Learning from doctors’ illness narratives

TomlinsonJonathan Tomlinson is a general practitioner in London, UK, and a NIHR In Practice Research Fellow at the Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry

Kate Granger, a young doctor with cancer, recently wrote a book called 'The Other side'. It's a book for doctors ‘to be better able to understand exactly what being the patient is really like …” Other medical writers have also been motivated by the shocking realisation that medical education and clinical practice had taught them so little about what it’s like to be a patient, the particular problems that doctors themselves have in coping with illness and the health risks associated with their profession; loss of identity, shame and stigma, the need to be treated as a person and an acute awareness of mistakes were common themes of narratives.

Inspired by their stories, I have been leading teaching seminars with medical students, GP trainees, GP trainers, GP retainers, medical humanities students and the public and learned a few more lessons along the way.

Doctors’ illness narratives have a particular power because of the inescapable sense that if it happened to ‘one of us, it could also happen to me’. Members of every audience I have spoken to – ranging in size from about twenty to two hundred, have wanted to share their personal stories after the session. At Guys and St Thomas’ Medical School in London, where I spoke to about 200 fourth year medical students, we broke out into small groups of about 10-15 students facilitated by members of the student welfare service. We had rich, thoughtful and supportive discussions about their experiences as patients, or relatives of patients or as students in the course of their training. Small groups work best, as people are unwilling to share stories in the lecture theater. Medical students tended to be more concerned about what lessons can be learned about the humanity of patient care and were often quite surprised or skeptical about how bad it can be. Older doctors were more likely to have experienced serious illness, and be concerned about how this affects them as a professional and a colleague and how we look after each other. With the lay public, discussion centred about how to re-humanise medical education and practice and this older audience seemed the most willing to share personal stories.

All asked why there wasn’t more teaching for medical students and doctors about patients’ experiences, and doctors’ experiences as patients. In every audience there have been doctors or students who have been personally affected and they benefited from the shelter of a safe and supportive environment afterwards. Learning and reflecting on the experiences of doctors as patients is a process, best continued within the structure of small groups of peers, initially at least with expert support. We have a lot to learn from each other.

Jonathan, who is studying moral development in medical education and clinical practice, shares thoughts on his own blog own blog and learns a lot on twitter about the relationships between doctors, patients and health policy.

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