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Medicine and the arts

Shapiro, Johanna PhD

Special Theme: Faculty Development: MEDICINE AND THE ARTS

Dr. Shapiro is professor and director of medical humanities, Department of Family Medicine, University of California, Irvine College of Medicine, Orange, California.

How is a patient like a poem?, I sometimes ask the medical students and residents I teach when I see glazed expressions that indicate they have fallen asleep with their eyes open. While I talk about how reading poetry helps us understand the experiences of patients and doctors, they sit there, politely enough, but no doubt wondering how they had the misfortune to wind up in this seminar. They thought that they had finished with English after freshman composition 101.

There is an initial stare of uncomprehending silence. I hasten to reassure them that I do not mistake people for texts, and that of course patients are not actually poems. (There is a slight collective sigh of relief, as though they are reassured I am not completely insane.) I am only speaking metaphorically, as a kind of imaginative exercise. The value of a metaphor, I remind them, is that by comparing two dissimilar things, we sometimes discover qualities about one or the other that previously has escaped our notice. Being good physicians-in-training, they are intelligent and inventive and, after their momentary shock, they are willing to play.

The answers I receive always surprise and delight me. Sometimes they are humorous. A patient is like a poem, explains one student, because reading a poem is usually over quickly, just like seeing a patient in the managed care health system. You have the feeling there is a lot more there, but the experience is over in a flash and it's time to move on. Another chimes in that patients are like poems because they both use an elliptical, indirect form of communication. An essay comes right out and says what it means in straight-forward, rational prose, but patients and poems seem to beat around the bush, using indirection, allusion, and inference. Patients and poems both make you work—hard—to understand them. Another time a resident mentions that poems sometimes have “doorknob kickers,” just like patients. You think you understand what the poem is about, then in the last stanza or concluding couplet, it throws in a monkey wrench, an ironic twist, or a completely new piece of information. Patients can have the same frustrating tendency, mentioning their chest pain or shortness of breath just as the doctor is heading out the door.

There are more serious answers as well. One student, his eyes fixed on the table in front of him and not looking at any of his peers, says, “Poetry is lyrical, and within every patient is a song.” In a different session, a student expresses a similar idea. “Poems have something important to say. So do patients, if we listen to them carefully enough.” A third student elaborates on this theme. “Poems are about meaning—the meaning of life and death. This is exactly what we have to understand about our patients… what their illnesses mean and what their lives mean.”

After this kind of discussion, it is a lot easier to read a poem together. Sometimes we read poems that are explicitly about patients, such as “Old Lady Patient” by Cortney Davis, who is both a poet and a nurse practitioner. In this poem, the content, structure, and tone all converge to give us deep knowledge of this patient. Initially, we see a cantankerous, complaining old woman in a hospital or nursing home. However, we quickly plunge into her loneliness, embarrassment, and helplessness precipitated by the rough, uncaring treatment of her physicians and nurses. In the concluding lines of the poem, her hostility is transformed through a simple act of caring.

Sometimes we read poems that, in their creation, probably had nothing to do with doctors and patients. An example of such a poem is the haiku by Basho, a seventeenth-century Japanese poet. In giving a talk to physical medicine and rehabilitation residents on professionalism,1 I used this poem to illustrate the concept of mindful practice.2 After reading the poem aloud, a resident commented, “The pond is the ancient wisdom of physicians, stretching back over centuries. The frog is the pain and suffering of the patient. We need to learn how to empathetically reverberate the patient's suffering, reflect their suffering while absorbing it with all our accumulated wisdom.” I had to pinch myself. How did he get to be so smart?

How is a patient like a poem? It is always a good question to ask. Inevitably, it leads to an even better question, How is a person like a poem? It is through this question that my students discover that poems are not just about patients or doctors—they are about the human condition.

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1. Markakis KM, Beckman HB, Suchman AL, Frankel RM. The path to professionalism: cultivating humanistic values and attitudes in residency training. Acad Med. 2000;75:141–50.
2. Epstein R. Mindful practice. JAMA. 1999;282:833–9.
© 2002 Association of American Medical Colleges