narrative medicine

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Opinion: When The Doctor Must Choose Between Her Patients And Her Notes

By Dr. Mary C. Zeng
Guest Contributor

It’s been a long day in the psychiatry clinic.

Seeing patients is never dull, and each interaction is meaningful in its own way. From the moment they walk into my office to the moment they leave, I try my best to be fully present with the patients sitting in front of me. That means listening to every word, watching every nuance of body language, hearing every concern — both spoken and unspoken. It means bearing their grief as they tell me about the father they’re losing to cancer, their pain as they suffer through profound bouts of depression and their agony as they recall their nightmares of childhood trauma.

It also means putting aside my personal agenda to focus wholly on them, which includes resisting my urge to take notes during the patient interview so that I can save time later, with fewer notes to complete after the patient leaves.

It is a common complaint that doctors look at their computer screens and type on their keyboards more than they listen to their patients. But consider this reality: From the doctor’s perspective, every moment she spends focusing on you, the patient, rather than on the “note” she needs to write up about your appointment, is a debt that must be repaid later in the day. If the doctor can’t complete your note during the 15 minutes you spend with her, then she must add another 15 minutes to the end of her workday in order to finish that note. Multiply that 15 minutes by the 10-15 patients she sees in a day and all of a sudden she has missed the family dinner and the kids are already asleep by the time she comes home.

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Face It, Doctor, All Medicine Is Postmodern

Description Dr. Peter Pinto with the Urologic Oncology Branch at the National Cancer Institute (NCI) examines a patient. (NCI/Wikimedia Commons)

Description Dr. Peter Pinto with the Urologic Oncology Branch at the National Cancer Institute (NCI) examines a patient. (NCI/Wikimedia Commons)

By. Dr. Steven Schlozman
Guest contributor

Greetings from the Narrative Medicine conference at Kings College in London, where, I must unhappily report, Americans at this highly international gathering are looked upon with not a little disappointment.

While we in the U.S. can feel a certain hegemony and even pride in our diagnostic and technical prowess (to paraphrase one of the workshops I attended), we are perceived as having forgotten how we ought to listen to our patients’ stories.

This is hardly an original criticism, but still, it made me quite sad. I know that some of the conclusions I heard in discussions were more grand than accurate — “The American medical system does not and will not focus on these matters!” — but I also know as a medical educator that hearing a patient’s words as stories themselves is something that we teach parenthetically rather than directly.

Attempts by my colleagues and myself to teach these ideas more explicitly have in fact been met with various forms of passive and active resistance. “If you want to stress this in your teaching, you must have rigorous scientific data to support why you’re teaching it,” we’re told.

Here is how far we have gotten from what has always been to me the core of why I became and love being a doctor:

This meeting, a medical meeting, focused on fundamental postmodern edicts of epistemology.  Can you imagine my delight in hearing words like “postmodern” and “epistemology” at a medical gathering? I’ve often wondered, how can medicine be anything but postmodern?

If they want to become any sort of doctor, they should learn to tolerate ambiguity.

If postmodernism is roughly defined as the willingness and even capitulation that we endure discomfort with the fact that we might never know with certainty what we think we know, then I can think of no better way to describe the tribulations and wonders of being a physician.

I tell my medical students that if they want to become psychiatrists, they must learn to tolerate ambiguity. However, that comment is a bit of a ruse and I regret saying it now. I should generalize and broaden the sentiment. I should say that if they want to become any sort of doctor they should learn to tolerate ambiguity.

Take the fact that I have ruptured both of my Achilles tendons. Continue reading