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May 14, 2013 13 Comments

Should doctors be able to write?

At first glance, this might seem like a question with an easy answer.

Yes, you might say, doctors receive a doctorate and are trusted with communicating to and about people at critical moments in their lives. Or you could reply, No, they are scientists and so need to be functional communicators able to write basic notes and prescriptions, and anything more than that is professional frosting.

As with all questions, sorting out which answer is (more) correct is easier if we define our terms.

The key words in this question are ‘doctor’ and ‘write’. Both have literal bare-bones definitions, and both play out in the real world in myriad and widely varied ways. For the purposes of this post, doctor means a licensed physician who engages in clinical care, research, education, or health care leadership and writing means the ability to use narrative to effectively communicate ideas, thoughts, feelings and opinions to others.

Of course, as a doctor-writer who teaches other doctors how to write, I should admit that I’m biased.

But I recognize that I am a doctor who enjoys writing and wants it as part of her career. From that perspective, writing might be one of my hobbies, comparable to the activities of colleagues who invent creative cocktails, build musical instruments from raw materials, or breed lamas (…yup, I know at least one doctor who does each of these things…)

The difference between these activities and writing is that one can be a very fine physician without ever having mixed a drink, carved the fine curves of a violin, or inspired romance between lamas.

On the other hand, I would argue that one cannot be a good doctor without being able to communicate one’s thoughts, knowledge, opinions, and analyses in writing. Sure, a person might be a remarkably skilled surgeon or an uncannily perceptive leader of family meetings, but if that information isn’t relayed accurately and effectively in the chart or in written materials for families, the well-being of patients and families are in jeopardy. These faulty hand-offs, transitions, and instructions have been shown, repeatedly, to be the cause of medical errors, readmissions to hospitals, unnecessary tests, and death.

And that’s just one aspect of the doctor’s role. Another fundamental set of professional responsibilities, cited in the Physician Charter, adopted by leading medical societies in the US, Canada, UK and Europe in 2002 included “providing expert advice to society on matters of health.”

Note, it doesn’t say “to patients” but “to society” – and what are the most effective ways to reach large numbers of people? There are really just three modalities: text, audio, and video. And the latter two, to be effective, often have scripts. Moreover, they always require the clarity of language and expression, mastery of storytelling, and judicious use of data that can best be taught and practiced through writing.

So my vote on should doctors be able to write?

A resounding YES.

We don’t – won’t, can’t – all be Chekhov or Gawande, but we should all have some basic ability to discuss matters of health and health care in ways that are accessible, interesting, and informative to people with no medical background.

Lucky for me, it seems increasing numbers of other doctors agree: In the last few months, I have taught Public Medical Writing at the University of California San Diego, Oregon Health Sciences University, the Society of General Internal Medicine meetings (with Lisa Saunders of the New York Times and Anna Reisman of Slate), and the American Geriatrics Society annual meeting, to name a just a few.

At each place, I encountered  health professionals eager to tell stories of their patients, colleagues, research and practice, and at each place I was thrilled to find that alchemy of passion, advocacy, expertise, and talent necessary to produce good work and improve the world.

My hat’s off to them…

 

P.S. For examples of work by UCSF trainees who participated in one of our Public Medical Writing courses or workshops see here:

Christina Palmer,  Huffington Post “A Spoonful of Tax (Makes Obesity Go Down)”

Palav Babaria, LA Times “Sofia’s Choice”

Jennifer Chang, New York Times “It Was Benign But Almost Killed Him”

Sanjay Basu, San Francisco Chronicle “Recession Makes Dying Too Expensive for the Poor”

Ilana Sherer, Health Affairs “Oh, My Father Hit Me”

 

13 Responses to Should doctors be able to write?

  1. Pat Rich (@cmaer) May 15, 2013 at 5:35 am #

    I agree wholeheartedly that doctors should be able to write, for the reasons you outline.

    However, in 30 years of medical journalism and working with physicians, I find few physicians have an appreciation that writing is a skill that needs to be learned. In addition to basic writing skills, writing to a mass audience takes additional training.

    Few physicians are natural communicators in the print and for specialized social media such as Twitter, the skill set is slightly different again.

    • Louise Aronson May 16, 2013 at 8:14 am #

      Hi Pat – thanks for the comment! I totally agree. That’s why we’re developing training programs – Writing for Change for residents and Public Medical Writing for med students. At the very least, they will learn how hard it is and some of what it takes. In the best cases, they work at it and we end up with the articles I linked to at the bottom.

  2. Ronan Kavanagh May 15, 2013 at 6:25 am #

    I think that being able to write (as well as you can write Louise) is a great gift but also takes a lot of work to get right. Even those of us who are just starting out and who are willing to put in the time it takes have very few opportunities to obtain good objective assessments and guidance for our efforts

    Its great that you’ve set up your Public Medical Communication programme Louise. I would love to attend but geographical distance makes it impossible (Galway to Sanfrancisco!). I think there is a real opportunity for people like you (and experienced editors like Pat Rich – see comment above and other medical / scientific journalists) so offer this sort of tutoring / course on-line. What do you think?

