Ellen D. Mandel, DMH, MPA, MS, PA-C
close reading mean to you? Do you think it means holding a book close to your eyes due to myopia? Maybe it means reading about a close relative or a topic close to your heart? Well, these are not even close to the definition. In the realm of narrative medicine, close reading means reading for a purpose, to discover things that would not be discovered or discerned with a casual
reading approach. According to Rita Charon, MD, PhD, professor of medicine and director of the narrative medicine program at Columbia University, close reading might help train clinicians to notice more about what their patients are communicating, leading to many benefits. It helps us to read between the lines, and thus better communicate. Communication is a two-way street.1
In close reading, readers train themselves to clearly register a work of prose, poetry, and even musical lyrics, in terms of genre, narrator, diction, timing, space, plot, choice of vocabulary, and images.1 If your eyes are glazing over, thinking of Shakespeare, Henry James, Ayn Rand, or Walden Pond, I’m sorry. However, good quality literature lets us enter worlds that are unknown to us. It is especially important to do close reading if you had an idyllic and wonderful childhood, easily found the perfect life partner, achieved every goal with limited fuss, have more money than you know what to do with, had no one close die (pet or human), never been stereotyped or discriminated against, and generally have experienced nothing awful. Well then, honestly, close reading is essential. Frankly, you don’t know what you don’t know—scary. The reality is, every clinician will benefit.
Close reading lets clinicians see and nearly feel via the vehicle of a well-written work, domestic violence, murder, betrayal, lying, substance abuse, theft, adultery, death of the innocent, medical malpractice and a host of other unsavory activities, all from the safety of a comfy sofa (comforter included). It reveals individual and group differences in thought and behaviors based on religion, culture, morals, and ethics. It trains the PA student (often referenced as a millennial and by commonly voiced opinion, having an attention span of a short YouTube video), to carefully read a story and keep track of multiple characters, move back and forth in time (recall foreshadowing from English class), note discrepancies in plot, and stay on top of a story. Not so unlike collecting a history from a patient who does not present information in the accepted template order: possibly one with a low score on a mental status examination?2
Physicians, who have historically been fed a diet of myths about their perfection, are experiencing burnout, substance abuse, relationship fall-out, and suicide. Narrative medicine helps here, too.3 If it helps the physician, it will help the PA. Remember, we are trained in the medical model and also are subject to its risks and benefits. Close reading in groups has been shown to improve coping, resilience, and job happiness.4
So, set aside some time every day to ready a juicy book. Take it all in. Discuss it with others. Avoid
War and Peace for now. Enter another world and fall into it. And please, take millennials by the hand, and bring them into close reading. All of you will learn, improve your patient communication skills, and get some relief from the less-than-rosy world we inhabit.
1. Charon R.
The Principles and Practice of Narrative Medicine. Oxford University Press, 2017.
2. Charon R. To see the suffering.
Acad Med. 2017;92(12):1668-1670.
3. West CP, Dyrbye LN, Erwin PJ, et al. Interventions to prevent and reduce physician burnout: systematic review and meta-analysis. Lancet. 2016;338:2272-2281.
4. Sanchez-Reilly S, Morrison LJ, Carey E, et al. Caring for oneself to care for others: physicians and their self-care.
J Support Oncol. 2013;11(2):75-81.
Ellen D. Mandel is a clinical professor in the Department of PA Studies at Pace University-Lenox Hill Hospital in New York City. The views expressed in this blog post are those of the author and may not reflect AAPA policies.