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Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy
■ Clinical Practice Management
■ Training & Education ■ Leadership

Creativity: The Radiologist as Author

The only thing that separates a story from paper or computer screen is one's right or left hand.

Every physician is a writer, a storyteller. It's true. Whether you are writing in the patient's health record — translating a patient's health or illness "story" for that office visit and adding additional information (such as lab tests) to enrich the story --or you are creating a narrative to accompany a CT scan(suspecting aspiration when you see endoluminal opacities in lower lobe airways in a patient with altered mental status), you must tap into not only a deep well of knowledge and experience, but also access your mind's creativity to paint a full picture of what you are confronted with.

I believe that radiologists are particularly creative physicians, natural (made, if not born) storytellers. Why? Look at a chest radiograph when you've been given no other information than "cough," "pain," or, one of my personal favorites, "intubated." In spite of a paucity of clinical information, you can probably craft a reasonably robust report discussing artifacts, pulmonary opacities, cardiomediastinal contours, the thoracic spine, and equipment position (or malposition).

Don't buy into the self-defeating creativity mythology that one must be born a creative person, that you cannot deliberately cultivate creativity. There's a saying that, "A picture is worth a thousand words." I doubt you would provide a 1000-word dictated report for a chest radiograph. (If you did, no one would read it.) However, here's an interesting exercise: take that same chest radiograph and now write a 1000-word story based on what you see. You know you can do it. And once you've finished, take another diagnostic image and craft a story to go with that one. It's that easy.

Question: Where do you get your ideas?
Arthur Miller: I wish I knew. I'd go there more often.

The pages of medical journals are heavy with original research articles that must meet expected standards of content and form. In that sense, although the research itself may be based on creative ideas, the classic communication of research results in scholarly journals doesn't appear particularly creative. But in the era of social media, there are newer forms of writing that stand alone or can complement and support expository and technical writing. Look no further that this blog, which offers a different perspective on JACR subject matter in both structure and style. There's even "very short-form" writing know as tweets, which can really test an one's creativity in communicating maximum information using 140 (or less) text characters, sometimes combined with emojis and/or media. Twitter is to journal articles (sort of) what haiku is to poetry, with the added purposes of short-term broadcasting one's thoughts to (sometimes) lead readers to a longer written piece (like a journal article) and long-term continued engagement with the subject matter in a variety of forms and from varied sources.

Here is a lengthy, though certainly incomplete, list of physicians who are authors. Some are fiction writers, others non-fiction writers. Some write about health care topics and experiences, others include the subject of medicine infrequently or only peripherally. Some continue to practice medicine and, for them, writing may serve to enhance their abilities as healers. Other authors have left the practice of medicine entirely. And contemporary authors also interact with readers via social media (e.g. @Atul_Gawande and @cuttingforstone). Here are just a few examples you may recognize:

Atul Gawande's book, "Being Mortal: Medicine and What Matters in the End," formed the basis of a powerful and moving 2015 PBS Frontline documentary about end-of-life choices and the terminally ill.

A major theme in Abraham Verghese's book, "Cutting for Stone," is physician empathy for patients. Question: What treatment in an emergency is administered by ear? Answer: Words of comfort. No wonder this book was one of five on President Barack Obama's 2011 summer vacation reading list.

Neurologist Oliver Sacks wrote about patients he cared for, such as in the collection of stories, "The Man Who Mistook His Wife for a Hat."

Robin Cook writes novels that deal with hot medical issues (anyone interested in artificial intelligenct (AI) in medicine, read "Cell"); Tess Gerritsen writes medical thrillers, and Michael Crichton is well known for "Jurassic Park" and the TV series "ER."

"The Emperor of All Maladies: A Biography of Cancer" won the 2011 Pulitzer Prize for General Non-Fiction and was written by oncologist Siddhartha Mukherjee.

William Carlos Williams, awarded the Pulitzer Prize posthumously, was a contemporary of Robert Frost, and a key figure in the imagism movement in poetry. I've shared some of my own haiku (not poet laureate material) on this blog before along with an excerpt of one of my favorite William Carlos Williams poems because I believe that writing poetry is a healthy means of coping with professional (and personal) stress.

Jodi Picoult is not a physician, but she spoke to many health care professionals during her research for "My Sister's Keeper," which is about a young teen whose parents expect to her to donate a kidney her dying sister , but who instead sues her parents to become an emancipated minor. Picoult has this to say about writing:

"I don't believe in writer's block. It's easier to edit a bad page than a blank page."

If you want to write, just write. If you do that, you are a writer, a physician writer. It's that simple. QED


Want to engage in a wee bit of writing, just dip a toe in the water so to speak? Participate in the JACR tweet chat on Thursday, October 27, 2016 at 12 noon (Eastern Time). Just remember to include #JACR in your tweets. Not interested in tweeting this time? You can still "listen". Just type #JACR in the Twitter search field and follow along. Here are the three questions we'll be discussing:

T1: Between patient care, teaching residents and fellows, and participating in scholarly activities, where do I find the time to write? 

T2: For authors: Can you describe when and how you got into creative writing and the successes and challenges you have experience? 

T3: What are the benefits of creative writing to self-improvement as individuals and physicians?

Join this month's tweetchat moderator Dr. Bruce J. Hillman, MD, editor-in-chief of JACR, who is also a twice-published book author. His previous book, co-authored with Dr. Birgit Ertl-Wagner and Bernd C. Wagner, is entitled "The Man Who Stalked Einstein: How Nazi Scientist Philipp Lenard Changed the Course of History", a gripping story of the tense professional rivalry between physicists Albert Einstein and Philipp Lenard layered with the history of the rise of Hitler and anti-Semitism in the interwar years of the early 20th century. His new book, entitled "A Plague on All Our Houses: Medical Intrigue, Hollywood, and the Discovery of AIDS", examines the highs (embraced by celebrities) and lows (shunned by his home institution) of the career of immunologist Michael Gottlieb and how he persevered.


Diagnosis: Interpretus Interruptus
Your Relative’s Value Unit

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