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Commentary on Work-Related: A Coal Miner’s Story

Ogburn, Liisa S. MEd

doi: 10.1097/01.ACM.0000445345.07834.b8
Medicine and the Arts

Ms. Ogburn is director, Documenting Medicine Program, and instructor, Center for Documentary Studies, Duke University, Durham, North Carolina; e-mail: liisa.ogburn@duke.edu.

The words “doctor” and “documentarian” are both derived from the Latin root “docēre,” which means “to teach, to see.”1,2 Reflecting on the overlap between the work of a doctor and the work of a documentarian is enlightening. In a sense, one measure of the success of each is the extent to which each professional notices and accurately reads those details that can reveal a person—and, in the case of the doctor, point to a diagnosis. Both endeavors require a well-developed capacity for observation.

With this shared etymology in mind, it’s not a far leap to see the benefits that some basic documentary training can have for a physician. Duke pediatrician and photographer John Moses, MD, appreciated these advantages soon after he first used his camera over 25 years ago to better understand the conditions that contributed to the poor health of migrant farm workers in Florida. In the years since, Dr. Moses has focused his lens on teen parents, children with cancer, and young gunshot victims.

Considering the impact of his documentary project about teen parenthood on his practice as a physician, Dr. Moses commented:

The teenagers I photographed taught me a lot.… I came away with … a richer, more accurate context in which to see them, and I hope, better understand their experience.3

Projects like Dr. Moses’s offer a different portal into understanding patient perspectives, and they provide a unique means of nurturing empathy. “When doctors can see illness from their patients’ eyes,” says Ronald Drusin, MD, vice dean for education at Columbia’s College of Physicians and Surgeons, “they become better doctors.”4

In 2010, due largely to the widespread use of the documentary projects of Dr. Moses, he and I received support to mentor medical residents and fellows in the production of small documentary projects focused primarily on patient experiences.

While many faculty at medical teaching institutions understand the power of narrative to foster empathy and connection with both self and patient, Dr. Moses and I have personally experienced, as well as heard from our participants, that documenting patient stories can enable an even richer connection. Editing these stories into meaningful narratives may teach us something we may not learn in any other way, and the unique materials produced can be used to educate physicians as well as the general public.

While narrative medicine programs are on the rise, most focus on discussing existing works and using writing as a tool for reflection. This emphasis comes as no surprise, given the understandably sacrosanct focus on patient privacy: By limiting creative efforts to writing, we can more easily mask identity and avoid the real risks associated with sharing private medical information.

Given this legitimate concern, why pull out the camera? The answer lies in our biology. We are humans, wired through millennia, for connecting with one another through story. We have recently discovered that when we read or hear or see stories, our mirror neurons (the neurons that fire both when we act and when we observe someone else acting) enable us to understand people’s actions, intentions, and feelings as if they were our own.5 The more senses a storyteller or documentarian stimulates through the telling of a story, the more deeply the viewers connect with the story and remember it over the long term.

Over the last three years, Dr. Moses and I have worked closely with residents and fellows from diverse medical specialties to develop documentary projects that provide a more intimate glimpse into the experiences of patients, their family members, and those taking care of them.6 Participants repeatedly remark on the benefits of the experience: a better understanding of their patients, improved communication skills, and the unanticipated value of creative expression. Because the documentary projects are unique, the documentarians have been invited to share their work widely—through gallery and online exhibitions, grand rounds, publications, and local, national, and international conferences.

On the facing page, we share an image from one documentary, Work-Related: A Coal Miner’s Story, by Dr. Cynthia Feltner, which explores the reasons workers may underreport injuries.7 Dr. Feltner introduces us to this project and its impact on her work as a physician:

In our culture, worker injury claims are often met with skepticism or suspicion of fraud. This leads to stereotyping and bias directed at workers in medical interactions.… This project explores one coal miner’s experience following a work-related injury. It highlights the importance of understanding the worker’s experience—both in terms of workplace safety and socioeconomic position in the community. This is also my Father’s story. His open and personal account of the medical care he received following his injury is one of the most important lessons I’ll carry with me following my occupational medicine training.

Producing documentary projects requires attending to—seeing—what is emotionally resonant and weaving it into a meaningful narrative—that can teach others. Because it is not just an intellectual exercise, but a very personal, emotional experience, the lessons learned in producing such projects may stay with us for life.

Liisa S. Ogburn, MEd

Ms. Ogburn is director, Documenting Medicine Program, and instructor, Center for Documentary Studies, Duke University, Durham, North Carolina; e-mail: liisa.ogburn@duke.edu.

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Reference

1. Doctor [etymology]. . Oxford English Dictionary. 19892nd ed Oxford, UK Oxford University Press
2. Document [etymology]. . Oxford English Dictionary. 19892nd ed Oxford, UK Oxford University Press
3. Coles R. The Youngest Parents: Teenage Pregnancy As It Shapes Lives. 1997 New York, NY Center for Documentary Studies in assoc. with W.W. Norton & Co.
4. Rasminsky A. How storytelling is changing the way doctors treat illness: A simple, ancient philosophy that could transform the practice of medicine. 2012 http://www.oprah.com/health/Narrative-Medicine-Patients-Telling-Their-Stories. Accessed January 31, 2013
5. Iacobani M. Mirroring People: The Science of Empathy and How We Connect With Others. 2008 New York, NY Picador
6. . Duke University Documenting Medicine Program Web site. http://www.documentingmedicine.com. Accessed January 31, 2013
7. Feltner CDuke University Documenting Medicine Program. . Work-Related: A Coal Miner’s Story. 2012 http://www.documentingmedicine.com/work-related/. Accessed December 23, 2013.
© 2014 by the Association of American Medical Colleges