Inviting in the Life World:
Illness Narratives and Personal and Creative Writing in Medical Education

Jessica Singer Early, Ph.D.
Jessica.Early@asu.edu

Meredith DeCosta, M.Ed.
meredith.decosta@asu.edu

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Abstract

This paper shares a historical framework for understanding the inclusion of literature and creative writing courses in medical schools around the world. Furthermore, it examines how these two instructional approaches teach significantly different perspectives about the role of doctors in relation to their patients. More specifically, the recent use of patient and doctor narratives and personal and creative writing in medical courses represents an important pedagogical shift in medical training to include more of the life world of patients and doctors.

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Unless we can attend to the interior life, the courage, if you will, of our developing doctors, we will end up with doctors who flinch when things don't go well, who abandon patients when they're dying (Charon n.d.). [1]

Technical Rational vs. Life World in Medical Practice

Over the last thirty years there has been a shift in medical education in countries around the world to include the voices of patients and doctors through the medical humanities and, more specifically, through literary studies and personal and creative writing. This paper explores the difference between literary studies and personal and creative writing in the medical humanities and examines how these two instructional approaches represent and teach dramatically different perspectives about the role of doctors in relation to their patients. The recent use of illness narrative and personal and creative writing in medical curriculum represents an important pedagogical shift in medical training to include more of the life world of patients and doctors.

Elliot G. Mishler’s (1985), The Discourse of Medicine: Dialectics of Medical Interviews, describes a study of various doctors’ medical encounters with patients. [2] Through an analysis of doctor-patient discourse, Mishler theorizes that doctors and patients operate in separate orbits. He names these orbits, or ways of communicating and thinking, the “technical rational” and the “life world.” The technical rational is the voice of medicine and belongs to doctors who are trained to think and act in a highly scientific manner. The life world represents the voice of patients who share their personal lives through emotions and stories. Mishler describes the divergent ways in which doctors and patients communicate and how this difference often leads patients to feel alienated, misinterpreted, or ignored when visiting doctors. If doctors discount the stories and feelings of their patients by relying only on their technical rational training, then they may miss important opportunities to communicate and connect with patients, and, perhaps, to discover information relevant to their patients’ health and willingness to follow medical regimes.

The incongruent orbits of doctors and patients did not exist in ancient medicine when medical practice incorporated human narrative, ritual, and religion. Physician and narrative medicine expert Charles Anderson (1990) describes how early doctors used personal story to make diagnosis, “A crucial element of ancient medicine was a belief in the power of the spoken word, of dialogue between the sick person and others, as a cure for or palliative to disease” (40). [3] A shift away from the acknowledgment of personal story in medical diagnosis occurred during the fifth century B.C. The technical rational perspective in science developed during the Enlightenment. Foucault, in The Birth of the Clinic (1973), wrote about the scientific gaze. He described the scientific stance as impersonal and objective. [4] This way of thinking about science and medicine actively fought against the use of tradition and superstition in ancient medicine.

Charles Anderson explains, “Disease became an objective phenomenon that doctors worked to isolate, observe, describe, and treat” (1990, 40). [2] Aldous Huxley, in Literature and Science (1963), describes the technical rational viewpoint of scientific practice:

The man of science observes his own and the reports of other people’s more public experiences; conceptualizes them in terms of some language, verbal or mathematical, common to the members of his cultural group; correlates these concepts in a logically coherent system; then looks for operational definitions of his concepts in the world of nature, and tries to prove, by observation and experiment, that his logical conclusions correspond to certain aspects of events taking place out there (5). [5]

Huxley’s description of the scientific stance leaves out human connection, story, and custom. Furthermore, Huxley’s description, if applied to doctors, ignores affect or nuance. Patients become distant members of “cultural groups” and their stories become far away “aspects of events taking place out there.”[5] The doctor-patient binary has also mirrored medical training for the last several centuries where future doctors were, and often still are, taught to sift through the narratives of their patients in order to make informed choices about medical care and form a scientific diagnosis. The medical practice shifted long ago from the life world of patients and doctors favoring, instead, the technical rational world of science.

