Guest: Dr. Danielle Ofri
Guest Bio: Associate Professor of Medicine at NYU School of Medicine, Physician at Bellevue Hospital in New York
City, Editor-in-Chief of the Bellevue Literary Review and Author of four books, including her most recent:
What Doctors Feel: How Emotions Affect the Practice of Medicine.
Dr. Ofri and I discuss her work as Editor-in-Chief of the Bellevue Literary Review, and the impact that poetry, writing and the arts have had on her personally and professionally.
Health Professional Radio
Emily: You’re listening to Health Professional Radio. This is Emily and my guest today and Dr. Danielle Ofri, an Associate Professor of Medicine at NYU School of Medicine, a physician at the Bellevue Hospital in New York City, editor-in-chief of the Bellevue Literary Review, and an author of four books, including her most recent, What Doctors Feel: How Emotions Affect the Practice of Medicine. Dr. Ofri, welcome and thanks for speaking with me.
Dr. Danielle Ofri: Thank you so much.
Emily: I’d love to talk about the Bellevue Literary Review. We were just talking about your most recent book, What Doctors Feel, and I’m wondering, is there a connection between your work on this literary journal and your own personal writing?
Danielle: There is. The journal started when I was asking medical students to write me stories about their patients. We read their standard medical write-ups, which after a while like all the patients sound the same. I want to hear about the individual patients and I have this wonderful collection of student essays. So some colleagues and I first thought about maybe making a student journal in-house. But we realised that there’s really a larger interest and concern about our health vulnerability.
After all, you can go through life and never need an accountant, but you’ll never get through life and never need a doctor for yourself or someone else in your family. So we all share just a little bit of anxiety about the medical world. So we thought having a journal that looked at these issues creatively with poetry, fiction and non-fiction would be another way to examine this.
So we took out some writing ads and thousands of submissions have poured in. So now we’ve been publishing for 12 years and it’s giving us another way of thinking about this.
Emily: I love that. Your website says that it’s a forum for illuminating humanity and human experience. I think that really describes what you just told me that we all have this shared collective experience that’s usually fraught in some way out with trauma or fear, and I love that we can sort of break down those boundaries. Also, you talk a lot in your writing about empathy and about how sometimes being able to connect through something literary or artistic.
Something that strips away the differences between us perhaps cultural, linguistic, perhaps you admit. That can really help us to see one another as human, doctor and patient.
Danielle: I wholeheartedly agree. Usually in the daily life in a hospital or doctor’s office, patient experiences happen so quickly. You have a 15 minute visit and then there’s the next patient. Or in a hospital someone is sick or dies and then a new patient comes in and there’s very little time to really think about how these very powerful emotions affect us. Having an artistic outlet is another way of giving some space and time to thinking about what these patients have meant to us, how they’ve affected us, how we’ve affected them. For me, writing and also music is a way of, again, giving the emotions their due.
Emily: Has writing transformed your practice?
Danielle: I would like to hope so. One thing that writers do, particularly novelists, is pay very careful attention to details of what makes one character different from another. As doctors, as internists, that’s our job also, and writing sharpens those skills. Looking very carefully at how a patient appears, how they sound, how they walk. All of those details are important to making the diagnosis, to understanding the patient. It also makes me very interested in the patient’s story outside the office.
Where did they come from? How did they get here? Who’s in their family? All these things, as a writer, you would use in creating a character but as a doctor it gives me a context for my patient, because one pneumonia is very different from another depending on their background.
Emily: Yes. You, in your book, How Doctors Feel, you describe a patient whose condition seemed, according to one of your colleagues, incompatible with life. Then you described meeting this patient’s wife and beginning to learn his story, and those stories made him suddenly appear to you and to others as a real person with a history, with family, with emotions himself instead of a case.
Danielle: If this was a patient, a tragic case of a patient with skin ulcers that had so ravaged his body there was literally nothing left. We could see his bones. He was hardly a person and he could hardly talk and he had some dementia and almost no body left. So it was very hard to connect and to make him seem like a person. Then his wife arrived and suddenly she began to tell us about him. We saw his family life, his background, and it completely changed how we viewed him.
Of course, it doesn’t change the tragedy of his medical condition, but it enabled us to connect with him more. I think for his remaining time he had a warmer experience from his caregivers because he really meant something to us as a real person.
Emily: Let me ask you sort of a strange question. To what degree do you see yourself in your patients? Has writing intensified that experience?
Danielle: When you look carefully, you realise that people are more alike than different. I see patients from all walks of life, wealthy, poor, immigrants, native. While there are many superficial differences, when people are sick and still vulnerable, that commonality is much more powerful. The times that I’ve experienced being a patient, I tune into that also and I recognised that fearing of my patients and so I try to hang on to that.
When I see my patient remember, even if, for example, the patient’s being difficult and arguing with me or disagreeing, that much of this comes from the fear and vulnerability and try to keep that in mind. Writing gives me the chance to explore that vulnerability, because often that’s the primary issue at hand that the patient’s fear, justified, is colouring the interaction.
Emily: I see. Do you ever encourage your patients to write?
Danielle: I have mentioned that to patients. It’s an interesting thing. The population that I work with, most don’t speak English and many have not much education, but what I do talk about writing and also reading and I try to suggest a patient’s copies of the BLR of the Bellevue Literary Review whenever I can.
