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Sometimes, I ask medical students to use a consultation from a different perspective to gain something other than the overt clinical presentation, and then to write a story or a poem (or a piece of music, a song, visual art) based on, and stimulated by, their observations. This allows them to concentrate on other aspects of the transaction without having to exercise their clinical acumen. It is a chance to observe more particularly the non-verbal language of both the patient and clinician, to note their interactions, the position of the chairs, the dynamics of the room, and the impact of another person, partner, parent, friend and child. What might the student gain from this approach? Additional information from the patient, certainly. Perhaps more insight into the effects of the circumstances on the patient, the physician and the companion. Perhaps an increase in self-awareness. These are all aspects that experienced clinicians will work into their consultations. The more so by giving patients time to tell their stories. But the face to face time is limited. Some patients can be encouraged to write in between appointments, a limited number who have the will. How else can physicians and students increase their breadth of vision, their fund of perspective? Well, perhaps by reading books such as this one. Here is the time, the ability, the leisure to tell, eloquently and movingly. And it is not only patients; they fill the first section only. Then, the tales of family and friends, neglected people giving new insights. And finally, the practitioners giving permissions.
Ars Medica is a Canadian biannual literary journal, subtitled A Journal of Medicine, the Arts, and Humanities. What better way to be introduced to the journal than by an anthology that looks back to its beginnings, whenever that was. (The year 2006 if you believe the book's introduction or 2004 if you prefer the version on the website. But a small gripe.) I suspect regular readers will have a feast too.
But the purpose of the journal goes further say the founding editors. They hold ‘… that a core curative aspect of recovery is the relationship between the patient and practitioner, and that this relationship is best understood when all parties in the process tell stories from their own perspectives’. They share an assumption that ‘attentive reading’ and ‘attentive listening are variations of the same skill’. And that ‘medical tales aren't only told on the page, but also in our offices’. It is sad that this last is not a more universal belief.
They have chosen pieces from all aspects of ‘our health community: practitioners, patients, their families and friends and professional artists and medicine watchers’. This is an attempt ‘to engage both sides of our brain’ and ‘to address the growing divide between science and humanism’. And what is more, they wish to encourage patients to read others’ stories too.
As you turn to the start, you pass through a user's guide. Ah, so you don't just read it then? But you do, and you don't, as you please. It makes you think. Seven headings appear in this guide, such as Mental Health, and Death and Dying, so you can gather perspectives on the same topic. I tried this for Children and Parenting, because the Friends and Family list was long. I read stories that moved me, stories with humour, stories that made my eyes moist. The dad coming to terms with caring for his disabled son, alone, after his partner walked out. (What about her story? I can only imagine.) Or a girl, writing in late middle age, of life growing up with a dad who had polio and paralysis, contracted when she was 18 months old. The mother, on her son who had bacterial meningitis and learning from her wisdom: ‘If you spend too much time focusing on what he may still never do, you will miss today’. Why didn't I hear that years’ ago? And this boy's paediatrician, whose child also has severe illness, and talks of denial as a positive force.
You could read it section-by-section, cover to cover. Or just dip in randomly and find gems, like the memoir of the three sisters, two of whom they always knew would die young, and they did aged 8 and 27, written by the third sister.
Reading in all three ways means some rereading, but the writings are strong enough for that, giving more by so doing. All three sections offer insights and build on each other. We are used to patients’ stories, and practitioners’ stories and these add to the lexicon. But I kept returning to the novelty of the tales of Friends and Families. These are less frequently told giving insights of much more than the obvious, and I have found my eyes being opened more widely.
This book is a wonderful learning tool not just for practitioners, but for everyone. It is also a joy to read. Buy it. You might even take out a journal subscription. I will.
Provenance and peer review Commissioned; internally peer reviewed.
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