Course Descriptions

Can Poetry Improve the Difficult
Clinician-Patient Relationship?

Johanna Shapiro, Ph.D.
1999-current

3 hour session taught to approximately 10 post-masters nursing students as part of a year-long certificate program training family nurse practitioners sponsored by the UCI Department of Family Medicine

  1. INTRODUCTION
  2. OBJECTIVES
    1. Understand the rationale for using imaginative literature/creative writing as tools for professional development
    2. Understand how literature and writing can increase clinician empathy for patients' experiences and clinician experiences
    3. Demonstrate how literature-based approaches can help change our attitudes towards patients and can even help us develop new problem-solving strategies for dealing with difficult clinician-patient encounters
  3. THE IMPORTANCE OF PATIENT STORIES
    1. Human beings think narratively
    2. Illness disrupts our expected life narratives
    3. Stories have therapeutic power to heal
  4. TWO MODES OF THINKING: LOGICO-SCIENTIFIC AND NARRATIVE.
    1. Both scientific and narrative thinking are useful for achieving certain ends, but they differ in important ways from each other.
    2. Narrative emphasizes the primacy of storytelling in the way we construct and make sense of our experience.
  5. HOW CAN WE UNDERSTAND THE PATIENT'S REALITY?
    1. Logico-scientific - Particulars of personal experience are eliminated in favor of abstractions, generalizations, systems of classification and diagnosis
    2. Narrative - emphasis is on particulars of individual experience
  6. WHOSE POINT OF VIEW AND VOICE ARE IMPORTANT?
    1. Logico-scientific - the patient's point of view is subjective, therefore suspect; the patient's voice often disappears from the medical record
    2. Narrative - the patient's point of view is subjective, therefore essential to help the physician develop an empathic stance toward the patient
  7. WHAT IS THE PROPER RELATIONSHIP BETWEEN CLINICIAN AND PATIENT?
    1. Logico-scientific - Emphasis is on objective stance, detachment, distance
    2. Narrative - requires emotional engagement and participation in the event
  8. THE CRAFT AND ARTISTRY OF LITERATURE
    1. Because of its craft, literature can articulate insights and feelings in ways that often the rest of us ordinary people, including our patients, cannot
    2. Gives voice to what is submerged and suppressed
    3. Defamiliarizes the familiar (helps us see familiar experiences, like our 500th newly diagnosed diabetic patient, in new ways)
  9. THE DIFFERENT ASSUMPTIONS AND INTERESTS OF LITERATURE
    1. Goal is storytelling, not differential diagnosis: so reminds us of the patient's story
    2. Emphasis is on character and relationships, not on treatment: so gets us to think about the effects of treatment on the person and on her relationships with others
    3. Orientation is toward discovery of meaning, not problem-solving: so reminds us to investigate the meaning to the patient of the solutions we suggest
  10. THE SAFETY OF LITERATURE
    1. In psychodynamic terms, literature can be viewed as a transitional object
    2. The playpen effect
    3. Helps us reconnect to a state of child-like wonder and openness
    4. Lack of clinical responsibility
  11. WHAT IMPORTANT CLINICAL SKILLS CAN LITERATURE HELP US DEVELOP?
    1. Develops creative imagination and curiosity
    2. Gives us empathy for multiple perspectives (dr, pt, nurse, orderly, family)
    3. Encourages us to risk emotional connectivity and engagement
    4. Reminds us of whole person understanding
    5. Teaches skills of close "textual" reading; similar to paying close attention to patients
    6. Stimulates reflection on experience, what we might have done differently, how we would act
  12. SIMILARITIES BETWEEN CLINICIANS AND POETS
    1. Struggle against mortality and death
    2. Create order from chaos
    3. Relief of suffering
    4. Concern with healing
    5. Combine emotional distance (steadiness) with emotional engagement (tenderness)
  13. POINT OF VIEW WRITING: DEFINITION
    1. Adopts the patient's point of view
    2. Describes key life events and clinician-patient encounters.
  14. POINT OF VIEW WRITING: TECHNIQUE
    1. Select a patient on basis of perceived difficulty or highly charged affect
    2. Commit to 10 minutes of writing time
    3. Write in the first person voice ("I"), relating the patient's perspective, thoughts, feelings about a recent clinician-patient encounter, illness episode, or other major life event
    4. Use information actually known about the patient from past encounters, but also try to imagine aspects of the patient's life that are unknown
  15. POINT OF VIEW WRITING: PURPOSE
    1. To develop increased understanding of and empathy for the patient's situation.
    2. To encourage playful, imaginative, and creative thinking about patients
    3. To stimulate compassionate curiosity about and greater appreciation for patients
    4. To decrease feelings of frustration, irritation, anger, and helplessness toward patients
    5. To develop innovative strategies for patient interaction and management

 



Any Problems, Comments, Or Suggestions?
Email Dr. Johanna Shapiro (jfshapir@uci.edu)
Copyright © 2000-2002, UCI College Of Medicine, Medical Education Dept.
University Of California, Irvine