Emily: You write about an interesting interaction. There’s an article that I recently read of yours entitled “Poetry of Medicine,” and you talk about sharing a poem entitled, I’m Gonna Slap Those Doctors with your medical team and with a homeless alcoholic patient. Would you describe that experience for us?
Danielle: Sure. Again, this is the kind of patients that doctors have a lot of trouble having empathy for. They’re smelly, they’re annoying, they keep coming back, they keep harming themselves no matter what we seem to do. They just keep drinking and we just roll our eyes when they come in. I have this wonderful poem by Jack Coulehan, a physician and poet, from the perspective of an alcoholic who’s so angry about his doctor’s really “holier than thou” attitude and he just wants to slug them.
The poem really talks about him getting his emotions out and his fantasy of just punching that doctor. So one day we had a patient who spoke English and was reasonably literate. He said, “Hey guys, can we read this poem?” It was a little bit of an odd thing. Everyone was not sure what I was doing, but the patient loved it. He said, “Yes! That’s exactly what it feels like.” What was interesting is suddenly he was the expert on this topic and we the doctors were less experts, and we learned a lot from him.
He became, again in our eyes, he felt more of a real person. After that, I observed that the team treated him very differently, much more respectful. They came and talked with him more. It made him a real person, and when I can I try to do that.
Emily: That’s so interesting. I love that story, because I love the idea that the patient who was disagreeable in the first place lit up. I read the poem and it’s crude and it’s crass, and I love that that patient really connected with that and said, “Yeah, that’s exactly how it feels.” I think that’s fantastic.
Danielle: Not much of what we tell the patient to talk about has meaning for him. We talk about a rehab and your liver and what’s happening and mostly just going over his head. He’s heard it a million times before and it’s not connecting. But this, which describes his experience quite accurately, that connected. So that was a really important lesson for all of us.
Emily: I love that. Going back to the BLR, the Bellevue Literary Review, who submits to this?
Danielle: Everyone. Everyone. There are a few doctors and nurses, but that’s quite the minority because I think that everyone has grappled with these issues. So we have people who are writers and lawyers and ordinary people who have had an experience or thought about this and maybe want to express that in a poem or in a story. You may have heard the term about fiction as being the great lie that tells the truth.
Sometimes, with fiction and poetry, we can get more at the nugget of what something means than by a very dry case presentation or a factual textbook.
Emily: Right. Because we’re talking about hospitals, about healthcare, would you say that the content or the submissions are inordinately negative, depressing, sorrowful?
Danielle: That’s what I feared initially, but in fact that’s not the case. Many certainly are, but we also look for pieces that transcend the story per se so that even if it’s a story about illness or death that there’s something larger at hand and we find very skilled writers who can find the greater meaning that gives it more than just the sadness. You can be sad but also be uplifted, and sometimes laugh.
Finding poems and stories that do bring in humour and irony into sad situations is a real treasure because it gives us other ways to think about this.
Emily: Right. We know that in healing and in a relationship between a doctor and a patient, how we feel, our emotions, our attitude can have a big impact on our recovery or our overall health. Do you see an impact? Can you tell that your work with poetry is making a difference in the health of your patients?
Danielle: It’s difficult to say because I can’t do a controlled study within or without, but I get a sense from patients that when they feel connected to their doctors it’s easier for them to do their part. Certainly studies about empathy do show this, that patients of doctors who score higher on empathy scales have better control of their blood sugar and cholesterol, their cold is shorter, less depression.
It may be because these doctors are more observant or it may be that patients feel more reassured and more respected, and therefore can then do the things they need to do. So I’m hoping that this approach helps my patients. I don’t think it’s harming them, but I always keep my eyes alert in case it is. Maybe some people aren’t comfortable with this and I don’t want to push upon them things that aren’t what they would want to do.
Emily: Of course. You describe in your most recent book What Doctors Feel: How Emotions Affect the Practice of Medicine. You describe learning to play the cello. You still play the cello today, is that right?
Danielle: My lesson’s tomorrow.
Emily: Wow, that’s great. You describe having something that would give you that spirit of learning that you were missing once you began practicing outside of the academic realm and that sense of paying attention to details of practicing something that was going to lead to enhancement on a daily basis in a way that you could feel accomplished. Do you think that that kind of well-rounded life that you are achieving by playing the cello is in another way fed from the literary aspect of your work?
Danielle: I would hope so. I can’t say that everyone should be doing some art or music. I don’t think it’s harmful and I find personally, again, it gives me the chance for growth but it also gives me a certain amount of humility. It’s very humbling to play in front of a teacher and get critiqued and feel very small and feel very unskilled, but it again reminds me how my patients feel. They’ll come into the hospital without medical knowledge. They often feel very vulnerable and humble.
If I can hang onto that bit of feeling, it gives me a chance to remember how they might be feeling and pay a little bit of attention to that. So it’s a good reminder.
Emily: Right. Well that’s wonderful and I just think that’s such as really neat concept to have a literary review that comes out of a hospital institution. What a cool thing. The Bellevue Literary Review. You’re listening to Health Professional Radio. This is Emily and I’ve been speaking with Dr. Danielle Ofri, an Associate Professor of Medicine at NYU School of Medicine, a physician at Bellevue Hospital in New York City, editor-in-chief of the Bellevue Literary Review and author of four books, including her most recent What Doctors Feel: How Emotions Affect the Practice of Medicine.
Dr. Ofri, thank you so much for your insights today.
Danielle: Thank you.