Boston Globe, March 12, 2010

Book clubs connect doctors with the humanity behind the job

By Alan Scher Zagier, Associated Press  |  March 12, 2010

COLUMBIA, Mo. — Doctors, nurses, and other health care workers are tapping into their inner Tolstoys to better connect with patients.

With increasing regularity, they’re meeting in monthly book clubs to discuss medical-themed literature. Humanities courses are now required in many medical schools.

“The humanities can remind them that they’re dealing with very complicated, whole individuals with their own needs and opinions,’’ said Elizabeth Sinclair, coordinator of the Maine Humanities Council’s literature and medicine program.

A hospital in Bangor, Maine, hosted the first program in 1997. The idea has spread over the years to 25 states, including California, Florida, Massachusetts, Missouri, New York, Ohio and Virginia.

“If you want to understand what someone who is dying is going through, the highs and lows, the emotions, read Tolstoy’s ‘The Death of Ivan Ilyich,’ ’’ said Dr. Robin Blake. “One hundred years before Kübler-Ross identified the stages of dying, Tolstoy had it.’’

Blake’s lifelong love of literature led him to retire early from the University of Missouri medical school to write short stories and teach an undergraduate honors class on medicine and literature.

He read recently from his work at the first meeting of the new medical book club at the university’s teaching hospital. The audience of doctors, nurses, medical librarians, and administrators listened raptly to a story of a young boy’s suspicious death and another about an old man begging to die.

Blake, 64, peppers his conversation with knowing nods to the great writers whose work informs his own: Tolstoy, Albert Camus, William Faulkner, Flannery O’Connor, and William Carlos Williams, among others.

The North Carolina native moved to Missouri nearly 40 years ago to attend medical school at Washington University in St. Louis. His own training meant medical charts and academic journals, not character development and plot exposition.

“In medical school, there was nothing of this,’’ Blake said. “And I think that was a big omission.’’

A 2005 study by the Maine council showed that participants reported greater empathy for patients and colleagues, higher cultural awareness, increased job satisfaction, and improved interpersonal skills.

“The program reminds them why they got into the profession in the first place,’’ Sinclair said.

Trained to deal in certainties, some doctors can struggle with the murkier rules of literature, she added.

Dr. Abraham Verghese, a novelist and Stanford University professor, has devoted much of his career to exploring the connections between literature and medicine. A decade ago, he founded the Center for Medical Humanities and Ethics at the University of Texas Health Science Center in San Antonio.

Verghese agreed that patient empathy is at the heart of the humanities in medicine movement. He also advocated for a more physician-centric outlook.

“There’s a great hunger in clinical practice for discussions and explaining and reconciling the things you’re seeing,’’ he said. “It’s as much about the physician as it is about the patient.’’

One month after Blake’s inaugural reading, the 25 or so members of the University of Missouri Health Care book club discussed “The Diving Bell and the Butterfly,’’ the memoir of the late Jean-Dominique Bauby, editor in chief of Elle. His sudden stroke left him paralyzed save for some movements with his head and eyes.

Over cold cuts and lemonade, the group spread out across a medical school classroom with an informality rarely seen in the hospital corridors. Nurses called doctors by their first names — a hierarchical breakdown program supporters point to as another step toward humanizing medicine.

Literature, Sinclair said, has a lot to teach the health care world about medicine.

“Literature is messy. There’s not a black and white answer,’’ she said. “So much of the expectations on them are black and white, to have an answer. This helps them fit into that hard space, of not necessarily knowing the answer.’’