Narrative Medicine: Harnessing the Power of Storytelling through Essays

By Arthur Lazarus MD MBA

Discover the powerful impact of storytelling and narrative in the medical field with, “Narrative Medicine: Harnessing the Power of Storytelling Through Essays,” by Arthur Lazarus, MD, MBA.

The book is divided into three sections:

Section 1: Medicine
Section 2; Storytelling
Section 3: Writing

Fifty-one essays offer insights and reflections that delve into the heart and soul of healthcare practice, storytelling, and narrative writing. As the pages unfold, you will journey through the compelling world of narrative medicine, showcasing the profound effect of stories in healing and understanding, and underlining their significance in shaping patient experiences, guiding treatment approaches, and fostering a deeper connection between healthcare practitioners and those they serve. This book is an invitation to explore the intricate tapestry of medical narratives and to acknowledge them as an integral part of the therapeutic process.

• Language: English
• Publisher: iUniverse
• Release date: Apr 3, 2024
• ISBN: 9781663261427

Arthur Lazarus MD MBA

Arthur L. Lazarus, MD, MBA, is a healthcare consultant, certified physician executive, and nationally recognized author, speaker, and champion of physician leadership and wellness. He has broad experience in clinical practice and the health insurance industry, having led programs at Cigna and Humana. At Humana, Lazarus was vice president and corporate medical director of behavioral health operations in Louisville, Kentucky, and subsequently a population health medical director for the state of Florida. Lazarus has also held leadership positions in several pharmaceutical companies, including Pfizer and AstraZeneca, conducting clinical trials, and reviewing promotional material for medical accuracy and FDA compliance. He has published more than 250 articles in scientific and professional journals and has written seven books, including Neuroleptic Malignant Syndrome and Related Conditions; Controversies in Managed Mental Health Care; Career Pathways in Psychiatry; MD/MBA: Physicians on the New Frontier of Medical Management; Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine; Medicine on Fire: A Narrative Travelogue; and Narrative Medicine: The Fifth Vital Sign. Born in Philadelphia, Pennsylvania, Lazarus attended Boston University, where he graduated with a bachelor’s degree in psychology with Distinction. He received his medical degree with Honors from Temple University School of Medicine, followed by a psychiatric residency at Temple University Hospital, where he was chief resident. After residency, Lazarus joined the faculty of Temple University School of Medicine, where he currently serves as Adjunct Professor of Psychiatry. He also holds non-faculty appointments as Executive-in-Residence at Temple University Fox School of Business and Management, where he received his MBA degree, and Senior Fellow, Jefferson College of Population Health, Philadelphia, Pennsylvania. Well known for his leadership and medical management skills, Lazarus is a sought-after presenter, mentor, teacher, and writer. He has shared his expertise and perspective at numerous local, national, and international meetings and seminars. Lazarus is a past president of the American Association for Psychiatric Administration and Leadership, a former member of the board of directors of the American Association for Physician Leadership (AAPL), and a current member of the AAPL editorial review board. In 2010, the American Psychiatric Association honored Lazarus with the Administrative Psychiatry Award for his effectiveness as an administrator of major mental health programs and expanding the body of knowledge of management science in mental health services delivery systems. Lazarus is among a select group of physicians in the United States who have been inducted into both the Alpha Omega Alpha medical honor society and the Beta Gamma Sigma honor society of collegiate schools of business. Lazarus lives with his wife near Charlotte, North Carolina. They have four adult children. He enjoys walking, biking, playing piano, and listening to music.

Book preview

Copyright © 2024 2024 Arthur Lazarus, MD, MBA.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.

iUniverse

1663 Liberty Drive

Bloomington, IN 47403

www.iuniverse.com

844-349-9409

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Any people depicted in stock imagery provided by Getty Images are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Getty Images.

ISBN: 978-1-6632-6141-0 (sc)

ISBN: 978-1-6632-6142-7 (e)

Library of Congress Control Number: 2024906369

iUniverse rev. date: 04/02/2024

To Laura and

my narrative medicine classmates,

with heartfelt gratitude and appreciation for the stories we have shared and the stories we continue to write together.

