Listening and responding to patients’ stories for over 20 years as an emergency physician has strengthened my appreciation for the many ways that the skills and principles drawn from writing fiction double as necessary clinical skills. The best medicine doesn’t work on the wrong story, and the stories patients tell sometimes feel like first drafts—vital and fragile works-in-progress. Increasingly complex health challenges compounded by social, financial, and psychological burdens make for stories that are difficult to articulate and comprehend. In this (...) essay, I argue that healthcare providers need to think like creative writers and the skills and sensitivities necessary to story construction deserve a vital space in medical education. A thorough understanding of story anatomy and the imaginative flexibility to work stories into open spaces serve as antidotes to the reductive nature of clinical decision making and have implications as patient safety and risk management strategies. The examples that I have selected demonstrate how thinking like a creative writer functions at the bedside, providing tools for clinical excellence and empathy. This approach asks that we re-imagine the importance of story in clinical care: from a vehicle to a diagnosis to its place as a critical destination. (shrink)

I could have been more understanding, especially when police brought a man I'll call Mr. Atkins to the emergency room for depression and suicidal ideation. But it was 3:00 a.m. and the ER was a carnival of disease and discontent, a parade of drunk drivers and folks who practiced conflict resolution with knives and bullets. A patient well known for her drug abuse wasn't done yelling at me for refusing to write her a narcotic script when a nurse tweaked at (...) my elbow to please come speak with Mr. Atkins, who was making a case to walk out. (shrink)

“I'm not afraid of dying,” he says, despite his plea on arrival. “Listen up, douchebag. Are you calling my cousin or what?” The emergency department might be the only sphere of human exchange where one party—patients (and sometimes family)—are permitted to insult, threaten, and even spit at the very people on whom they depend for help, while the offended parties—physicians, nurses, and other health care providers—must not only tolerate the abuse, but treat their tormentors. Does the ED's collective duty to (...) greater numbers of patients demand a revised ethos of tough love for extreme cases of misbehavior? Can we ask these patients to leave without legal recourse after extending genuine, compassionate efforts to participate in their care—barring evidence of a medical explanation for their toxic comportment or a mental illness that puts them at risk of harming themselves or others? (shrink)

On September 1, 2005, Memorial Hospital was on “survival mode.” Hurricane Katrina had felled the levees of New Orleans, submerging a modern city with floodwaters of biblical proportions, tasking physicians and nurses to make morally sound decisions under unprecedented conditions, where, as one physician stated, “[T]he laws of man and the normal standards of medicine no longer applied” (p. 9). In Five Days at Memorial, Sheri Fink, a Pulitzer Prize‐winning journalist, resists the urge to assign easy blame or take a (...) position. Instead, she weaves together the perspectives of a cast of people tested by this catastrophe and constructs a tapestry of experiences that isn't neat and comforting but disturbing, compelling, and admirable all at once. (shrink)

I’m avoiding Mr. G’s room. I shouldn’t have read the emergency room notes from the other hospital, where this middle‐aged man raised a stink about the wait. What type of person calls the triage nurse a bitch? From the timestamps on the electronic medical record notes, he stormed from that ER and drove his abdominal pain, vomiting, diarrhea, and discontent directly across town to us.I’m reminded of this oft‐quoted aphorism from Sir William Osler: “The good physician treats the disease; the (...) great physician treats the patient who has the disease.” It’s cited by medical educators as an invocation to never forget the humanistic heart at the center of clinical care. But what if the patient is a jerk? That I haven’t met Mr. G, only read briefly about him, doesn’t stop these ugly feelings from surfacing. (shrink)