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Vol. LIX, No. 25
December 14, 2007
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Hearing the Call of Stories
Literature Bolsters Medical Education, Says Plotz

On the front page...

The source of drama is conflict: Stories that lack it simply don’t hook us and fail to move us. A heartfelt statement of conflict—a problem, a need, a critical gap—is how Dr. Paul Plotz, chief of the Arthritis and Rheumatism Branch, NIAMS, opened his recent lecture in the Great Teachers Series.

“It troubles me and many physicians of my age,” he told a full house in Lipsett Amphitheater, “that changes in the practice of medicine, many of them wonderful, also serve to deprive students and young physicians of what seemed to us to have been the most intense and formative part of our own education.” And that is the time to learn at the bedside; to hear the call of stories told by patients and by practitioners seeking to heal them.

Continued...


  Dr. Paul Plotz  
  Dr. Paul Plotz  

Plotz, who won the 2000 NIH Director’s Award in Mentoring, created and still sustains the Contemporary Clinical Medicine: Great Teachers series, now a fixture in Grand Rounds at the Clinical Center. His own specialties include inflammatory and genetic muscle disease and lupus nephritis.

Having been at NIH for 40 years, he outlined a problematic trend in medical education: abbreviated hospital stays cut short the encounter between doctor and patient—and thus between teacher and student—making meaningful exchanges all too brief. With fewer opportunities for observing role models, students aren’t getting something essential.

Becoming a physician requires more than technical skills, stressed Plotz. It also takes skills developed by “watching a clinician touch a patient, not just as a diagnostic maneuver, but in silent communication for the relief of anxiety or suffering.” The insight gained in “those luminous scenes” between clinicians and patients is crucial, since “the underlying job, the relief of suffering, requires physicianly or perhaps just human skills that are never quite complete over a lifetime.”

Yes, we’ve all had experiences with illness, he noted, whether in our personal lives, or perhaps from reading, looking at art or even television— shown in his sequence of slides from early 19th century painting to the TV drama House. And the arts, whether classic or popular, are not mere accompaniments to medical education. Nor should they be.

Newman displays chambered nautilus.
Becoming a physician, says Plotz (r), requires the full use of one’s imaginative powers, which take time to develop. Art and literature can help “convey semesters of advice.” In an image from a classic TV series, young Dr. Kildare (a white-coated Richard Chamberlain) is backed up by his mentor (Raymond Massey).

“The burden of my message,” he said, “is that [medical education] fundamentally requires the development and full use of your imaginative powers...It will call on imaginative powers for the rest of your life.”

He then offered the audience a brief survey of literature reflected in several genres—including essays, memoirs, plays and fiction, with high praise for “the novelists [who] convey complete worlds.” He read nine excerpts aloud, and offered a reading list with 34 other authors, from Albert Camus to Susan Sontag.

Some highlights of his lecture, “The Vocation of Medicine: Lessons from Real and Imagined Physicians”:

Aleksandr Solzhenitsyn’s 1968 Cancer Ward features many characters, including an oncologist, now ill with cancer herself. She knows what is ahead and comes to see her old mentor, but even her own “good doctor” could not relieve her. The novel, said Plotz, “is full of such encounters; this is one all medical students should read.”

Anton Chekhov’s 1892 short story Ward Six shows how the tables are turned on a small-town doctor. He is admitted to a psychiatric ward by the deceit of an ambitious younger colleague, where overnight he “learns about pain and sickness that a lifetime hadn’t taught him.”

In French playwright Molière’s The Doctor in Spite of Himself, the impostor “talks nonsense, overwhelming the patient’s father,” said Plotz, showing how “we all fall back on this bad behavior when the truth is unknown to us. You could transform [this 1666 satire] into an episode of Scrubs or House.”

John Berger’s A Fortunate Man, an account of a general practitioner in a poor rural area, includes a scene of its subject, a country doctor, saving a man trapped beneath a fallen tree. Berger questions “how to evaluate an ordinary working doctor,” since “you cannot evaluate a man like stock in a warehouse.” The doctor’s work, while poorly paid, is nonetheless “his source of satisfaction—fulfillment in itself.” This is precisely why Berger dubs him “a fortunate man” and why the book’s “deep and unromantic understanding of human nature...conveys semesters of advice.” NIH Record Icon

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