Contents

About the Author

Preface

Section 1:  Medicine

1   Spread Aloha in Health Care

2   Medicine is a Paradox

3   The Arts Span Every Facet of Life – Including Medicine

4   Psychiatry in 1984 vs. Now: Has Progress Come at a Cost?

5   Burned Out at Thanksgiving

6   In the Blink of an Eye

7   Preventing Childhood Accidents

8   Death – Like Life – Should be Celebrated

9   New York Night

10   Bread and Circuses on Board the U.S.S. Enterprise

11   Bread and Circuses – Part Two: Homelessness

12   Aging and Memory Loss in Physicians and Politicians

13   Medical Numerology

14   How Narrative Medicine Empowers Neurodivergent Patients

15   Neurodiversity and the DSM

16   Autism and Doctors: Strengths and Challenges

17   What are the Qualities of Exceptional Physicians?

18   E.T. Has a Close Patient Encounter

19   Open and Honest Communication with Patients is a Virtue

20   Rebuilding Trust in Public Health Agencies After COVID-19

21   Physician Engagement Determines the Value of Value-Based Health Care

22   The Shock and Awe of Malpractice Litigation

23   Just How Personal Should Personal Statements be on Medical School Applications?

24   Why Not Treat Patients the Same Way We Teach Medical Students?

25   Medical Residency Closures: Is Nothing Sacred Anymore?

26   Should You Fire Back After a Stealth Firing?

Section 2:  Storytelling

27   The Shame and Stigma of Growing Up Overweight

28   Do You Have a Secret Story?

29   The Eloquence of Storytelling

30   The Power of Story

31   Stories Heard and Stories Told

32   The Greatest Story Ever Told

33   The Asheville Halfbacks

34   The Story Behind the Stories in Medicine on Fire

35   Road Trip

36   Tales of a Medical Time Traveler

37   Shepherd Your Story – and Help Others Shepherd Their Own

Section 3:  Writing

38   How to Get Started Writing and Publishing

39   The Enchantment of Writing and Telling Stories

40   Good Writers Borrow. Great Writers Steal!

41   Write What You Want to Know About, Not What You Know

42   A Word About Memory and Narrative Writing

43   Writing in the Shadow of the Text

44   The Benefits of Expressive Writing

45   Someone Called Me Boswell. It was a Compliment of the Highest Order

46   Daydreaming and the Default Mode Network in Narrative Creation

47   Apologize to Patients in Writing

48   How Does the Writer’s Mood Affect the Writing and Rewriting of Narratives and Memoir?

49   The Impact of Mental Illness on Writing and Writers

50   Artificial Intelligence (AI) is My New Friend – Really?

Afterword

51   Words of Encouragement for Self-Imprisoned Writers

Notes

About the Author

Arthur L. Lazarus, MD, MBA, is a healthcare consultant, certified physician executive, and nationally recognized author, speaker, and champion of physician leadership and wellness. He has broad experience in clinical practice and the health insurance industry, having led programs at Cigna and Humana. At Humana, Lazarus was vice president and corporate medical director of behavioral health operations in Louisville, Kentucky, and subsequently a population health medical director for the state of Florida.

Lazarus has also held leadership positions in several pharmaceutical companies, including Pfizer and AstraZeneca, conducting clinical trials, and reviewing promotional material for medical accuracy and FDA compliance. He has published more than 250 articles in scientific and professional journals and has written seven books, including Neuroleptic Malignant Syndrome and Related Conditions; Controversies in Managed Mental Health Care; Career Pathways in Psychiatry; MD/MBA: Physicians on the New Frontier of Medical Management; Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine; Medicine on Fire: A Narrative Travelogue; and Narrative Medicine: The Fifth Vital Sign.

