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Medicine and the Arts

Commentary on an Excerpt From Mansfield Park

Arjmand, Susan MD, MHPE

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doi: 10.1097/01.ACM.0000532185.41117.a1
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Commentary on an Excerpt From Mansfield Park

In this excerpt from Jane Austen’s Mansfield Park, Fanny is comforted by her cousin Edmund in whose home she is now a guest. Feeling homesick and out of place, Fanny has tried to hide her discomfort and keep her sorrows to herself. The world of Mansfield Park is foreign and inhospitable to Fanny, despite the ostensible kindness of Sir Thomas and Lady Bertram who, along with their children, try to make Fanny feel welcome but are unable to put themselves in her shoes.

Enjoying the very privileged conditions at Mansfield Park and knowing that Fanny’s own background is simple and her circumstances constrained, the Bertram family cannot hide their conviction that Fanny is lucky to be in their home and should naturally feel grateful for their help and happy with her “good fortune.” They are oblivious to her sense of isolation and loneliness and would not have understood it even if Fanny had been able to articulate it. Fanny, for her part, is too intimidated and uncomfortable to freely express herself to them, and thus readers encounter her crying alone on the attic stairs when Edmund finds her.

As a result of their exchange, Fanny and Edmund’s relationship is completely transformed. Fanny believes that she has finally found a friend at Mansfield Park, and in turn, her demeanor changes because she feels welcome and understood by her cousin. What Fanny receives from Edmund is his listening ear and open heart. He demonstrates a willingness to hear her story and thus to know her. “Let us walk out in the park, and you shall tell me all about your brothers and sisters.”

When doctors interview patients, they follow the method instilled in them in medical school; that is, they direct the interview in such a way as to gain the information they need to make a diagnosis and formulate a treatment plan. This tried-and-true method is designed to gather the information into a neat SOAP (subjective, objective, assessment, plan) note. Although this typical method of conducting patient interviews is efficient and usually leads to the sought-after goal (a diagnosis), it is fraught with the potential for misunderstanding. Doctors, familiar with the world of medicine, attempt to gather information into a format that makes sense in biomedical terms, and the patient, perhaps frightened like Fanny and relatively unfamiliar with the intricacies of the health care world, tries to convey the information that he or she thinks is important.

As any of us doctors who have ever interviewed a patient struggling with illness, pain, or fear knows, the narrative that the patient provides is not always expressed in a way that we find easy to fit into our paradigm. So we tend to try to fit the patient’s words in ourselves; interrupting patients, cutting off trains of thought that we believe are not leading to where we think we need to go. Under these conditions, the patient may leave with a diagnosis, but not with a sense of having been heard. When we wonder why a patient is slow to recover or does not follow the treatment plan as well or as easily as we think he or she should, we may ask ourselves what part of the story we might have missed. Did we in fact invite our patient to “walk in the park, and tell me all about your brothers and sisters?”

Given current trends in medical practice, such a perambulation may seem impractical and unrealistic; the most well-intentioned physician may have difficulty creating the space for a patient conversation of this nature because of the scheduling demands that dominate most busy clinics. However, physicians do well to consider the benefits of creating the circumstances for a true dialogue to occur. In this space, an exchange of vital information may take place—not just a relaying of medical facts, but of the stories that a patient wishes to tell. These are the stories that tell us who our patients are, what they value, what they fear, what the illness means to them. When considered this way, it is easy to see how stories can help a physician guide patients through illness and through the medical system in a compassionate manner that helps not only the patient but also members of the medical team who are pursuing a diagnosis or developing a treatment plan. The ideal may not necessarily be offering more time for conversation, but it is surely offering our most attentive selves.

Finally, readers see that Fanny’s exchange with Edmund and her newfound friendship with him eventually affect her relationship with the entire family as they come to view her as a more agreeable and pleasing companion. “The place became less strange, and the people less formidable; and if there were some amongst them whom she could not cease to fear, she began at least to know their ways, and to catch the best manner of conforming to them.” Austen shows us that the most important resource people bring into a relationship or dialogue is their stories, and the deepest way of acknowledging a person’s presence and importance to us is to give those stories—and that person—our full and complete attention.

Susan Arjmand, MD, MHPE
S. Arjmand is adjunct lecturer, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois;

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