The next generation of doctors sees patients as "authors" 

Sick Story

When Matt Dettmer was a senior in college, a couple of his writing professors said he'd make a great "doctor-poet" who writes "nifty poems about surgery."

"At first I was like, Oh god, who wants to read a poem about DNA?'" he recalls during a drive home from a full day at the clinic. "But now that I spend less and less time outside medicine, it's become important to me.

"Especially the clinical exposures — the human side of medicine."

Dettmer, 24, is a third-year medical student at the Medical University of South Carolina. Straddling the worlds of art and science isn't the only thing setting Dettmer apart from his peers. He spent his childhood in Saudi Arabia, where his father worked for an oil company. He attended high school at a Wisconsin boarding school and college at Marquette University in Milwaukee, where he majored in physiology and English Literature. Growing up abroad has influenced not only his writing, but the way he approaches patients.

"In Saudi Arabia, where Caucasians were in the minority, I was constantly around people who didn't look like me," he says. "As a doctor, my patients — even if we're from the same ethnic background — are going to be highly varied in terms of socioeconomic and other factors."

Like many med students, Dettmer says his decision to become a doctor was a spiritual epiphany he couldn't ignore. Even so, Dettmer takes time at least twice a week to write poetry, fiction, and songs for his rock band.

It doesn't detract from his studies. On the contrary, Dettmer says that medicine has inspired creative approaches for his writing as much as his writing has inspired creative approaches to his patients.

"When I've interviewed patients, I've found it very helpful to think of what they are telling me as a story, rather than a list of risk factors to be checked off, dated, and documented," Dettmer says.

"I like to take a patient's history and consider it part of a narrative — not simply because of my own fascination with literature, but in order to get a better idea of who the narrator is, in order to better understand my patient."

This practice, Dettmer explains, stems in large part from a seminar he took during college called "Narrative Psychology." The course, taught by an English and psychology professor, put forth the idea of patients telling their life stories.

Through these stories, the clinician could work backward to figure out the psychology of the patient. Dettmer has since learned to apply the same set of principles to his work as a physician. Such an approach grants patients greater respect and autonomy, allowing them to be the "authors" of their own health story, rather than the passive victims of a disorder.

"The history I take from patients — from their body as well as their words — tells the story of their disease," Dettmer says.

Without ethics, you're screwed

Many would consider Dettmer to be the picture of an ideal doctor, one who combines an aptitude for science with the humanistic insight of an artist.

But in many ways Dettmer isn't unique. He's part of a growing trend at medical universities in which courses in the humanities — that is, the human-oriented fields of art, music, literature, history, religion, and philosophy — are playing a larger role in educating the next generation of doctors.

For three decades, the Medical University of South Carolina has made a point to include the humanities in a curriculum otherwise dominated by science, technology, and medicine. In November, it took a big step in advancing what are often called "the soft disciplines" by appointing sociologist J. Herman Blake as its inaugural humanities scholar-in-residence.

MUSC has for some time offered humanities courses, but these often fail to attract students and are cancelled, because students' schedules are already overloaded by, among other things, heavy academic commitments.

For this reason, Blake intends to take a different approach.

"When I was appointed, I was asked about bringing speakers," Blake says. "So I'm compiling a list of very skilled, sensitive individuals to speak about an array of topics that fit into the scheme of things here."

With a proposed speakers series, Blake's goal is to stimulate creative thinking. Medicine is task–oriented, astounding, and necessary, but not enough.

"We have to include the soul," he says.

Including the humanities in a medical school's curriculum is not novel. A number of schools devote whole departments to their study.

What is unique, however, is MUSC's student-run literary journal, Humanitas. For 12 years, it has been a steady creative outlet for students like Matt Dettmer, who contributed poems to the past three issues.

"We wanted a publication that would show the other side of medicine and showcase the thoughts of faculty, students, and staff," says Carol Lancaster, an educational administrator who helped found the journal. Sanford Zeigler, a second-year medical student and the new editor of Humanitas, has been impressed by the talent and emotion of the poetry, short stories, essays, and art submitted for consideration.

Most of the work addresses medicine, allowing contributors to process in a less clinical way the joys and sorrows of wearing the white coat, such as seeing a patient recover from cancer or caring for an abused child.

Zeigler wants to expand the journal to include more of those voices, which he thinks are important for the whole university to hear.

"If you're going into a healthcare profession and all you can focus on is dosages and physiology, that doesn't really speak to your average patient," says Zeigler, who, like Dettmer, majored in English literature as an undergrad. "It keeps you grounded to be involved with the arts. I thought medicine was going to be very black and white, but actually there's a lot of gray.

"If you're not equipped to think about ethics and morality — which humanities can help teach — you're screwed."

An ideal balance

Incorporating the humanities into the lives of medical students remains a challenge for the university. Matt Dettmer says he's been frustrated when creative endeavors stall under the pressures of a demanding course load.

In 2007, Dettmer founded a book club called the MUSC Literary Experience. The reading list included The Kite Runner and Life of Pi, books that focus on social and cultural issues beyond medicine.

"Over the year, we had some cool conversations," Dettmer says. "I was really struck by the interest in discussing prose and poetry as a break from — and hopefully a bit of a supplement to — the grind of a medical education."

As time went on, however, the group caved to increasingly binding and disparate schedules. Now locked in to the clinical rotations that dominate the third and fourth years of the med-school curriculum, Dettmer probably won't have a chance to start it back up.

Dettmer himself is a metaphor for this conundrum. On the one hand, he was attracted to the power of his literary interests. On the other, he's equally drawn to the practical, concrete nature of medicine.

It's easy to devote oneself entirely to art or medicine, he says. The challenge, and perhaps the ideal, is to maintain a balance between the two.

"I really enjoy chewing the fat over Hemingway," he says, "but unless you're a Hemingway expert, it can be hard to have a career in literature that's applicable to the real, physical world.

"In the end, I thought it made more sense to have a job as a physician, and use that as the basis for my creative pursuits."


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