Authors: Johanna Shapiro, Sarah Mourra
Publication date: 08 Dec 2010
Johanna Shapiro and Sarah Mourra ask whether poems make you a better doctor
Medical educators are always experimenting with different ways to develop self aware, reflective, empathic, and compassionate doctors. One of these ways is poetry, which can help medical students by offering a unique method for re-examining self, others, and the world. The importance of poetry in medicine is increasingly being recognised; for example, an international symposium on poetry and medicine is going to be held at Warwick University, United Kingdom, in 2011 ( [Link] ).
Why should medical students take time to write a poem about their clinical experiences rather than polish their case presentations for morning rounds? Why should an overburdened medical student read a poem about medicine rather than a report on a double blind randomised controlled clinical trial? Although some medical school curricula include poems about medicine, and many medical schools publish original student poetry, not many medical students turn to poetry to better understand their profession. But poetry about going through medical education and the nature of doctoring can help students who feel isolated or are experiencing burnout. It can also provide insights into the socialisation process of medical education, and what practising medicine is about.
In 1994, one scholar estimated that since 1930, about 0.0019% of doctors in the United States were also poets. Perhaps we should not ask which specialists write poetry, but whether more medical students should explore writing poems to see whether writing poetry might help them to become better doctors.
Well known doctor-poets
Some doctor-poets include: John Keats (1795-1821), who gave up medicine at 21 and died from tuberculosis at 26; Oliver Wendell Holmes (1809-1894), a general practitioner known for his writings on anatomy; and William Carlos Williams (1883-1963), a paediatrician who practised in a poor, immigrant area of New Jersey.
Examples of modern doctor-poets include: Dannie Abse, a Welsh chest physician; John Stone (1936-2008), emeritus professor of medicine (cardiology) at Emory University, Atlanta, Georgia; Jack Coulehan, professor emeritus of preventive medicine at the State University of New York at Stony Brook; Richard Berlin, professor of psychiatry at the University of Massachusetts Medical School; Miroslav Holub (1923-1998), a Czech immunologist; Peter Pereira, a family physician in Seattle; Rafael Campo, who practices general internal medicine at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston; Marc Straus, previously an oncologist in New York; Audrey Shafer, professor in the department of anaesthesia at Stanford University School of Medicine in California; John Graham-Pole, a retired paediatric oncologist from Florida; and Paula Tatarunis, who practises internal medicine in Massachusetts.
Poetry versus reflective writing
Writing poetry has a lot in common with reflective writing, which is already used in medical schools. Poetry can form a subset of students’ reflective writing because it encourages them to contemplate their experiences. Poetry is unique because it fosters innovative use of language, propensity for metaphor, and attention to sound and rhythm—all of which help us to think about things in different ways.
Reflective writing is invaluable to medical education, especially when guided by skilled feedback. However, it can become formulaic if professors’ expectations of what constitutes “good” reflection influences students to produce predictable essays, rather than write what they think and feel. By valuing image and emotion over logical reasoning, poetry can be more transgressive than prose; in other words, the logic required in much prose writing leads the mind along well worn paths, whereas a fresh metaphor or an unexpected feeling may show surprising facets of the event being written about. In this way, writing a poem may liberate the writer to think in ways they did not fully anticipate.
Themes in poems by students
In an analysis of almost 600 poems written by students, common themes included: becoming a doctor; the rewards and stresses of training; how medical school was changing the students; their relationships with patients; role models (positive and negative); death; students’ personal lives; and occasionally the state of the world or the meaning of life. Students might explore such topics in poetry because they are not adequately dealt with in the curriculum, yet students care about them and they deserve thinking about.
Judging poems by medics
Literary merit might not be the most important factor to look at when analysing medics’ poems. Ginnie Bolton, who has written extensively on using reflective and creative writing in medical settings, observes that “poetry does not have to be great so long as it is useful to the writer and to an appropriate audience.” Although there are varying degrees of integrity, ability, technique, and originality in poetry by medical students, when they write about their experiences with patients, peers, and attending doctors the results are moving, compelling, and impossible to ignore.
The future of poetry in medical education
The Association of American Medical Colleges reported in 1998 that at least three quarters of US and Canadian medical schools offer some form of medical humanities. No hard data exist, however, on how many have incorporated poetry into their syllabus. Many professors enjoy including poetry in their teaching because it is short and can be quickly read (although it may take longer to understand). Few studies have attempted to assess the effects of exposing medical students to poetry. In one qualitative study, students read poetry and reported that doing so helped them to explore emotions, understand different perspectives, and improve self awareness. Participants speculated that such skills could lead to a better understanding of their patients’ experiences of illness and therefore improved care.
A second study had students read four poems related to particular clinical stations as part of an objective structured clinical examination at the end of their third year family medicine clerkship. About two thirds to three quarters of students indicated that the readings had either a moderate or a high effect on their treatment of patients, increasing empathy and decreasing levels of stress.
Assessing results in the medical humanities is a complex and controversial topic.  Opinions differ on how best to measure “narrative competence,” or the capacity to recognise, interpret, and be moved by patients’ stories of illness, whether achieved through reading or writing poetry or exposure to other literature, and how best to link such competence to improved patient care. Research in this field is in its infancy, and it must be approached in ways that take into account the subjective nature of poetry and the need for demonstrable outcomes in medical education.
Competing interests: JS is the author of The inner world of medical students: listening to their voices in poetry.
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Johanna Shapiro professor
Department of Family Medicine, University of California Irvine, School of Medicine, California
Sarah Mourra resident physician Yale Department of Psychiatry, New Haven