The Observer, October 13, 2006
Volume XXXIX, Issue 7
One Foot Out the Door: Narratives in medicine increase
On a recent trip to Barnes & Noble, I came across a new section – Physician Writers. The list includes Oliver Sacks (The Man who confused his Wife for a Hat), Michael Crichton (Jurassic Park), Sir Arthur Conan Doyle (Sherlock Holmes), Nawal El Saawadi (The Hidden Face of Eve: Women in the Arab World), and Cecil Helman (physician with training in Anthropology.)
The last of these, Helman, recently published a book of his memoirs (Suburban Shaman: Tales from Medicine's Frontline). He wanted partially to explain this recent proliferation of physicians who have become writers. He used timekeeping as an analogy for the narrative. With a digital watch, when you look for the time, you literally see only the present – a "snapshot" of time. Prior to the digital era, however, one reads the time on a watch with hands, and could see the time "before" as the time "after." In his opinion, recent medicine (for multiple reasons) has limited physicians to look only for a snapshot view of patients 'lives (the brief moment they are sick and come into a clinic), when they would really prefer a fuller, contextualized view (the "before" and "after"). And yet even in these brief interactions, the physician works aggressively to form a narrative. Helman's book is introduced with the idea that, "Medicine is not just about science. It's also all about stories, and about the mingling of narratives among doctors, and between them and their patients." The narrative, for him, was the therapy as much as anything else.
He felt that the greatest gift you can offer anyone–a patient or otherwise–will be a story: the story you share and engage, the one you listen to and mold, the ones you commit to unfolding with enthusiasm and humility. This being Helman's perspective, he found it no surprise that with increasing pressures limiting the physician's ability to engage a full narrative, they are now writing them.
The latest additions to this genre have come from American physicians writing not about their medical career, but about their training: the 100 hour weeks, 36 hour shifts, the late night calls, the rites of passage they fought through, and the heroic measures it took to survive training. Provocative descriptions like Surviving Harvard Medical School are not difficult to find.
An initial read through such works might lead one to see them as a type of excessive reality TV turned (only slightly) more intellectual. Perhaps, more euphemistically, one might call it a "narrative self-therapy," where the telling/creating of the narrative helps the medical student (or intern or resident) cope with the situation. The regularity of such language found amongst those in the medical profession has prompted some anthropologists to suggest it may be an intentional effect.
The institution of biomedicine works deliberately to make those in the system feel that they have taken on some heroic measures to become a physician. The argument would then imply that if physicians saw their training as somehow more bearable, less than impossible, something closer to a "normal" 40–hour work week, the institution of biomedicine would lose authoritative power.
While on paper these arguments seem convincing, seeing the narrative from the red, half–closed eyes of a resident completing a 112 hour week, and thoughts of him/her as a vehicle of institutional power is far from your initial thoughts.
