On Being a Doctor

Module Overview: Caring for Strangers

The medical humanities offer us a formidable remedy for what ails our profession. A growing body of research has demonstrated that exposure to literature, the fine arts, philosophy and anthropology broadens a doctors cultural competence and encourages the linking of both cognitive and affective, objective and subjective approaches to the physicians task. Ongoing dialogue with colleagues from the arts and sciences both complements and strengthens our views of health, disease and healing. Poets, musicians and artists have been contemplating suffering for at least as long as we have and have much to teach us. They also give us permission to rediscover the art in what we do and to fully imagine what makes that work beautiful. Narrative-based medicine, a form of clinical practice informed by a new approach to listening to patients and propelled by the writing, reading and telling of stories, is gaining credibility worldwide. Reading a story, like Entertaining Angels Unaware, allows us to enter another world and to stretch our understanding of how a medical career can change a person. On one hand, some of the experiences described are familiar because our training acculturates us all in specific ways. At the same time, we are struck (even dismayed) by what happens to the female protagonist of this story, as she moves from being a vulnerable , deprived child to a cynical, highly defended consultant. She comes to think of herself as one of the boys and objectifies the people she is meant to help.

Doctors often forget how to read for pleasure because our education has trained us to extract the facts and establish the sequence of events to a pragmatic end. Yet paying closer attention to how a text is constructed allows us to reflect more deeply and to identify larger themes.

As you read this story, pay attention to its setting and to how time passes. What do we learn about the main protagonist from her actions and comments over time? How do you feel as you read the story? Are you left relieved or unsettled by the ending? What do you imagine happens after the last line? What is the genre? Is this just a short story or might we consider it to be a fairy tale, parable or cautionary tale?

The following questions will help you reflect on the story and on your own personal reading/interpretation of it. Questions can also be shared in a group or classroom. Some of the questions will direct you to linked content on narrative medicine, exploring personal values, achieving balance, and improving communication with patients.

Sources for reading about the doctor -patient relationship both in memoir and fiction and a list of films on the doctor patient relationship are also provided.

1. Who (if any) are the angels in this story? What purpose does this metaphor serve? What is the literary source for this title and how does that give the story meaning?
2. What vulnerabilities and insecurities does Cassiopeia, the girl, manifest as the grown-up woman doctor? Is she aware of these conflicts? Which defenses does she use to cope?
3. Is this piece sexist or realistic? Is this the reality of medicine today? How might a man read this story differently from a woman? What challenges do women still face in medicine?
   Resource: Women in Medicine
4. How does this story explore socio-economic realities for both doctors and patients?
5. Which boundary issues are raised in the various encounters portrayed in this story (doctor/patient, doctor/nurse, doctor/trainee, doctor/doctor)?
6. How are patients portrayed here? What language is used to describe them and what purpose does that language serve?
   Resource: Improving Communication with Patients
7. What are Cassiopeias values and priorities? Does she like her work? Is she a caricature or have you met colleagues with similar approaches and styles? How is professionalism portrayed in this story? Is there in fact a loss of professionalism among today's young physicians, as this story would seem to imply? If so, what is its cause?
   Resources: Burnout Scale | Personal Values | Professionalism References
8. If this story is a cautionary tale, what dangers does it reveal?

Writing exercises for further reflection:

Writing a short story about a specific incident in your life and work can help you make sense of it and increase your reflective capacity. When jotting down your story, write the way you speak, as if you were chatting with a friend. Don’t get hung up on syntax and grammar. Let your thoughts flow onto the page without judging them. Aim for a first draft. You can rework it later if you like.

1. Write about an incident that felt unprofessional. Tell the story with a beginning, middle and end. Don't just tell what happened; show it through images, sounds, sensations. Let the reader know how you felt about what happened.
2. Find the letter you wrote to get into medical school. Compose a letter to your younger self, incorporating what you have learned since then.
3. Write your own Hippocratic Oath in 20 lines or less.
   
   Resource: Medicine as a Moral Enterprise
4. List 5 things you can do to protect yourself against cynicism and empathic burnout.
5. Write a 3-line reply or rebuttal to one of the inappropriate comments that is attributed to Cassiopeia in this story. How could you challenge an inappropriate comment or attitude in a colleague without humiliating them or causing conflict?

Learn More: Literary, humanities and film resources