Syllabi: Narrative in Medicine: A Writing Class

INSTITUTION: University of California at Berkeley

INSTRUCTOR: Guy Micco, M.D., Director of UCB Center for Medicine, the Humanities, and Law (email: guym@socrates.berkeley.edu)

ENROLLMENT: Students from the Joint Medical Program; elective

SEMESTER: Fall and Spring 1999

COURSE OBJECTIVES:

In this 'course' designed for medical students, we will 'warm-up' with poetry and short story readings as well as writing exercises which turn us to a different channel from the usual in a medical school environment. With the help of an experienced writer we will write about our medical experiences, our patients, our work-induced emotional life, and more, and then discuss the rich details with each other in a safe, non-judgmental setting.

Medical students and physicians are traditionally taught the need to be emotionally detached from patients -- Osler called it "Aequanimitas". The reasons for this include protection of ourselves from being overwhelmed by patient suffering and protection of patients from physician loss of 'objectivity.' The soundness of this rationale may be (and recently has been) questioned; however, it is widely held. But being emotionally detached, whether appropriate or not, does not mean devoid of emotion. In prepara- tion for, during, and after clinical encounters with patients, many feelings -- both 'positive' and 'negative' -- naturally arise in medical students; these have to do with seeing, touching, and learning from patients, and from making mistakes. (Indeed, seasoned physicians are not immune from these feelings.)

What is a medical student/physician to do with his or her emotions? Many learn to 'stuff' them, ignore them -- doctors do get good at denial. Would it not be better, at least for some, to acknowledge them, give them breathing room, think about them, discuss them? This is a primary goal of the class. In addition, we will begin to see the value of regarding the medical history as a 'text' which can be written and read from differing, equally valid points of view. To this end we will rewrite our traditional medical histories from the non-biomedical perspective of our patients or their loved ones, then compare and contrast the versions.