Born in Philadelphia, Pennsylvania, Lazarus attended Boston University, where he graduated with a bachelor’s degree in psychology with Distinction. He received his medical degree with Honors from Temple University School of Medicine, followed by a psychiatric residency at Temple University Hospital, where he was chief resident. After residency, Lazarus joined the faculty of Temple University School of Medicine, where he currently serves as Adjunct Professor of Psychiatry. He also holds non-faculty appointments as Executive-in-Residence at Temple University Fox School of Business and Management, where he received his MBA degree, and Senior Fellow, Jefferson College of Population Health, Philadelphia, Pennsylvania.

Well known for his leadership and medical management skills, Lazarus is a sought-after presenter, mentor, teacher, and writer. He has shared his expertise and perspective at numerous local, national, and international meetings and seminars.

Lazarus is a past president of the American Association for Psychiatric Administration and Leadership, a former member of the board of directors of the American Association for Physician Leadership (AAPL), and a current member of the AAPL editorial review board. In 2010, the American Psychiatric Association honored Lazarus with the Administrative Psychiatry Award for his effectiveness as an administrator of major mental health programs and expanding the body of knowledge of management science in mental health services delivery systems.

Lazarus is among a select group of physicians in the United States who have been inducted into both the Alpha Omega Alpha medical honor society and the Beta Gamma Sigma honor society of collegiate schools of business.

Lazarus lives with his wife near Charlotte, North Carolina. They have four adult children. He enjoys walking, biking, playing piano, and listening to music.

We’re all stories, in the end. Just make it a good one, eh?

—Doctor Who

Preface

Welcome to the world of narrative medicine, a unique crossroad of healing and human experiences, where the fabric of healthcare is weaved with therapeutic threads finding strength in stories of suffering and survival.

I define narrative medicine in its broadest sense, an interdisciplinary approach to healthcare that values the importance of writing and storytelling in medical practice, whether those stories are told by physicians, patients, families, caretakers or anyone remotely connected to the medical field. Here, the healthcare system is intricately interlaced with healing narratives, deriving resilience from tales of adversity and endurance.

Narrative medicine emphasizes the understanding and integration of illness into health care. Narrative medicine advocates for the inclusion of individual experiences, emotions, social contexts, and personal values in treatment settings. Narrative medicine fosters more empathetic, patient-centered care. It especially promotes the use of reflective writing and storytelling among patients and healthcare professionals, leading to greater self-awareness, improved communication, and better patient-clinician relationships. Ultimately, narrative medicine seeks to humanize medicine and enhance the holistic care of patients.

Narrative Medicine: Harnessing the Power of Storytelling through Essays is a compendium of insights and reflections that delve into the heart and soul of healthcare practice, storytelling, and narrative writing. As the pages unfold, we journey through the compelling world of narrative medicine, showcasing the profound impact of stories in healing and understanding, underlining their significance in shaping patient experiences, guiding treatment approaches, and fostering a deeper connection between healthcare practitioners and those they serve. This book is your pass to explore the complex network of medical narratives, recognizing their profound significance in the realm of health care.

In my writing, I sought to emphasize the paramount importance of narrative and storytelling in comprehending disease, charting recovery, and reclaiming health. Yet, I also had additional aims. By marrying the disciplines of medicine and literature, I aspired to introduce a distinctive viewpoint to healthcare. By honing in on storytelling, I offered a doctor’s insight into patient experiences, thereby augmenting comprehension in medical practices. Crucially, the essay format facilitated the incorporation of a wide variety of voices and experiences, rendering this book an engaging and enlightening read for those interested in medicine, patient care, or the craft of writing and storytelling.

Every narrative within this work encapsulates a story or a suggestion of a story, ignited by a thought or response to something I read, heard, conversed about, recalled, or came across during my seventy-year journey through the realms of medical practice and healthcare administration. My reflections were recorded in both ordinary and unusual settings and circumstances – in the classroom, while showering, during leisurely vacations, or just sitting at my desk – throughout January and February 2024.

