Doctors Who Wield the Pen to Heal the Profession - New York Times

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May 15, 2007

BOOKS

Doctors Who Wield the Pen to Heal the Profession

By ABIGAIL ZUGER, M.D.

Like the racket of dozens of birds on a clothesline, the sound of doctors is filling the air.
The strongest voices at the moment belong to Dr. Jerome Groopman and Dr. Atul Gawande, both clinicians
at Harvard and writers for The New Yorker, both with articulate new books garnering impressive reviews
and climbing in parallel to best-sellerdom. But they are only two of many doctors holding forth these days,
in escalating volume.
The last six months alone have seen the publication of a half-dozen volumes of memoir and opinion by
doctors at every stage of professional life, from newbie (M.D.: A Four-Year Journey Through Medical
School by Shani Stein-Ratzker) to emeritus (Galileos Gout: Science in an Age of Endarkenment by
Gerald Weissmann).
Some books promise to educate and inspire (The Man With the Iron Tattoo and Other True Tales of
Uncommon Wisdom: What Our Patients Have Taught Us About Love, Faith and Healing, by John E.
Castaldo and Lawrence P. Levitt). Some books promise social critique instead (The Corrosion of Medicine:
Can the Profession Reclaim Its Moral Legacy? by John Geyman, due out at the end of the month).
Doctors are also filling up newspaper columns (like this one), blogging, submitting work to literary journals
and signing up for courses designed to help them break into print.
It all prompts the same questions as a sudden swooping, squawking murmuration of starlings: where are
they all coming from? And what in the world are they trying to say?
Some listeners hear a set of new variations on very old songs.
Doctors are storytellers, said Kathryn Montgomery, a professor of literature who directs the medical
humanities and bioethics program at Northwestern Universitys Feinberg School of Medicine in Chicago.
They spend all day long listening to stories and telling stories.
They tell stories, she went on, even when no one is around to listen to clarify their own thoughts, to teach
and to stimulate research. Its not surprising they write, she said.
Reflecting the literary tastes of our age, Ms. Montgomery suggested, the fiction and poetry of doctors like
Anton Chekhov, William Somerset Maugham and William Carlos Williams, among others, are being
replaced by memoirs.
The current television schedule may also influence the speeding of modern doctors work into print. With
every second actor now wearing scrubs and saving lives, publishers undoubtedly sense a public appetite for
the words of real doctors who are ready to spill all.
But any reader anticipating a good, light read is likely to be disappointed. On television, the frenetic energy

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of the hospital may spell entertainment, but on the page it has become food for the increasingly sober
existential thought.
A look back at The New Yorkers articles about medicine during the last few decades reveals the darkening
mood of medical writing.
For decades, the magazines medical beat belonged to Berton Rouech, a journalist who stumbled in the
late 1940s onto the great unmined literary lode of medical practice. With no medical background himself,
Mr. Rouech (who died in 1994) carefully constructed his dozens of stories about medicine to give the
doctors he interviewed the primary narrative voice.
Mr. Rouechs contributions to The New Yorkers Annals of Medicine were as addictive and as predictable
as any detective fiction: a patient developed mysterious symptoms (a man grew breasts, a woman lost all
her strength), and an astute doctor figured out why (the mans wife used an estrogen-containing cream; the
woman had the paralytic condition myasthenia gravis, but an operation let her dance again).
Dr. Groopman and Dr. Gawande have assumed the Rouech mantle, but their cautionary fables could not
be more different from his neatly packaged stories of medical success.
Dr. Groopman made his New Yorker debut 10 years ago with the story of a patient dying of cancer, who
came to him asking for magic. The patient had heard that Dr. Groopman was a medical genius, a
wizard, and liked to address him as St. Jerome.
On television, this character might have gotten his magic. In reality, Dr. Groopman struggled to get him a
few months of remission, only to find the man more miserable in health than he ever was in his fight
against disease.
Dr. Groopman has made it clear, in his writings since then, that medicine has no magic, wizards or
geniuses, and very few saints. Instead, there is only uncertainty in an endless spectrum of grays, with
doctors whose skills promote an illusion of magic and others who stumble.
In his latest book, How Doctors Think, Dr. Groopman looks at when the sleight-of-hand goes wrong. Why
should an emergency room doctor misdiagnose a heart attack, or a pediatrician fail to recognize a
malnourished infant, or a highly pedigreed surgeon mistake the problem crippling Dr. Groopmans right
wrist? The flawed thinking is broken down, step by step, like the diagrams in a manual of how to palm
cards.
I wrote this book because I was dissatisfied, Dr. Groopman said in an interview. In general theres a high
level of dissatisfaction among physicians. Some doctors look to systems analysis to start to fix things. Maybe
Im a dinosaur; I go for narrative instead.
Dr. Gawande is also in the fix-it business. He too began his writing career debunking the idea of magic in
medicine. The whole edifice of medical training is based on subterfuge, he wrote in the online magazine
Slate while a second-year surgical resident 10 years ago, going on to deconstruct the surreptitious
manipulations that conspire to camouflage medicines inexperienced trainees.
In his new book, Better: A Surgeons Notes on Performance, Dr. Gawande is still tracing the near-invisible
maneuvers required to sustain the gigantic ambitions of the medical system. His book celebrates some of
the most routine parts of medicine the washing of hands, the inoculation of children and explains how,
should these actions be omitted, the structure of the enterprise begins to teeter.

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What a difference from the glib confusion that passes for medicine on television, or the comforting linear
narratives of Mr. Rouech. Instead of speeding along in double time, Dr. Groopman and Dr. Gawande, like
the frustrated coaches of a losing team, are slowing the motion of medicine down to half-speed, examining
each play, then each frame and image, trying to figure out where the glitches lie.
It is prose with a mission, to find and to fix. And they are not the only ones who have come to the written
word as a way to fix medicine, rather than simply to celebrate it.
Humanists have long argued that when doctors cultivate the skills involved in constructing a written
narrative an ear for plot, images and elisions they become abler, more humane doctors.
Almost all medical schools now ask students to read writing by doctors, and some now require students to
write about their own experiences.
Older doctors may turn instead to short courses like Writing the Medical Experience, offered at Sarah
Lawrence Colleges summer school, or the short workshops in narrative medicine offered by the faculty of
the Columbia University College of Physicians and Surgeons in New York.
Unfortunately, an appreciation of the written word and its power does not always correlate with talent. The
doctors and nurses who submit writing to The Bellevue Literary Review, a publication devoted to healthrelated poetry and prose, are heartfelt and have a lot to say, but arent necessarily fine writers, said Dr.
Danielle Ofri, the editor. Most are of mediocre quality. Their writing, that is. Im sure theyre fine
clinicians.
In other words, the birds on the clothesline are likely to be singing loudly, passionately and, some of
them, completely out of tune for quite some time to come.

Copyright 2007 The New York Times Company

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