This became particularly true in the 1900s when medical schools’ curriculum all but ignored the life world of patients. In 1910, Abraham Flexner’s Report, “Medical Education in the United States and Canada,” made a call for medical training to focus on scientific thinking. [6] Flexner critiqued the lack of scientific rigor and the nonsystematic approach to medical schooling. Cooke et al. (2006) states that “caring for patients,” and in effect patients’ narratives, became less important in medical schooling as a result of the report. Rigorous scientific training outweighed the social, humanistic, and personal aspects of medical curriculum. [7] Flexner later lamented in 1925 that the report’s unidirectional focus on the scientific side of medicine had unintended consequences: “Scientific medicine in America — young, vigorous and positivistic — is today sadly deficient in cultural and philosophic background.” [8]

The Emergence of Humanities in Medical Education

While significant scientific advancements were made in the 1900s, the focus on technical rational thinking without attention to human interaction created a backlash in the late 1960s and early 1970s throughout the United States and Europe. [9] Collective concerns of hospital chaplains, moral and ethical theologians, philosophers, and academic clinicians resulted in the emergence of the humanities in medical education. [9] “Medical progress has enabled physicians to make enormous advances in the treatment of serious diseases,” but this has also frustrated patients who “feel alienated, who feel their doctors have become distant, uncommunicative, and unable to address crucial aspects of sickness” (Anderson 1990, 34). [2] Due to this public outcry, medical schools began to incorporate the humanities into their curriculum.

The incorporation of the humanities into the medical school curriculum has included courses focused on medical ethics, religion, anthropology, history, psychology, literature, and composition. Since the late 1960s and early 1970’s, medical humanities curriculum has spread in various forms to a large portion of medical schools in the United States, Great Britain, Australia, Canada, and other parts of the world (See Table 1). Table 1 exemplifies that the majority of medical humanities courses are currently offered in the United States. However, outside of the United States there are a number of medical humanities programs and professional development opportunities available, including those created by Gillie Bolton in Great Britain, Rakesh Biswas in India, Malaysia, and Nepal, P. Ravi Shankar in Nepal, and many others.

Table 1. Medical Humanities Courses Currently Offered at Universities with Medical Humanities Programs

University

Country

Literature Courses

Illness Narrative Literature Courses

Personal/Creative Writing Courses

Other Courses (e.g. Medical Ethics)

Not Specified

Baylor University

USA

X

X


X


Columbia University

USA

X

X

X

X


Cornell University

USA





X

Dalhousie University

Canada




X


Davidson College

USA




X


Drew University

USA

X

X

X

X


Drexel University

USA


X


X


Duke University

USA





X

Durham University

Great Britain





X

East Carolina University

USA

X

X


X


Harvard University

USA




X


Institute for Medical Humanities (University of Texas Medical Branch)

USA

X

X


X


Institute for Medicine in Contemporary Society (SUNY Stony Brook)

