EP. 133: THE CRAFT OF MEDICAL STORYTELLING

WITH ANNA REISMAN

Oct 10

WITH ANNA REISMAN, MD

The director of the medical humanities program at Yale Medicine shares how creative writing sharpens the minds of clinicians and how she teaches storytelling to capture the most beautiful devastating, and meaningful moments in medicine.

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Episode Summary

Medicine is filled with stories that illustrate the most beautiful, devastating, hopeful, and consequential moments of life. But how do we capture these moments and transform them into everlasting lessons that guide us on our search for meaning? That's where the art of storytelling comes in.

Our guest on this episode is Anna Reisman, MD, director of the Program for Humanities in Medicine at the Yale School of Medicine. Dr. Reisman is not only a physician-writer whose essays have appeared in The Atlantic, The New York Times, and other major outlets. She has also dedicated her career to helping clinicians better reflect and write about their experiences.

Over the course of our conversation, we discuss how Dr. Reisman went from being an English major in college to working as a physician, her own experiences with burnout and what helped her overcome it, her approach to creative nonfiction writing, concrete ways that writing sharpens the mind of the physician, and more.

Anna Reisman, MD is an associate professor of medicine at Yale School of Medicine and serves as the director of the Program for Humanities in Medicine and the Yale Internal Medicine Residency Writers’ Workshop.
Dr. Reisman’s path to medicine was unconventional. Initially an English major at Yale, she became interested in medicine after reading Thomas Mann’s The Magic Mountain, which spurred her fascination with the human condition and disease. Following her undergraduate studies, she completed a post-baccalaureate program at Columbia before attending NYU School of Medicine. Her clinical training included residency at NYU Medical Center and Bellevue Hospital, where she also served as chief resident.
Dr. Reisman is also a prolific writer, contributing to publications like The New York Times, The Atlantic, and The New England Journal of Medicine. Her work often explores the intersections of compassion, narrative, and medical practice, as well as the personal challenges of being a physician
In this episode, you will hear about:
• 2:00 - Dr. Reisman’s path from English major to physician
• 3:45 - The scope of Dr. Reisman’s current work
• 8:22 - How Dr. Reisman became involved in medical humanities and how she created a writer workshop at Yale Medicine
• 14:19 - How writing and the medical profession goes hand in hand
• 22:49 - The VA Writes reflective writing group
• 27:56 - Teaching observational skills to medical students in today’s technology-forward landscape
• 30:25 - How to approach the writing process if you are new to writing
• 45:57 - What Dr. Reisman wishes she would have known at the beginning of her career
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and healthcare executives those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Tyler Johnson: [00:01:02] Anyone who has listened to our show will know that medicine is filled with stories that illustrate the most beautiful, devastating, hopeful and consequential moments of life. But how do we capture these moments? How do we transform them into everlasting lessons that guide us on our search for meaning? That's where the art of storytelling comes in. Our guest on this episode is Dr. Anna Reisman, director of the program for Humanities in Medicine at the Yale School of Medicine. Dr. Reisman is not only a physician writer whose essays have appeared in The Atlantic, The New York Times, and other major outlets. She has also dedicated her career to helping clinicians better reflect and write about their experiences. Over the course of our conversation, we discuss how Dr. Reisman went from being an English major in college to working as a physician, her own experiences with burnout, and what helped her overcome it. Her approach to creative nonfiction writing, concrete ways that writing sharpens the mind of the physician, and more.
Tyler Johnson: [00:02:11] As an aside, I'm delighted to be able to do this interview in person today. Earlier this morning, I delivered a Grand Rounds talk here at Yale Medicine about the lessons we've learned from the podcast. And now I'm here with Anna next to the beautiful Yale Medical School library. Anna, thank you for taking the time to join us and welcome to the show.
Dr. Anna Reisman: [00:02:35] Thank you so much.
Tyler Johnson: [00:02:36] So we pretty much have everybody start with kind of their origin story, and we would love to hear. How is it that you ended up in medicine. How did you become a doctor?
Dr. Anna Reisman: [00:02:45] So I was an English major. Medicine was not on my radar at all. No doctors in the family other than one great uncle read The Magic Mountain the summer before senior year for my dad's suggestion, and kind of it kind of opened up my eyes to this other world of science and medicine and the history of medicine and tuberculosis. And it took me all summer to read, but it kind of just made me interested in this whole world that I had been ignoring. And so after college, I did a post-bacc and worked in some sciencey jobs, and I just started thinking about medicine because that seemed like a good career option. But actually, once I started thinking about it, I realized, hey, this is actually appealing and I can learn more about sciencey things and also work with people and and do good and all of the clichés, but they're true. So here we are.
Tyler Johnson: [00:03:46] So we'll get to some of the some of your more directly humanities related work in a minute. But for now, can you just tell us what do you do in your clinical work?
Dr. Anna Reisman: [00:03:58] So I trained in primary care internal medicine, and I have been seeing patients at the VA in Connecticut for more than two decades in primary care. And then I took a break from that and did house calls. The VA has a program called Home Based Primary Care, which I did for about four and a half years. And now I'm just there one day a week. And I work with an interdisciplinary team that includes nurse practitioners who are doing a residency, and I do a lot of precepting, and I see patients.
