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Physicians Can Find Relief in Fiction

Every person working in medicine has stories to tell, and sharing those stories is a great way to process grief or stress, celebrate triumphs, vent, move on or think more deeply.

Occasionally, writing about an experience helps others facing a similar situation. True narratives of and reflections on medicine are now encouraged, honored, promoted—and sometimes required of medical students.

This is a commendable trend, though the exercise can be affected by issues with the Health Insurance Portability and Accountability Act (HIPAA), designed to protect patient privacy, and other confidentiality issues. And students may feel too vulnerable to share their deep-seated emotions; some of them have told me that, concerned about “setting off alarms,” they started “dumbing down” their mandatory writing in order to avoid worried calls from advisors who are concerned that the students might be depressed or too anxious.

Freed by Fiction

Fiction, then, is an amazing outlet—one rarely tapped in medicine or medical education. It can be as long as an entire book or as condensed as a short story. Creative expression can be as brief as a haiku or “flash fiction”―a short paragraph written quickly. Given the constraints on a medical student’s or physician’s time, that can be a real blessing.

Most fiction has a basis in amalgamations of real people, real events and real places, and it is remarkably liberating. Your characters can be inspiring or weak; they can struggle or shine. They can exhibit many attributes at once, because people are complex. (As Walt Whitman said, “I am large, I contain multitudes.”)

I’ve found both professional and personal release in my novels, which belong to a genre I call “evidence-based medical adventure.” Making physicians and patients come alive through fiction has been tremendously satisfying. I can get to the heart of how a physician reacts to stress; I can explore how he or she deals with a missed diagnosis that may be haunting, or manages an especially difficult patient. After all, a simple sore throat can be a sign of leukemia, and a depressed patient may cause self-harm. Though such scenarios are rare, giving them consideration in story form can allow doctors to better deal with such issues in the real world.

Making Doctors Real

Fiction grants physicians the opportunity to show sides of their lives that patients don’t always get to see.

Physicians worry about their patients and about their own competence, which sometimes leads to loss of sleep and then having to deal with fatigue as well. They have all the same needs for friendship and romance as everyone else does, and they make the same mistakes. Their relationships may be particularly affected by long hours, work distractions and fear of failure. Their ability to cope may be strained, for physicians tend to expect themselves always to be right; it is critical to their identity. But of course no one is always right, which contributes to how vulnerable and sometimes flawed doctors can feel. And somehow they must balance all of this at the same time, in order to stay capable and effective.

It’s a complicated life.

Exploring the Doctor’s World

Yet none of the difficulties of being a doctor negates the joy of an effective intervention, the satisfaction of helping a patient better control a chronic condition or the many rewards that come from daily interactions with people seeking help.

Being able to include all aspects of the medical issues, keeping a story scientifically accurate and compelling, showing the process of divining a diagnosis and dealing with patient struggles—these are challenges I truly enjoy.

The protagonist of my novels is a young female physician who has battled an anxiety problem and is starting over at a unique rural clinic on the edge of the Grand Canyon. This setting allows me to incorporate much of what I love: primary care medicine, hiking, geology and astronomy. That’s the beauty of fiction: you can create your own world and explore whatever you desire. It can be serious and playful at once, it can be both somber and absurd, it can be devastating and triumphant. What a great and entertaining challenge.

Surprisingly little fiction is written about physicians or med students, and even less about female physicians and primary care roles. If asked about medical fiction, I suspect most American doctors would conjure up The House of God by Samuel Shem, written almost forty years ago.

Well-known American physicians alive today, writing traditionally published medical novels in the last five or so years, include Abraham Verghese (Cutting for Stone), Khaled Hosseini (And the Mountains Echoed, parts of which are about medicine) and Tess Gerritsen (who writes medical thrillers). I’ve probably missed other American physician/authors; more untapped stories likely lurk within the ranks of self-published authors, including Therese Zinc (Mission Rwanda and Mission Chechnya).

Getting Started

So what should you do if you are a doctor or medical student who wants to try your hand at fiction? If you’re a student, any of your medical narratives can be transformed into fiction, so long as you keep issues of privacy in mind.

Physicians can find—or start—writing workshops at medical conferences, or just about anywhere else, at any time. These workshops can become part of wellness or burnout-prevention events. To interact with other writers, all you need is a champion―someone to organize a time and space for you to get together and share what you’ve written. It’s great to exchange ideas and give feedback to one another, either online or off. Participants in these events can feel energized, enlightened and creative. You can even tweet haikus or flash fiction to one another. The work doesn’t have to be perfect; it just needs to be thoughtful and come from the heart.

Not everyone wants to write, but there’s room for those who have not yet tried. Who knows? You might wind up writing a book or two yourself.

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Sandra Miller, M.D.

Sandra Miller, M.D.

Dr. Miller is a recently retired academic family physician in Phoenix. After ten years in private practice, she was residency faculty and a clinical assistant professor at the University of Arizona College of Medicine - Phoenix. Her first two novels are Only Rock is Real and Crooked Trails.

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