USA

X

X


X


Indiana University-Purdue University Indianapolis

USA




X


Kings College London

Great Britain

X

X


X


Loyola University Chicago

USA

X

X


X


McGill University

Canada



X

X


Michigan State University

USA

X



X


Newcastle University

Great Britain





X

Northwestern University

USA

X

X


X


Southern Illinois University

USA

X

X


X


Stanford University

USA

X

X

X

X


SUNY Upstate

USA

X

X

X

X


Swansea University

Great Britain

X

X

X

X


Universite de Montreal

Canada





X

University College London

Great Britain

X

X


X


University of Alberta

Canada





X

University of Arizona

USA



X

X


University of Arkansas

USA

X

X


X


University of Bristol

Great Britain

X



X


University of California, Irvine

USA


X

X

X


University of California, San Francisco

USA

X

X

X

X


University of Connecticut

USA

X

X


X


University of Florida

USA

X

X

X

X


University of Geneva

Switzerland

X



X


University of Glasgow

Great Britain




X


University of Houston

USA

X

X


X


University of Iowa

USA




X


University of Louisville

USA




X


University of Manitoba

Canada




X


University of Newcastle

Australia





X

University of Rochester

USA

X


X

X


University of South Carolina

USA





X

University of South Florida

USA




X


University of Sydney

Australia





X

University of Texas Medical Branch at Galveston

USA

X

X


X


University of Texas Medical School at Houston

USA


X


X


University of Texas Health Science Center San Antonio

USA

X

X


X


University of Utah

USA

X


X



University of Wales

Great Britain

X


X



Vanderbilt University

USA

X



X


Yale University

USA





X

Note: This information is up-to-date and draws from the information found at New York University's Medical Humanities Community website. It also includes information found at the various universities’ websites. While comprehensive, this list is not exhaustive. Furthermore, courses, instructors, programs, and their syllabi are in constant flux. "Other Courses" denotes that the program offers medical humanities courses that are not literature or personal/creative writing courses, including medical ethics, history, anthropology courses, etc. "Not Specified" denotes that the university's website does not give sufficient course information at this time.

In 2009 in the United States, for example, out of 126 medical schools, 96 required at least one course in medical humanities, either separate or embedded in another course, and 68 schools provided elective or optional course offerings. This is a significant change from 2000 when only 8 schools in the United States required a separate medical humanities course (Association of American Medical Colleges 2008; Association of American Medical Colleges 2000). [10, 11] While humanities has entered the curriculum of medical schools throughout the United States, Australia, Canada, and Europe and has also been introduced to other parts of the world, it is not the predominant focus of medical training. Courses are generally offered only to third and fourth year medical students and are often optional electives or special study modules. Further, while there are well-established courses in ethics, literature, and other areas of the humanities at universities, only 13 medical humanities programs offer courses in personal and creative writing, placing writing courses on the fringes of medical curriculum.

Medicine and Literature

One of the curricular foci in the medical humanities is the study of literature, which works to provide a new perspective and discourse for future doctors. The journal Literature and Medicine was established in 1990 as a forum for this new approach to medical education and practice. [12] Rita Charon, the director of the Narrative Medicine Project at Columbia Medical School, and Maura Spiegel, both former co-editors of the journal, describe the role of literary studies in medical training:

By now, medical schools and hospitals are used to having literary scholars in their midst. Most schools of medicine teach literary texts and methods to students; more and more health professionals are completing graduate degrees in English or comparative literature. What literary studies provide them – in developing narrative competence, in learning how to adopt alien perspectives, even in simply reading or listening for the clinical plot – is irreplaceable, fundamental, and urgent (2001, vii-x). [13]

Literature studies, according to Charon and Spiegel, invite doctors to adopt the perspective of the patients met in their medical practice.

Several benefits to incorporating literature into medical school curriculum have been cited. Rita Charon (2006) believes that literary texts offer students an opportunity to practice letting in the life worlds of their patients because acts of reading and acts of healing are intertwined (108). [14] She argues that the study of literature in medicine is a powerful tool to assist doctors in connecting to the lived experience of their patients by helping the physician to interpret the texts of medicine, to develop empathy, and to deepen the ability to reflect (2000, 285). [15] Doctors cannot be effective without the necessary “skills, attitudes, and bodies of knowledge,” which are arguably offered through literature courses (2000, 285). [15]

