One of the most difficult transitions a young medical student makes is the graduation from bench science and classroom learning to the clinical application of knowledge in the clerkship years of training. Wide-eyed and at times naïve, physicians in training wade, or are sometimes thrown headlong, into life on the wards. These young doctors-to-be are inundated with patient stories; they bear witness to hardship and loss as the patients under their care are often at their nadir.
To cope with these vivid experiences and emotions, some doctors turn to writing — by writing they may better understand the practice of medicine, illness, and the complexities of human life. One such physician writer is Dr. Anna Reisman, a general internist and educator in New Haven, Connecticut who is published in the LA Times, Slate, and The New York Times.
I reached out to Dr. Reisman because her writing spoke to me — I first came across her work in the Atlantic when I read the article “The Clothes Make the Doctor.” Her wit and insight jumped off the page, and I wanted to know more about how she came to be a writer and how she mastered her craft.
She started writing by keeping a journal from childhood through her third and fourth years of medical school and beyond. While mired in the clinical years of her training, Dr. Reisman found it necessary and helpful to write down her patient care experiences as they took place.
As she relates, the barrage of patient stories and diagnostic uncertainties prohibit the budding physician from thinking critically about these clinical experiences. By writing about them, Dr. Reisman found that she was able to turn them over in her mind and reflect. Her musings and meditations turned into poetry at first; this succinct format best communicated the depth of her emotional experience.
One such poem, entitled “East Baltimore Morning Clinic” can be found in the Journal of Medical Humanities. By reading this piece, one can garner the pace and emotional indigestion that Dr. Reisman alludes to in her commentary about the profession. Within the morning, as described in her poem, she encounters patients with arthritis, high blood pressure, AIDS and cancer. The tempo is such that the reader hardly has a moment to chew before the next patient is ready to be seen.
As Dr. Reisman matured in her medical writing, she gravitated toward prose, which offered the ability to relate larger stories in a more accessible medium. One such article entitled “House of Death” published in The New York Times recounts her struggle with visiting a patient in hospice for the first time. She eloquently describes her consternation about making the trip to visit her dying patient. The level of detail Dr. Reisman uses to recount the journey makes the reader feel more like an active participant than a passive observer. Eventually, she developed enough chutzpah to visit her patient, to their mutual benefit.
Additionally, Dr. Reisman and Dr. Lisa Sanders lead the Yale Internal Medicine Residency Writers’ Workshop, an annual two-day program that allows residents to learn about the craft of writing and improve their abilities. Through honing their writing skills, residents have the opportunity to reflect, become more empathetic and appreciate the richness of patients’ stories. With ongoing mentorship, many of the essays written in this forum are eventually published.
For becoming a better writer, Dr. Reisman recommends reading as much as possible. There is great value in reading physician writers like Richard Selzer, Abraham Verghese, and Oliver Sacks as well as non-physician writers from Tolstoy to Toni Morrison, from Kafka to Stephen King. She also advocates joining a writing group — any forum where you can have a deadline and receive input from your peers. Further, she advises writers to attend conferences, both those tailored to physician writers and those for writers in general.
Finally, as physician writers, it can be difficult to write honestly about patient care experiences without compromising patient identity. Details about experiences in medicine make stories more vivid, interesting, and relatable, but these same details can jeopardize confidentiality. On this subject, Dr. Reisman asks an important and poignant question: how can we remove enough detail to make our patients unidentifiable, even to themselves?
To further explore the question of writing and patient confidentiality, please see Dr. Reisman’s article in the Atlantic, entitled “Should Doctors Write About Patients.” If you are interested in further honing your craft, check out Poets & Writers’ Conferences and Residencies Database.