My writing approach was unstructured or open, as often described by creative writers – I cross-referenced and refined the essays as I prepared them for publication. They were categorized thematically into three sections: Medicine, Storytelling, and Writing. My objective was to allow the essence of writing to guide me in limitless directions. You’ll notice recurring themes and ideas throughout the essays. However, as you progress, you’ll also experience sudden changes in direction. This was intentional – I wanted my connections to be unrestricted, yet not unfocused, all while maintaining alignment with the book’s main goal.

I perceive writing essays as akin to embarking on a journey. Essays take the writer (and the reader) on an exploration of ideas, arguments, and perspectives. Just as each essay and every journey broadens one’s perspective, narrative medicine encourages healthcare providers to look beyond clinical symptoms and diagnoses, to see the patient as a whole person and the writer as an emotionally engaged storyteller. It involves a deep exploration into the patient’s world and the world of medicine in general, with personal stories and viewpoints serving as the roadmap.

Like any journey, narrative medicine also involves a process of self-discovery. Reflective writing and listening to patients’ stories can lead to greater self-awareness and professional growth. Physicians and many other practitioners embark on this journey, navigating through patients’ experiences, emotions, values, and social contexts to understand their health concerns better.

Narrative medicine, like a journey, is a shared experience. It creates a stronger bond between the patient and the clinician – and between the writer and the reader – fostering trust and improving communication, which is essential for effective healthcare delivery. It’s believed that most worthwhile destinations start with an amazing journey. Narrative medicine is no exception, as long as the tour guide knows the terrain.

I will guide your tour.

Now let us embark on this enlightening journey together, one story at a time.

MEDICINE

1

Spread Aloha in Health Care

Let’s work toward a more idyllic vision of our health system.

I spent most of January 2024 in Honolulu – writing, working, and vacationing. With its high cost of living, scarce affordable housing, and homelessness problem, Hawaii is far from perfect, but the vibe is mostly better in this island state than on the mainland.

While ordering shaved-ice (a local favorite) at Uncle Clay’s House of Pure Aloha (HOPA), I came across the following oath. It was written by Clayton Uncle Clay Chang and his nephew Bronson Chang in 2008.

"I solemnly promise

To live every heartbeat of my life

From this day forward

With pure Aloha.

Every single word that comes out of my mouth

And every single action, be it large or small

Must first come from my compassionate heart

And be supported by my thoughtful mind.

With an open heart and an open mind

I will unconditionally love

Every person who crosses my path in life

As a fellow member of our one world ‘ohana.

If I truly do my best to do all these things

I will become the person I was born to be

Filled with inner peace and complete happiness.

Living every heartbeat with Pure Aloha

I can

bring love into the hearts of others

And make our world a better place."

The spirit of Aloha is all encompassing, including the core values or virtues of unconditional caring, personal inner peace, passionate self-discovery, courageous belief, humble collaboration, and the pursuit of excellence.

If we could live Aloha by conforming to the HOPA oath while also honoring the tenets of the Hippocratic Oath, just imagine what health care might look like today. The following changes could be observed:

1. Patient-Centered Care: Every patient would receive personalized, patient-centered care. The focus would be on understanding the patient’s needs, preferences, and values, and involving them in decision-making processes.

2. Preventive Medicine: There would be significant emphasis on preventive care rather than just treating diseases. Regular screenings, healthy lifestyle promotion, vaccinations, and early detection of potential health issues would be prioritized.

3. Universal Access: Everyone would have equal access to healthcare services, regardless of their socioeconomic status, race, or geographical location. Patients and doctors would be better matched. There would be no disparities in the quality of care received.

4. Holistic Approach: Care would not just focus on treating the physical symptoms but also consider mental, emotional, and social factors affecting health. Integrated care involving psychologists, social workers, and other professionals would be standard.

5. Technological Advancements: Advanced technologies would be fully integrated into healthcare. This includes telemedicine, artificial intelligence, electronic health records, genetic therapies, advanced imaging techniques and personalized medicine.