Robert Coles, a psychiatrist and professor of medicine at Harvard University, is a pioneer in the humanities in medicine movement. In The Call of Stories: Teaching and the Moral Imagination (1989), Coles describes the benefits of understanding the doctor’s role in relationship to patients that took place in his medical training after learning from his mentor and friend, William Carlos Williams. [16] Williams was a doctor and major literary figure, and he used his writing to inform and guide his medical practice. Note: other well-known doctors and authors include Anton Chekhov, W. (William) Somerset Maugham, Sir Arthur Conan Doyle and, more recently, Abraham Verghese and Atul Gawande. [17, 18] Williams once told Coles,

We have to pay the closest attention to what we say. What patients say tells us what to think about what hurts them; and what we say tells us what is happening to us – what we are thinking, and what may be wrong with us . . . Their story, yours, mine – it’s what we all carry with us on this trip we take, and we owe it to each other to respect our stories and learn from them (1989, 30). [16]

As a result of Coles’ relationship with Williams, he incorporated literary texts into his curriculum to allow the patient’s “story” to be considered; this included texts such as The Great Gatsby (1996), Lord of the Flies (1962), and The Catcher and the Rye (1951) to offer medical students an alternative path to understanding the “truth” in human experience. [19, 20, 21] It has been argued that literature and medicine ask the same rich questions regarding the “truth” of human experience, inextricably linking the two. [22] Further, Coles argues that the study of literature offers medical students a new language and a moral alternative to highly scientific medical training. [16]

Research on Using Literature in Medical Training

A few empirical studies, primarily qualitative and descriptive in nature, support the benefits of incorporating literature into the medical curriculum. For example, Lancaster, Hart, and Gardner (2002), found that by incorporating relevant medical themes, such as death and dying, addiction, and doctor/patient communication, and literature’s content and form into a special study module, students perceived they would have a greater ability to communicate and empathize with patients. [23] Jacobson et al. (2004) found similar results in their special study module that used focus groups and nominal group theory to determine the effects of studying literature and medicine. [24] Although continued research is needed, the results of these studies show that medical students self-report various improvements in their practice and/or understanding of patients after studying literature.

Literary Criticism and Analysis in Medical Curriculum

The practice of teaching literature and medicine has occurred, for the most part, in the tradition of literary analysis and criticism. While this approach represents a shift in medical training to include more of the life world through stories in novels and famous texts, literary criticism is often used to methodically and formally analyze texts from a distance. Medical professors interested in the humanities are increasingly studying in English departments, thus it makes sense that their instructional focus favors literary analysis over writing (Charon and Spiegel 2001) [13]; most English departments value literary analysis over creative or personal writing in response to texts.

One example of a literary analysis and medicine course includes Southern Illinois University School of Medicine’s “Literature and Medicine” course taught by Phillip Davis, PhD. This course is designed “to engage students in an in-depth analysis of works of fiction which, through guided study, allows them to develop the interpretive skills necessary to become aware of what fiction teaches us about our understanding of health and disease and the way in which their own clinical experiences can provide a useful context for interpretation of texts” (Southern Illinois University School of Medicine 2007). [25] The students in this course are evaluated by their discussion and on a final paper “which will explore a major theme in a selected novel and related literary works” (Southern Illinois University School of Medicine 2007). [25] In many cases, like this one, the use of literature in medical education remains highly analytical and favors a technical, rational way of thinking.

Another example of a recent literature and medicine course is a course entitled, “Narrative of Illness,” offered at the University of Texas Medical Branch Institute for the Medical Humanities which asks students to read “pertinent background readings in narrative theory along with some experimental meta-fiction that raises questions about the construction of narratives (e.g. narrative voice, point of view, and other literary elements)” (R. Lindley, pers. comm.). [26] This course requires medical students to use literary analysis to think about narrative structure in literary works. Courses that focus primarily on analysis do not often ask medical students to connect to the texts or to their own patient’s lives in personal or reflective ways.

Literary analysis seems to represent a mid-point between the scientific and humanistic perspective by offering rational and aesthetic inquiry, but formal analysis offered in some literature and medicine courses keeps the interpretation of and connection to life stories at an emotional distance. Charles Anderson (1990) explains the dangers of teaching literature in medicine using a technical rational method of instruction rather than teaching future doctors with strategies that allow them to truly connect with human stories.

