As a physician – Why write? Why reflect?
Hugh silk
I am excited for this new writing forum at UMMS in the medium of a blog. Another chance for clinicians, students, employees, etc to reflect and write, to ponder and muse, to opine and challenge. Perhaps to go even further and explore or be vulnerable, to bear witness and to be freed.
Why write? I have been asked this many times and plan to give a talk on this at a Medical Humanities conference this fall. As a physician, I feel an obligation to do some writing. I think without it I would be a lesser provider. That is not to say that those who do not write are lesser; but it is to say that I would be lesser. And if I may, it might be that my colleagues might be more.
How can I believe this? I am certain many of us are physicians because we love people. We marvel at the differences of culture, life styles, and stories. We yearn to take it all in. We spend most of our interaction with patients talking, not doing. We tell each other stories about these encounters, not about the prescriptions we wrote. Sure, we are interested in the science and the challenge of a diagnosis, but one does not do this for twenty years without the story.
And now the expediency of medicine is distorting our ability to wallow in the relationship. Seeing patients faster, the focus on billing, and the electronic health record have robbed us of the telling of the story and savouring what really happened between patient and healer. I used to dictate notes with nuance, humour and detail. Now I click buttons of criteria for billing and lawsuit prevention. I am embarrassed by my notes. I am not in that note, nor is my patient. We are on the outside looking in. And so, I write. I write stories, essays, poems, haikus, and the like.
The answer to “why write” answers the question of “why reflect”? Selfishly, I need it. It allows me to make sense of an encounter. I can fill in the gaps. I can think about why we said what we did, why we cried or raised our voices. I can imagine what they were thinking and what I was thinking. In some cases, like all story tellers, I might idealize the scenario. In other cases, I can learn from it. I can study my approach, my reaction, my awareness and bird’s eye view of the encounter (what others have called metacognition). My selfish desire for the writing makes me a better physician, one with a wider lens and better intuit, and ultimately my patients benefit from those skills.
When I read the writing of another healer, I learn from their observations. I learn how they “see” the encounter which may be different than the way I see it. Grand rounds help us learn how a colleague offers medical care to a patient; reading a medical story tells us how they experienced that care. That is the lesson I am interested in. As Muriel Rukeyser wrote, “the universe is made of stories, not atoms”.
And so, I write, and reflect.
A recent haiku after an encounter:
Drugs robbed you of life
Suboxone, giving it back
So proud of you – thrive!
So simple; so powerful; so easy; so rewarding. Write, reflect, enjoy. It’s your career – find ways to make it meaningful. Writing and reflecting works for me.
Hugh Silk, MD, MPH is a professor in the UMMS Department of Family Medicine and Community Health and is working with two other faculty to create a UMMS Medical Humanities Lab.