6. Efficient Administration: There would be streamlined administrative processes, reducing paperwork, and allowing physicians to spend more time with patients. Billing would be transparent and straightforward. Medical scribes would be commonplace.

7. Continuous Learning and Improvement: Medical professionals would be engaged in continuous learning, keeping up with the latest research and innovations. Healthcare professionals would stay abreast of the latest scientific developments and incorporate evidence-based treatments into their practice yet still embrace the art of medicine. There would be a culture of feedback and improvement, with reduced medical mistakes and, in the event of error, sincere apologies to families without legal ramifications.

8. Interdisciplinary Collaboration: There would be effective collaboration and communication among healthcare professionals across different specialties for comprehensive patient care. Internecine wars between various disciplines and practitioner types would not exist.

9. Global Collaboration: Healthcare providers and researchers would collaborate globally to share knowledge, resources, and best practices. This would accelerate medical advancements and ensure that breakthroughs benefit people around the world.

10. Emphasis on Mental Health: Psychiatry would not be a step-child to medicine. Stigma associated with mental health disorders would be eliminated, and mental health services would be routinely integrated into practice. Adequate mental health and substance use resources, funding, and services would be available for all.

11. Ethical and Transparent Practices: Medical professionals would adhere to the highest ethical standards, with transparent communication about treatment options, risks, and costs. Open and honest informed consent would be a cornerstone of medical practice. Anti-competitive business practices that harm patients, providers, and the economy would be eliminated.

12. Patient Empowerment: Patients would be empowered with information and involved in decisions about their care. This would involve effective communication between healthcare providers and patients, ensuring that individuals have a clear understanding of their health status and treatment options.

13. End of Life Care: There would be compassionate, respectful end-of-life care ensuring that patients can spend their last days in comfort and dignity. Treatment spending in the last six months of life would significantly decrease.

While achieving such an idealized vision may be difficult, ongoing efforts in health care aim to move closer to these principles through research, policy changes, and advancements in medical technology and practice.

What’s missing is Aloha. An infusion of Aloha is desperately needed to overcome challenges such as financial constraints, workforce shortages, and systemic inequities that often make it difficult to fully realize an ideal health system.

It’s important to note that many healthcare systems around the world strive to achieve these goals and have done a much better job than the U.S. without incorporating Aloha into their strategies. Can you imagine how differently medicine would be practiced today if the U.S. were to incorporate the power of Aloha? Patient care would be vastly improved. Student debt for physicians would be reduced or eliminated. Innovation would reign. Health insurers would increase reimbursement rates to practitioners and reduce premium costs for patients.

In 1962, Aunty Pilahi Pakī (1910–1985), a beloved native Hawaiian poet and spiritual guide, shared a bold prophecy that in the 21st century, The world will turn to Hawaiʻi as they search for peace because Hawaiʻi has the key; and that key is ALOHA.

Aunty Pilahi’s life’s work and desire was to spread the true meaning of Aloha to Hawaiians and non-Hawaiians alike.

Emulate people like Aunty Pilahi and Uncle Clay and help spread the meaning and spirit of Aloha. The future of the U.S. healthcare system depends on it.

2

Medicine is a Paradox

Life is, too.

Many years ago – 1991 to be exact – the television news program 60 Minutes did a feature on The French Paradox. This term refers to the observation that despite a diet rich in saturated fats, the French population has a relatively low incidence of heart disease, which some attribute to the regular consumption of red wine. (In French culture, red wine is often associated with meals.) In fact, after the segment aired, sales of red wine soared to record highs, and they continue to be robust today.

There are many observations in medicine that appear to be contradictory and puzzling. These paradoxes and puzzles highlight the dynamic and evolving nature of medical research, pushing the boundaries of our understanding and driving innovations in health care. Here are a dozen puzzles that may intrigue the curious among us:

1. The Placebo Effect: The placebo effect is a paradox where patients experience real improvement in their health after receiving a treatment that has no active therapeutic effect. This phenomenon