It Gets Easier: The Examined Life Conference 2018, Day 3

On the last day of The Examined Life Conference, presenters and MDs challenged me to keep going and to keep improving.

In the morning, Dr. Ann Green and Dr. Edward Fristrom lead a workshop highlighting their work with pre-med students. Their work centers around listening and narrative skills. This seems essential, but it’s even more important when dealing with younger students who tend to save the world first and ask questions later.
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Thursday Review: “Integrating Narrative Medicine into Clinical Care”

This week’s review centers around a brief but meaningful summary of a 2016 pilot to integrate Narrative Medicine into medical students’ clinical rotations.

So far, most Thursday Reviews have tried to discover how the authors’ findings support and expand the use of storytelling in medicine. This week, I’d like to do something a little different. I’d like to work through the paper and ask questions along the way.
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Thursday Review: “Physician Views on Practicing Professionalism in the Corporate Age”

In a previous Thursday Review focusing on Burnout, Deborah Lathrop1 emphasized the necessity for healthcare providers to have a space to to address any pain from hidden grief. Lathrop’s discussion of disenfranchised grief is sensible, considering the changes in medicine in the last 30 years.

The question, then, once we know the importance of acknowledging and mourning the changes is, “What next?”

Writing in Qualitative Health Research, Brian Castellani and Delese Wear have published a summary of 50 physicians’ thoughts on how to practice medicine in “the corporate age”. Castellani and Wear try to match the professional experiences of real physicians, theoretical underpinnings, and practical advice for current and future physicians. Their work ties together ethics, storytelling, and even clarifies and expands some of Lathrop’s work.
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Thursday Review: “Teaching communication skills to clinical students”

In a section of the BMJ under the header How To Do It, Ian Christopher McManus, Charles A. Vincent, S. Thom, and Jane Kidd offer practical advice from their experiences teaching communications to students at St. Mary’s Hospital Medical School.

I’m certainly not running a medical school, but there are still some interesting, practical ideas to be gleaned from the authors’ experiences.
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Thursday Review: “Enabling Narrative Pedagogy: Listening in Nursing Education”

Writing in the journal Humanities, Wendy Bowles addresses the question, How do nurse educators who enable Narrative Pedagogy experience Listening: knowing and connecting?

This article discusses the education of nurses in light of the “Concernful Practices” framework for Narrative Pedagogy, and centers on its “Listening: knowing and connecting” element. Bowles specifically presents how “Listening as Dialog” is present in nurse educators who implement Narrative Pedagogy strategies. Bowles is specifically addressing one facet of one element of an academic classification aimed at one specific profession.

If that sounds like a niche presentation, you’d be right. Bowles work exists inside the discussion of a specific set of tools. After reading the paper, though, let me see if I can zoom out, and give a broader context for why I think some of the elements Bowles writes about are compelling.

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Thursday Review: “Nursing students’ socialisation into practical skills”

Mona Ewertsson, Sangeeta Bagga-Gupta, and Karin Blomberg noticed that there is precious little data available on how nurses move from the academic knowledge of their profession into its clinical practice. Much of the literature on socialisation in nursing has focused on describing negative experiences that shape the socialisation process, they write in Nurse Education in Practice.
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Thursday Review: “Physician Burnout and Patient-Physician Communication During Primary Care Encounters”

This November, the Thursday Reviews will be dedicated to some of the literature available on Resilience and Burnout. We’ll be examining how storytelling and narrative are essential to healthcare providers’ well-being.

Nov. 2 | Nov. 9 | Nov. 16 | Wed., Nov. 22 | Nov. 30

The Quiet Burnout Bombshell

One of the major ideas behind medical storytelling is that better physician-patient communication yields better results.1 Writing in the Journal of General Internal Medicine, Dr. Neda Ratanawongsa, Dr. Debra Roter, Dr. Mary Catherine Beach, Shivonne L. Laird, Susan M. Larson, Kathryn A. Carson, and Dr. Lisa A. Cooper make a completely rational assumption:

[W]e hypothesized that professional burnout would diminish physicians’ inclination or ability to engage in rapport-building with their patients during routine medical visits. As secondary outcomes, we hypothesized that higher levels of burnout would be associated with less positive affect by physicians and patients, less patient-centeredness, shorter visit lengths, greater verbal dominance by physicians, and more negative patient ratings of satisfaction, trust, and confidence in their physicians.

It’s a kind of quiet bombshell, then, that after a survey of physician and patient interactions, no differences were evident in the rapport-building behaviors of physicians relative to their burnout scores.
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Thursday Review: “Disenfranchised Grief and Physician Burnout”

This November, the Thursday Reviews will be dedicated to some of the literature available on Resilience and Burnout. We’ll be examining how storytelling and narrative are essential to healthcare providers’ well-being.

Nov. 2 | Nov. 9 | Nov. 16 | Wed., Nov. 22 | Nov. 30

Grief for Patients and for Physicians

It’s easy enough to agree that grief is a part of a physician’s work. It goes without saying that a profession dealing with life and death has to come to terms with the loss of a patient. When I first picked up Dr. Deborah Lathrop’s article, I expected her discussion to revolve around how that kind of grief — the loss of a patient — can lead to physician burnout. Lathrop, however, widens the scope of the idea of grief to include not just the loss of life, but a loss of how a physician understands their role and the practice of medicine.
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Thursday Review: “Physician Burnout: Coaching a Way Out”

This November, the Thursday Reviews will be dedicated to some of the literature available on Resilience and Burnout. We’ll be examining how storytelling and narrative are essential to healthcare providers’ well-being.

Nov. 2 | Nov. 9 | Nov. 16 | Wed., Nov. 22 | Nov. 30

“What’s my motivation?”

It’s a simple questions at the heart of examining our own behavior. So much so, that it’s cliché to imagine a fussy actor hassling their director for an answer.

Building on Maslach’s work1, 2 (mentioned previously) Gail Gazelle, Jane M. Liebschutz, and Helen Riess discuss coaching. Professional coaching is widely used in other sectors, and is finding its way into the medical profession.
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The Examined Life Conference 2017

The Examined Life Conference is a gathering for the medical humanities hosted by The University of Iowa’s Carver College of Medicine. The conference is focused mainly on the intersection of writing and medicine, and is cross-pollinated with the literary chops of organizations like The Iowa Writers’ Workshop and The Iowa Review.

Dr. David Thoele, the Director of Narrative Medicine at Advocate Children’s Hospital, has been going for years. He introduced me to the conference, and convinced me to submit a workshop.

Now that the conference is behind us, here are some thoughts as I reflect on what I took away:
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