AAMC Reporter: January 2007

Physician-Poets Take Measured Approach

Jack Coulehan, M.D., M.P.H., co-editor (with Angela Belli) of "Primary Care: More Poems by Physicians," teaches and practices medicine at Stony Brook University Health Sciences Center. His poems and stories appear frequently in literary magazines and medical journals and have been widely anthologized. He has published four collections of poetry, most recently "Medical Stone: Poems." He is also co-author of "Chekhov's Doctors: A Collection of Chekhov's Medical Tales" and "The Medical Interview: Mastering Skills for Clinical Practice." Together, Belli and Coulehan edited "Blood and Bone: Poems by Physicians."

"Primary Care" is a collection of poems written by 52 poets whose work is representative of physicians who utilize the language of poetry as a means of personal reflection and self-expression. A high percentage of the poems in this collection arise from the physician's life at work—with the uncertainty, pain, anger, sympathy, longing, skepticism, desperation, and love they observe in their patients and often experience themselves. "Primary Care" is available from University of Iowa Press.

How is poetry used in medical education?

There are courses in medical schools that include literature in medicine. In the first or second year in some medical schools, rather than teaching ethics or sociology, instructors use literary works to teach about these issues. Literature introduces a more vicarious experience. Presently, there's a movement in medical schools called reflective practice or narrative medicine. These assist the students while going through various medical experiences to become more reflective. The courses encourage students to journal or to write in some format about their interior experiences and feelings. Poetry is also one of these formats.

Many people would be surprised to learn that medical students are learning how to write and analyze personal narratives and meeting regularly with their peers to share uncertainties, emotions and ambivalence that arise in their professional relationships.

They would be similarly surprised to discover that the tradition of linking healing and poetry is not alien to America. It came to us through the art of physician-poet William Carlos Williams. Williams' "Autobiography" (New York, 1951) is partly devoted to the medical side of his life and its crucial relation to his poetry—which, like his fiction, draws heavily on his experience as a doctor.

When did you begin writing poetry?

I always liked to write. I began writing in high school and continued in college and medical school. I gave it up during my early medical career and restarted [writing poetry] in my early 40s. I guess I had a midlife enlightenment and started writing again. I've been fortunate to have four collections of poetry published as well as editing Blood and Bone with Angela Belli.

In a clinical setting, how can poetry enhance the relationship between physicians and patients?

Because many patients experience their physicians as not taking their stories seriously or not being carefully attentive to them as a person, physicians are seen as not exhibiting the quality and skill called clinical empathy. Clinical empathy is the skill that helps physicians understand what the patient is actually experiencing and creates a connection of trust and respect between the two parties.

This is where poetry can enter the scene. There are many methods for physicians to learn to enhance their attentiveness, empathy, and respect for language. Poetry as language, rhythm, image, metaphor, and symbol lies at the core of cultural healing traditions throughout the world.

Medicine has always been an emotionally and spiritually challenging profession. Many physicians attempt to build into their lives opportunities for reflection and self-awareness. It is in this context that medical poetry blossomed.

Today, most major general medical journals publish poems regularly, usually in conjunction with other narrative features, like short stories and personal essays.

With more than 50 poets represented in your book, what were your criteria for selecting these physician-poets?

When I returned to writing in the mid-1980s, I only knew of two other physician-poets. Over the years, I was very interested in the relationship between medicine and poetry. Most of my career has been devoted to medical humanities. Because of this, people referred names to me, and when I traveled in the humanities circle, I began to meet more physicians who also wrote poetry.

With "Primary Care," we were motivated to bring poets more into the mainstream of medical humanities. These particular poets were chosen because of the quality of their work as well as for the diversity of their topics.

Many physician-poets keep poetry separate form their professional lives. We felt through this book, students and young physicians could benefit from reading these poems. Since our first book, "Medical Stone," was successful, our publisher at University of Iowa Press was interested in pursuing another book. So, we approached these poets and chose these particular poems from the selection, they submitted.

Why do physicians write poetry?

If asked why they write, the physician-poets represented in this anthology would likely give reasons similar to those of other poets. To them, it feels natural to write poems; they experience a need to express themselves in this way. Additionally, medicine provides physician-poets with unusually broad and deep access to human suffering, as well as tenacity, heroism, love, and joy.

It is not uncommon to find physicians sharing their patients' feeling in their poems. As patients acquire the medical facts about themselves via ever-advancing technological means, they must face a common side effect—the realization that their daily lives may very well be altered, for good or ill by the knowledge gained. The physician, too, may have similar awareness in confronting the facts about their patients' condition when the test results are revealed.

The subjects of the poems in the book are written about the everyday challenges in medicine—patient's conditions; the impact of illness; technology and its limitations; medical errors; death; the workplace or hospital; physician's personal lives. Humor is also frequently used as a means of relieving tension in medical situations.

A significant number of poems collected in this book reveal the poets' social awareness as they focus on local and global issues. Poets expand their visions to encompass life beyond our shores to comment on social upheavals caused by human brutality. Because they recognize the power of language to heal (as well as to damage) physician-poets speak out publicly, as poets have always done.

—By Lora Meisner, special to the Reporter

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