The practitioners of literature and medicine often substitute literary criticism for literary discourse, falling victim to the powerful analogy between the literary critic, who maintains a necessary aesthetic distance, and the physician, who maintains a necessary emotional one. If this is where literature and medicine stops, then it will only serve to legitimize, in nonscientific but equally scientistic terms, the distance between patient and physician, a distance that created the difficulties literature is supposed to alleviate. It will have missed the point (49). [3]

Literature and medicine courses provide powerful opportunities for future doctors to connect to the characters and stories of texts; however, the literature courses available to current and future medical students may “seriously impede their chances of developing any awareness of the patient’s perspective on and experience of illness” (Engel 2005). [27] The overt focus on analysis does not create a bridge to the day-to-day work of doctors and the lives of their patients because they do not “challenge these pre professionals to consider the medical world they seek to enter or the patients they seek to serve” (Engel 2005). [27]

The Role of Illness Narratives

As a result of the above concerns, many medical humanities programs have opted to focus more explicitly on narratives written by patients and doctors and have begun incorporating these texts into their literature courses. Many of these new courses do not focus on the technical, rational analysis of canonical literature; rather, they are intended to allow students to go beyond literary analysis and criticism into the life worlds of those who treat illness or face illness. Schools such as University of California at Irvine, King’s College London, and the Hebrew University of Jerusalem have integrated medical narratives from Abraham Verghese, Rafael Campo, Anne Fadiman, Rosalind Warren, Jerald Winakur, Arthur Frank, Raymond Carver, and many others into the curriculum.

The inclusion of illness narratives has not come without controversy, however: ethical questions naturally arise when biographical and autographical narratives in medicine represent flesh-and-blood people. Patients may be at risk of becoming literary characters which raises questions about authenticity and challenges how we truly “do justice” to people and their lives (Rimmon-Kenan 2006) [28] Further, reading illness narratives may provide insight into bereavement, loss, death, and grief, but a veil remains because readers have the power to distance themselves from the literary work at any point. “Readers are not static or single entities,” but they do choose when to close the book (Charon 2006, 109). [14] While still contentious, certain illness narratives literature courses may provide a window for future doctors to learn the reflexivity needed to become physicians who consider humans and humanity, which represents a vast and important contrast from strictly analytical models of studying literature in medicine.

Narrative Medicine and Writing

The term “narrative medicine” was first coined by Rita Charon in the January 2001 Annals of Internal Medicine. [29] “Narrative medicine,” according to Charon, “has developed in tandem with literature and medicine, weaving together theoretical perspectives, literary texts, and creative methods for the benefit of the practicing doctor and the ailing patient” (2001, 1898). [30] From the narrative medicine model, personal and creative writing in medical humanities courses has emerged as another tool for doctors to enter and reflect upon the life worlds of their patients in a less distanced manner. Changes to medical training are currently taking place in medical schools around the world to include personal and creative writing. Charon has integrated personal, reflective, and creative writing into her practice as a doctor and medical educator. For her and many doctors, it is not enough to study human experience from a distance. Writing is a means by which she and her students intimately connect with their subject matter. Charon (n.d.) describes the reasoning behind her use of writing in her teaching, “I wanted to find a way to help [medical] students focus on what they themselves were going through, and a way to focus on what their patients had to endure in the course of being ill…And so I made them write.” [1] Charon’s belief is that doctors and patients work in the practice of medicine and healing together. This is a dramatically different perspective regarding the role of the doctor because it asks doctors to embed both scientific and affective thinking into their work.

Charon developed a course at Columbia University School of Medicine in the narrative medicine program using a teaching method she calls “parallel charts” where medical students keep a written record of their personal experience as medical practitioners, which parallels the scientific recording of medical notes and reports. The parallel charts are written in addition to formal medical charts and are used as a way of letting in the life world of patients.

