My wife and I did a film recommendation tradeoff last weekend. With two kids (a two year old and a 6 month old), opportunities to watch films together are rather scarce. The ‘Watch Instantly’ feature on Netflix has been a bit of a godsend, however, as she watches films after the baby has gone to sleep (8-10pm) and I watch in the mornings before everyone wakes up (5-7am). Back to our film tradeoff – I asked her to watch the documentary ‘Dear Zachary’, which is about one of the most tragic films I’ve seen in the last two years. I had little idea that it would move me in the way that it did, and would recommend it without reservation. My wifes choice was the Masterpiece Theatre’s envisioning of ‘Anne Frank: A Diary of a Young Girl’. While skeptical at first, it became easy to lose myself in the phenomenal acting, character development, and gentle arc of the plot to its inexorable tragic end. For anyone who hasn’t experienced the ‘Anne Frank’ mythos, this film provided a wonderful entry point. The reason for this ramble? Well, one of the themes that pervades in both works involves the concept of writing and documenting to keep a record of the past.
As physicians, we are bombarded by narrative, and in many ways, rounding is like working through a book of short stories each day, only that we contribute to the narrative, page by page, in the form of progress notes. Documentation, or the ‘D’ word as some would have it – is a reality of medical practice. And given how much we take down, one would imagine that we as physicians would be excellent tellers of stories, sharing captivating yarns of woe and intrigue, with works ranging from tragedy to hope and victory through the tales of our patients. Sadly, this seems more the exception that the rule. Physician documentation is often workman-like, placing emphasis on objectivity, assessment and planning, which I suppose is not a bad thing. Scientific documentation should be heavy on details and analysis. Still, one can’t help but wonder if narrative exposition helps add important nuance that may provide clues to the physician upon re-reading.
Consider these two statements:
- Ms. Jones is awake, alert and pleasant, not complaining of any fever, nausea or chest pain.
- I met Ms. Jones while she was sitting up eating breakfast. She had no complaints, but seemed sad. When asked, she told me that she missed having breakfast with her husband two years ago and didn’t have much of an appetite.
Far be it from me to criticize one description over the other – however, upon re-reading those, which one creates a clearer picture in you mind? It is these recollections that we go on to develop as we hand off our patients, whether it be to oncoming colleagues, consultants or the patients PCP’s. The more vibrant a picture that we create both for ourselves and our colleagues, the stronger the engagement and activation of their deductive processes. This is by no means a unique notion – kudos to @KateEllington, whom I follow on Twitter, for linking to and discussing the power of narrative medicine. Furthermore, Rita Charon founded and runs the program in Narrative Medicine at Columbia, which runs three-day workshops to help providers hone their powers of observation, analysis and description of the things that they see, day-to-day. Here’s to taking back our calling!
Stay thirsty, my friends. 🙂