Literature as Path Toward Understanding Illness

Photo by Rachel Eastwood Jason Sanders

I haven’t attended many cocktail mixers lately, but I do still meet new people on the wards. I often mention that my background comprises two colleges and two degrees—one in biochemistry and one in English language and literature. While this may be a great conversation starter, it sometimes can leave us in the doldrums, set adrift from the normal current of medical topics. For each enthusiast who nods in approbation, another politely smiles while wondering how literature could really fit in with bench research and pathophysiology.

The Storytellers
Two mentors loom large in my introduction to the “medical humanities”: Dr. Ronald Schleifer (professor of English) and Dr. Jerry Vannatta (professor of medicine), who co-taught a colloquium at the University of Oklahoma. Ours was a consultation of literature as a way to probe the subtleties of the patient–doctor relationship, including issues regarding professional ethics. An outline of what we discussed and to whom we looked for guidance could be found in an anthology such as On Doctoring, which is distributed to matriculating medical students at Harvard and across the country. Just recently, both professors published their own “anthology” in the form of an interactive DVD-ROM titled “Medicine and Humanistic Understanding” (UPenn Press; see review in The Journal of the American Medical Association, July 27, 2005). This compilation features several notable people who are involved in teaching medical trainees about the narrative form of the “history of present illness” and about the empathetic competency necessary to relate to patients.

Literature and Medicine at HMS
Dr. Rafael Campo is one of the physicians interviewed in the DVD-ROM, and he teaches a seminar at HMS on “Literature, Arts, and Healing,” which I took with five other students in the spring of first year. At the same time I also took an elective on “Literary Narratives and Ethical Issues” led by Drs. Martha Montello and Maren Batalden, both HMS faculty members. There also were opportunities in Patient–Doctor I and the Mentored Clinical Casebook project to discuss themes informing the patient’s explanatory model. Yet there seems to be a paucity of longitudinal experiences within the official HMS curriculum for a continued apprenticeship in the art of humanistic understanding. As the review of the DVD-ROM says, despite the increasing prevalence of medical humanities courses, their role in clinical education remains to some merely “a nice idea.”

While biochemistry and literature usually inhabit separate parts of the mind, it’s high time that they start enjoying each other’s company more often.

Beyond Book Clubs
So how does reading literature help someone become a better physician? I frame this question in the context of appreciating stories and translating them into vehicles of connection between patient and doctor. Literature provides one interpretative path, but it is not alone. We all recognize the diverse experiences of our colleagues, who draw on perspectives from fields such as economics, fine arts, and the population sciences. As the Medical School plans for its students to embark upon in-depth experiences, literature should be one of the scholarly tracks officially recognized by our community as a complement to the medical curriculum (along with public policy, basic science, epidemiology, religion, and business, to list a few). While the pursuit of a joint degree would appeal only to a small number, there is much time after the first year for focused, scholarly instruction in how to use literature to better comprehend the patient’s story—the sine qua non for effective diagnosis and treatment.

At the Bedside
William Carlos Williams says in “The Practice” that “the physician enjoys a wonderful opportunity actually to witness the words being born.” The bedside interview affords the privilege of having the patient—and not abstract scribbles on a chalkboard—before everyone’s eyes. Demonstration of exam findings is a key part of this process, but Frederick C. Shattuck remarked in 1907 that “even when physical examination fully lays bare the disease, it may tell us little as to the subject of the disease, and our advice must be given to the individual.” Literature can help us realize the interplay between looking holistically and looking only at a single part (e.g., an enlarged liver) as a substitute for the person. Much is gained by the astute observer who notes both the familiar paradigm of an illness as well as the nuances of the particular situation. It is the master clinician who then asks the apprentice: what did we learn from this encounter that we didn’t know beforehand?

While biochemistry and literature usually inhabit separate parts of the mind, it’s high time that they start enjoying each other’s company more often. Are they not each an epistemological system for making sense of the story—whether the meta-narrative of human existence or the particular narrative of the patient in Room 11A?

—Jason Sanders is a third-year medical student at HMS.

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

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