I tell students that the Parallel Chart is not a diary. Writing Parallel Chart entries is not the same as writing a letter to your sister. Instead, it is part of clinical training. The writing I want is indexed to a particular patient. It is not a general exploration of one’s life and times. It is, instead, narrative writing in the service of a particular patient (2006, 157). [14]

The use of parallel charts is an acknowledgement that there is more going on in medical practice than technical rational thought, and that the moral, emotional, and spiritual development of doctors and patients must be recognized in “service” of patients (2006, 157). [14] Charon’s medical students go beyond interpreting distant stories and characters in literature. Instead, students use their own experiences with the narratives of their patients to create written dialogues, reactions, and reflections to help them empathize and humanize their practice. Arthur Frank, a sociologist at the University of Calgary, takes the parallel charts a step further. He suggests that a three-part chart is most effective, which includes the doctor’s scientific notes, his or her narrative notes, and the patient’s notes about the process. In Frank’s view, patients, as well as doctors, should record the experience and explore their understanding of illness. [31]

Many doctors and scholars believe that literary criticism and analysis has a place in the curriculum, but others suggest that personal writing in medical curriculum offers something that literary analysis cannot. Charon says, “I am a fan and the editor-in-chief of the journal Literature and Medicine, but I think the more clinically salient aspects of narrative training are not so much in close readings of great literary masterpieces but in personal experience with the discovery possible by one’s own writing” (R. Charon, pers. comm.). [32] The role of writing is critical in medical education because it creates a way for students to think about their own experiences along with those of their patients. Arthur Frank argues that medical education should actually shift from literature toward nonfiction writing. This writing, according to Frank, should include physician and patient narratives that can help physicians and patients alike realize that “life really is a story.” [31]

Personal and Creative Writing in Medical Schools

Writing personal, life stories is yet another way for doctors to process the difficult and human experience of practicing medicine. Rita Charon argues that successful doctors must be trained to think and act with more than scientific thought and that they need to acknowledge their interior lives along with the life world of their patients. Charon believes that what medicine often lacks – empathy and humility – can be solved, to a degree, through an awareness of narrative and personal and creative writing (2006, viii). [14] Gillie Bolton, an advocate of expressive and therapeutic writing, also contends that creative writing has its place in medical training and health care practice. Bolton (2001) advocates the use of a mentor to support and examine the lives of patients and believes personal and creative narratives can have a therapeutic effect on physicians. [33]

While still few in number, there are currently courses offered within medical humanities curriculums that focus primarily on personal and creative writing (See Table 2).

Table 2. A Sample of Creative Writing Courses Currently Offered in Medical Schools

Medical School

Course Title

Instructor

Type of Creative Writing Practiced

Columbia University
School of Medicine

Narrative Medicine

Rita Charon, MD

Writing personal reflections using parallel charts to react to their medical practice

Stanford University
Medical School

Creative Writing for Medical Students

Audrey Shafer, MD

Writing workshop for medical students to practice fiction and poetry

University of California, San Francisco School of Medicine

Narrative Medicine: The Medical Student as Writer

David Watts, MD and/or
Louise Aronson, MD, MFA

Writing workshop for medical students to develop skills as writers of fiction, memoir, and creative non-fiction

SUNY Upstate Medical University

Introduction to Creative Medical Writing

Deirdre C Neilen, PhD

Writing workshop for medical students to create a medical narrative

Swansea University School of Health Science

Writing and Reflective Practice

Not specified

Writing reflective pieces for the medical practice

McGill University Faculty of Medicine

The Poetry of Practice

Maureen Rappaport, MD

Writing poetry and other creative, reflective pieces

Columbia University School of Medicine

 

Reading and Writing the Body: Women’s Illness Narratives

 

Sayantani DusGupta, MD, PhD

Writing an illness narrative through a series of writing exercises around issues of the body