    • Louise Aronson May 16, 2013 at 8:17 am #

      Ronan – you read my mind! I have been considering ways to get this online. Clearly some parts lend themselves to that more than others – dissecting pieces for strengths, weaknesses, craft tools, etc. vs. getting good feedback on one’s own early efforts, for example. Might a MOOC work with crowd sourcing? Or would webinars be more effective? A combination? Eager to hear how people think they might learn best about this!

      • martina Nicholson, MD January 18, 2014 at 11:13 am #

        love this idea! Busy docs could participate when able to find the time…

  3. Peter English May 15, 2013 at 9:41 am #

    I agree, but only up to a point.

    Sure, doctors need to be able to write notes to that other doctors and health care workers know about the patients they’ve been treating, and how to write referral letters, as well as to be able to complete laboratory request forms and so forth. Much of this is fairly formulaic. Even writing medical research papers tends to be formulaic, with many journals requiring a style which seems rather stilted.

    But I’m not sure that we all need to be highly skilled at written communication. Most communication with patients is still (in most specialities) face to face, in speech. Verbal communication is a very different skill to written communication.

    • Louise Aronson May 16, 2013 at 8:20 am #

      Thanks for the comment, Peter! I would say we need a range of communication skills from oral in-person with patients, to basic written in chart notes and consultations and hand-offs, to at least basic skills at communicating with larger audiences and via social media given how communication generally is changing. And while there are definite difference in both form and content for these different activities, there are also some overlapping skills: being able to speak English rather than medicalese; using stories and analogies and metaphors to discuss and explain complex concepts; using data judiciously…

  4. Gaetan Sgro May 15, 2013 at 1:26 pm #

    I couldn’t agree more. I’m certain that approaching my clinical duties with a writer’s disposition (which comes naturally to me as an English major) makes me not only a more astute clinician but also a more compassionate one. I’ve been encouraging the residents in my training program to use reflective writing and storytelling to cultivate meaning in their careers, and the idea is definitely catching on.

    • Louise Aronson May 16, 2013 at 8:22 am #

      Sounds like we’re doing similar work! Our UCSF students and residents start out with feelings about this that run the gamut but the vast majority end up finding this useful, educational, clinically relevant, and meaningful.

  5. elizabeth neary, MD May 16, 2013 at 9:45 pm #

    I kept journals during med school and residency. I used it as a tool to cope with the tragedies that I saw in lives. At times, it was overwhelming for me and I needed a way to express what I was feeling… by writing, I could move beyond my emotions and care for my patients. Now, as I read this stories of patients from over 20 years ago, I remember the faces of patients, the emotions, the stories… I encourage med students to write- if only for themselves. I would love to do something more formal with them and would love it if you offered an online course for teaching med students.

    • martina Nicholson, MD January 18, 2014 at 11:16 am #

      I wish I had done this. I have this block of thinking I am not allowed to tell someone else’s story. So i have not written them down.

  6. Linda Brown May 31, 2013 at 5:55 pm #

    The article Oh, My Father Hit Me by Iilana Sherer was really engaging. We all encounter ethical dilemmas and need a way to process how we navigate through them. Doctors dealing with life and death matters must struggle with their decisions constantly. I’m finishing a documentary, You See Me that explores this very topic. I’ve been in discussion with Rita Charon from Columbia U. Narrative Medicine Program about adding not just literature into the medical school curriculum but all the arts including film. This has already happened in the Narrative Medicine Rounds where you have been a speaker. Personally I try to avoid doctors who are all about the illness and disregard the patient. I want a physician who will emphasize what we have in common, that we’re all vulnerable humans who can learn a lot about each other and ourselves when we are compassionate.

    Your work is important.

  7. Sarab Sodhi June 7, 2014 at 11:36 am #

    I came into medical school as a student of biochemistry and philosophy. My initial years of medical education convinced me that there was something missing- something that was lacking from the practice of medicine, from my life. It turned out that was writing.

    I’d never been much of a writer outside of classes and all but I began to find my voice again, and to write to make sense of the things I saw and did on a daily basis.

    Reading the blogs, books and articles of people like you who’ve walked this path ahead of me is so remarkable, so refreshing and so reassuring that I’m not the only one who is going through these that I cannot help but say- thanks a ton.

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Resources:

New York Times Health: http://newoldage.blogs.nytimes.com/ and http://well.blogs.nytimes.com/

Health in Aging: http://www.healthinaging.org/

Family Caregiver Alliance: http://www.caregiver.org/

Talking to Your Doctor: http://www.nih.gov/clearcommunication/talktoyourdoctor.htm

Kaiser Health News: http://www.kaiserhealthnews.org/

NYU Literature, Arts and Medicine Database: http://litmed.med.nyu.edu/Main?action=new

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