On Doctoring: Stories, Poems, Essays
- Book Review,
by Richard Reynolds, et al
From the New England Journal of Medicine, January 10, 2002
Few physicians and fewer medical students read novels. Nonetheless, literature has much to teach physicians and medical students about the type of work they have chosen. This anthology, aimed primarily at first-year medical students, is made up of bite-sized offerings. It includes 130 pieces (mostly poems, but also stories, essays, and one short play) by 81 authors, with all the pieces chosen because they illuminate an aspect of the practice of medicine. Although it is labeled as a third edition, the collection remains substantially similar to the 1991 first edition (about a dozen authors from the first and second editions do not appear here, and a few more than that have been added). Nonetheless, there is no better place than this book to begin an exploration of what literature tells us about physicians and what physicians have written that can qualify as literature. The core of the collection is made up of selections from writers whose stories will be familiar to many readers of the Journal; these include W. Somerset Maugham, William Carlos Williams, Ernest Hemingway, Flannery O'Connor, Jorge Luis Borges, and Raymond Carver. Nor will the poets (writing mostly about death and suffering) surprise the reader; they include Emily Dickinson, Robert Frost, Archibald MacLeish, Dylan Thomas, Denise Levertov, and one of the book's coeditors, John Stone. The best essays on medical practice in the collection were originally published in the Journal and include pieces by physician-writers Lewis Thomas, Robert Coles, Carola Eisenberg, Joseph Hardison, and David Hilfiker. Other contemporary physician-writers are also well represented, including Lawrence Altman, Melvin Konner, Abraham Verghese, Perry Klass, Jon Mukand, and Ethan Canin. Since 1991, when the first edition was published, the Robert Wood Johnson Foundation (of which coeditor Richard Reynolds was executive vice president at the time) has distributed the book free to all first-year medical students. The goal of trying to develop in physicians a lifelong habit of reading literature is a good one, since much of the practice of medicine involves understanding patients' narratives and listening to their stories. It is also difficult to quarrel with this book's content, although many of the selections over-romanticize the practice of medicine, and few hint at its economic and bureaucratic aspects. The inclusion of some less reverential pieces would have provided more insight into medical practice. Kurt Vonnegut's devastating short play, Fortitude, is the only entry with much humor. At least one excerpt from the novel that is most widely read by medical students, The House of God (New York: Dell, 1978), by Samuel Shem (the pen name of physician Stephen Bergman) and almost anything on medicine by Mark Leyner would have been welcome additions. Most of the fiction and virtually all the poetry is universal and aims deep. Nonetheless, it is the essays in this collection that will attract medical students the most, since they speak directly to the experience of being (and becoming) a physician. Those included are all strong, but the addition of something like David Rothman's essay on medical professionalism, which appeared in the Journal (2000;342:1284-86), would have made the collection both more contemporary and more challenging to medical students. The introduction to the book insists that "physicians and patients must continue to talk and listen together -- and literature can help in that exchange." But I doubt that this book will have a readership among patients. It is much more an insider's book. Moreover, reading is a solitary activity, and as Jay Katz has eloquently argued in The Silent World of Doctor and Patient (New York: Free Press, 1984), there is seldom much in the way of real communication between doctor and patient. Reading literature will not change this situation, although group discussions about readings (including medical school seminars on literature and medicine) could help. In addition to medical students, then, the other major target audience for this book should be medical school faculty members. The book does have one glaring problem. Although it includes selections by women writers, the collection is dominated by white male physicians. This domination -- something literature should help to expose and correct -- is reinforced (but unexplained) by the titles given the editors themselves; the two male physicians are called "editors" and the two female Ph.D. humanists (Lois LaCivita Nixon and Delese Wear) are described (in much smaller type on the cover) as "associate editors." The photographs and biographies of the two male physician-editors appear on the book jacket; there are no photos or biographies of Nixon and Wear. The message to medical students is unmistakable and perverse: even in the world of literature, only physicians matter. Finally, the editors treat all their selections equally, and organize them (with no explanation) according to the author's date of birth. It does not help new medical students simply to be told to read this book because it is good for them. They should be told where to begin. I think they should be told explicitly to begin with Richard Selzer's story "Imelda," Robert Coles's essay "Medical Ethics and Living a Life," David Hellerstein's story "Touching," and two poems: Rafael Campo's "What the Body Told," and Gregory Edwards's "The Shot." They can figure out the rest by themselves. George J. Annas, J.D., M.P.H. Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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