Columbia University School of Medicine

The City of the Hospital: Medical Student as Writer

David Hallerstein, MD

Writing essays and keeping a personal journal in response to medical school experiences

University of Florida College of Medicine

Reflective Writing

Gail Ellison, MD

Writing reflective pieces for the medical practice

University of California, Irvine School of Medicine

 

Creative Writing For Medical Students: A New Tool For Understanding Patients

Johanna Shapiro, Ph.D. and
Andrew Tonkavitch, MFA

Therapeutic, expressive, and reflective writing

Joanna Shapiro, Ph.D., the director of Medical Humanities and Family Medicine at the University of California, Irvine, and Andrew Tonkavitch, MFA teach an elective course called, “Creative Writing For Medical Students: A New Tool For Understanding Patients.” Shapiro and Tonkovitch require their students to examine theoretical and empirical work that supports the benefits of therapeutic and expressive writing and allow students to respond to their practice through reflective writing. [37]

David Hellerstein, MD teaches a course, “The City of the Hospital: The Medical Student as Writer,” at Columbia University School of Medicine. In his description of the course, Hellerstein writes, “The goal of this workshop will be to help students develop skills to write about their training experiences and to mold their observations into finished essays… Participants will be encouraged to keep a journal of their medical school experiences.” (Hellerstein n.d.). [38] Hellerstein explained his teaching methods; “We do in-class exercises on a variety of topics, and then I “encourage” e.g. force, them to rewrite one of those into a completed essay. They then read this in class and get classmates’ responses, and I again “encourage” them to rewrite/revise. They do a remarkable job at this!” (D. Hellerstein, pers. comm.). [39] In courses like Shapiro and Tonkovitch’s and Hellerstein’s, personal and creative writing gives medical students a way to reflect upon and make sense of the triumphs, defeats, and dailyness of medical practice without the distance of traditional literary criticism.

Research on Using Writing in Medical Training

Several studies, primarily qualitative in nature, support the benefits of personal and creative writing. Doctors and researchers Levine, Kern, and Wright (2008) found that interns increased their self-awareness, enhanced their emotional healing, and expressed deeper levels of reflection after writing narratives over the course of a year. [34] A wide body of research has also shown that completing writing exercises about one’s own experiences can positively influence health (Pennebaker 2000; Singer and Singer 2008). [35, 36] Medical schools that have accepted narrative medicine into their curriculum are including personal and creative writing as a way of training doctors to humanize their practice.

Conclusion

The use of illness narratives written by and about patients and personal and creative writing in medical education provides a bridge for doctors between the technical rational world of their scientific practice and the life world of their patients. If medical schools include humanities curriculum to offer their students ways of humanizing and personalizing medicine, but do not provide occasions for students to personalize the subject matter, then the inclusion of a truly humanistic perspective in medical training remains incomplete. More longitudinal and quantitative research is needed to understand the positive effects of reading narratives written by patients and doctors and personal and creative writing on medical education and practice. Medical schools like Columbia University School of Medicine provide an example of a unique medical curriculum that includes the necessary scientific training along with opportunities to practice creative, reflective, and expressive thinking in relation to medicine. Rita Charon (2003) explained in an interview with the United States’ National Public Radio, “Narrative medicine allows students to move more easily amidst the uncertainty, ambiguity and sadness they encounter and, in the end, have a larger capacity to reflect and act.” [40] A personal approach to medical education both compliments and strengthens a highly technical and rational practice. The use of narratives about illness and personal and creative writing in medical education helps to change the definition of a doctor’s role in relation to patients. Writing and reflecting on illness allows doctors to acknowledge the ways they both affect and are affected by their patients. Hopefully, the use of illness narratives and personal and creative writing in medical education will impact doctors’ ability to communicate with patients in a more supportive, interactive, and respectful manner.

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Published: September 21, 2009