasingly, literary folks in the late
70s and early 80s and through the late 80s began crossing the line from fiction
and poetry into nonfiction. Number two, scientists and doctors began
experimenting, realizing that the age of the expert was upon us, because there
was so much more to learn. And people began writing in a story-oriented way.
Oliver Sacks was someone who began writing that way in the late 80s early 90s,
and obviously helped carry the banner into the world of medicine.
Are you surprised by
the volume of submissions you’ve received for your anthologies from doctors who
want to write?
Yes, for our anthologies that had to do with changing the
medical system, we did open calls, and we got hundreds of submissions. For
Silence Kills, we thought we would get 98% complaining patients, but that
wasn’t the case at all. There are about 16 essays, four or five are from
physicians, telling significant stories that reveal how frustrated they are
with the way the world of healthcare is being run. In an anthology I just
published a couple of months ago called Twelve Breaths a Minute, Stories About the
End of Life, I didn’t count, but of 23 essays there have to be six or seven
from physicians. Physicians for a long time have had a very difficult time
speaking out. In private, they have their own problems and complaints and
frustrations. By giving them a forum, they are very anxious to talk about what
they seem to not be able to talk about among their colleagues.
You’re now collecting stories from nurses for a new
anthology. Since historically physicians ‘cure’ while nurses ‘care,’ and since
nursing is generally associated with a more humanistic approach to begin with,
do you see a difference in submissions?
To be perfectly honest, the submissions for the nursing
anthology are very low compared to other anthologies. In my experience, we don’t
get nearly as many submissions as we would like from nurses. I don’t quite know
why. It’s been very frustrating, and frankly we don’t get a lot of cooperation
from nursing programs. No one seems to be incredibly interested. Nurses in many
respects have a lot more to say that physicians could never say, because they spend
so much more time with patients. They have frustrations with the medical system
that are completely diff from those physicians have. They have so much to say
and the stories they tell would help bring others in the field.
Perhaps they are more
afraid of or intimidated about sharing their stories?
Right. One hates to just blame the system, but it’s a
difficult place to negotiate, especially these days. Physicians have a certain
amount of power and influence that nurses don’t have. It’s the same with social
workers. They have incredible interactions with families and they don’t contribute,
and that’s too bad.
Perhaps legal
implications hold them back? Do doctors struggle a lot with patient privacy in
their writing?
I haven’t seen that as an editor, but as a writer, I’ve seen
the gates close from certain medical centers when you try to get information or
make connection with physicians or nurses. Sometimes the gates are really
closed by administration. It seems physicians are as open as ever once you get
around all the guards barring your way in.
Are you currently
offering any narrative nonfiction training to physicians?
In late fall or winter, we’re going to start introducing online
narrative medicine courses. We’re going to link a physician-writer with another
teacher. We’ve been talking with Manoj Jain, who writes terrific narratives for
the Washington Post and other [publications]. He’s an infectious disease physician
who lives in Memphis. He will be teaching with one of our teachers our first
narrative medicine course. We’re also chatting with folks at Health Affairs’ “Narrative
Matters” section about doing a narrative medicine conference in Washington
sometime soon to bring together editors and physicians interested in writing
and publishing narrative.