In a recent session of Practicing Empathy: A
Reflective Writing Seminar, a second-year medical
student reads aloud an excerpt of his essay detailing his
aunt's fight with cancer, a battle she would
not win.
The story mentions how the student's family was
ill-equipped to deal with the loved one's illness,
and of their inability to talk about it openly.
Eric Bass, a professor in General Internal Medicine at
the School of Medicine and faculty
adviser for the Practicing Empathy seminar, said it's
moments like this in the workshop when he feels
obliged to comment.
"I told him what he is observing in his own family
situation happens to most families when
someone is diagnosed with cancer," Bass said. "I said it's
valuable as a physician to be sensitive to
those things and provide more support to the family in
those circumstances."
Bass said that the message applied to all 11 medical
students in the workshop seminar, an
elective portion of the School of Medicine's Patient,
Physician and Society course.
Practicing Empathy premiered in 2006 and was the
brainchild of Monique Tello, then a fellow in
General Internal Medicine. Tello knew of similar courses at
other medical schools, notably Yale, and
wanted to offer Johns Hopkins students a similar reflective
writing experience.
Tello asked Wayne Biddle, a visiting associate
professor in the Krieger School's Writing
Seminars, to lead the workshop, which he has done for
its first three years.
Biddle, who has been teaching courses in nonfiction at
Johns Hopkins since 1998, is the author
of four books of nonfiction, as well as hundreds of
articles that have appeared in American and
European newspapers and magazines. His reporting on the
"Star Wars" anti-missile system for The
New York Times won a Pulitzer Prize.
The workshop, offered each fall since 2006, has been
funded by a grant from the Osler Center
for Clinical Excellence at Johns Hopkins, an initiative
that seeks to train physicians in the basic
elements of a sound doctor-patient relationship.
The students meet once a week for a four-week period.
Each session lasts two hours.
They are required to bring with them to the first
session a 1,500-word essay involving a patient
care or personal medical experience. It can be about a
family member's illness, an experience at a
clinic or any medical-related situation that has had an
impact on them.
The students are encouraged to reflect on several
aspects of the experience. Each person's
story gets workshopped, and he or she is allowed to revise
it once before final submission.
When Tello finished her fellowship last year and took
a position at Harvard, she handed over
leadership of the course to Bass and Rachel Levine, an
assistant professor in General Internal
Medicine.
Biddle focuses on the writing, while Bass and Levine
try to bring out the clinical relevance and
insight contained in the stories.
Bass said that the sessions can get very emotional.
"[The students] probe more deeply into their thoughts
and feelings than they normally would,"
he said. "It gets very personal. I think the workshops
bring out a level of discussion that is quite rare
in medical training. The vast majority of what medical
students do is memorizing and mastering a huge
body of knowledge, and they have little time to talk about
the human side of health care."
The students come out of the workshop better equipped
to deal with patients, Bass said, and
know each other a little better.
They also leave as better writers, Biddle said.
"They have all been very good. In my 10 years teaching
in the Writing Seminars, these students
are some of my best," Biddle said. "They are smart, and
they have a subject; that makes all the
difference. That is why I'm so happy to be doing this and
to work with them."
One student's essay was published in the December 2007
edition of the Annals of Internal
Medicine journal. The story, written by Adrienne
Shapiro, was titled "An Uneasy Understanding" and
talked about her experience in an obstetrics clinic when a
doctor had to inform a couple that its
unborn child had a severe abnormality, a hole in the skull
through which part of the brain had
protruded.
She wrote: "All of a sudden, 'encephalocele' was no
longer a clinical term in a fat, dry text; it
meant saying 'your baby will probably die' to expectant
parents."
Shapiro's essay detailed the pain inherent in
delivering such devastating news, and how she was
able to learn from the experience. Her essay concluded:
"But to my patients yet to come, I will be able
to offer the benefits of what I was given in that room. The
costs of today will be repaid again and
again, when future sorrows are lessened by what I have
learned."
Bass said that having students come to these
all-too-human realizations makes the workshops
worthwhile, and are all the reason to keep the seminar
going into the foreseeable future.
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