Tyler Johnson: [00:04:31] And talk to us a little bit about, I think you we have had a couple of physicians on the show who have very briefly mentioned doing some kind of specific house calls with some of their patients in particular circumstances, like, I think we had a medical oncologist once who talked about having visited a couple of his patients in their homes and whatnot. But as someone who actually had that as a principal part of your job for a time. What was that like, and how does that change the tenor of a doctoring visit to be visiting people in their homes?
Dr. Anna Reisman: [00:05:03] So I had been in just regular hour after hour, day after day primary care practice for about nine years at the VA, and I did start to get a little bit burned out. I had always thought house calls would be pretty cool, and it turned out there was an opportunity and it was way beyond cool. Um, for so many reasons. You know, the most concrete, just having time, just sitting in the car and driving into different neighborhoods and different towns that I had no familiarity with, and suddenly getting this sense that of like seeing, seeing things through my patient's eyes in a certain way, and then of course, being in their homes, being welcomed into their homes mostly. Um, I had a couple of patients who I kind of took with me from primary care. My primary care practice. And I went to their homes and apartments to see them because I thought they would benefit from that, and it was truly eye opening and literally like walking into somebody's social history and seeing everything right, seeing their either their lack of a mess or their mess or their collection of blue glass or the pill bottles in the medicine cabinet, but also in the kitchen cabinet and on the table and under the couch, and the feeling of what, whether they felt safe going out of their apartment to take a walk or not. And if I was telling them, go take a walk and they couldn't go because it was an unsafe area, or there was a step and it was just impossible to actually get out of their house, which is why so many of them were actually homebound. It made me grateful to have had the opportunity to do that, and going back to not doing home visits and seeing people in in person in the clinic, I think it just gave me an insight that this is not the whole story, what I'm seeing of somebody and what they're telling me.
Tyler Johnson: [00:06:52] One of our very first guests on the program was Abraham Verghese. And he made the argument that because I will confess that for me, seeing patients on video visits for clinic is just not something I like very much. You know, I feel like I spend the day taking care of ghosts or something. But he made the argument that one of the things that he actually really likes about video visits is that you get at least a little bit of a window, right? Even if all you see is the backdrop or the people who are coming into and out of the frame or whatever, but there's a little bit of a at least a suggestion, right? And I think I will grant him that. I mean, I have definitely noticed that I have some of some of my more organized patients definitely have their like favorite backdrop. Right. That's who knows, maybe their entire house looks like this. But in any case, their one bookcase looks really beautifully arranged when they're on the, you know, the zoom meeting or whatever. But yeah, I can only imagine that actually going into a person's home, like I've done that a very few times as a medical oncologist, but it is. It just gives you a completely different flavor for who the person is and what their life is like.
Dr. Anna Reisman: [00:07:57] Yeah, and it really also kind of shifts the typical power differential because you're on their turf. And so you they want to take care of you. They want to offer you a cup of tea and have you sit down and put your feet up and, and show you around. And it's just it's just really nice. When I would see people at home, I felt like I was really seeing them, as opposed to seeing somebody in the office, you know, in an empty clinic room and dwarfed by the fluorescent lights. Right.
Tyler Johnson: [00:08:22] And also, you know, to some degree, I think most patients, when they come to the hospital, they bring to the to the clinic or whatever the version of themselves that they want to bring to the doctor. Right. Which is just a different thing than seeing someone in their home. So let me ask you then, one of the things that's very distinctive about your career, right, is that although you have had and continue to have a clinical practice, you also have carved out this very significant niche in the medical humanities. Now, you already mentioned that you're an English major. We do seem to have a proclivity on this show for finding all. Not all, but many doctors who were English majors, philosophy majors, religious studies majors, what have you. So we know that you already had this, you know, some of this bent even before you came to medical school. But how did your path turn in such a way that it took you towards having this much more formalized place in terms of doing so much with the humanities in medicine?
Dr. Anna Reisman: [00:09:18] I've always written through my training and kept a journal and encouraged my trainees to to keep journals and write things down and kind of capture that what they're going through at the time, and publishing a little bit of poetry and a couple of essays. And then in the early 2000, I think in 2003, maybe I just happened to hear from one of the residents in clinic that an email had gone out saying, you mentioned Abraham Verghese. I'm going to mention him again, that Abraham Verghese was coming to Yale to teach a writer's workshop, and my heart started pounding. It was very, very exciting. And so and I was at that time, I was really based at the VA and didn't, didn't know many of the people in my department just because I didn't spend time over, over here at the medical school and the medical campus. And so I found out who was putting it together. I showed up at his office, Doctor Asghar Rastegar, and said, I need to be involved with this. Please, please let me be involved with this in some way. And so he he allowed that to happen. And I was there as kind of at this first writer's workshop. I was there as kind of an observer, along with Helena Hansen, who was then a PhD student in MD, PhD in anthropology.
Dr. Anna Reisman: [00:10:32] The two of us kind of just observed and took notes, and we did not participate. And then we wrote wrote up a paper based on our observations and some focus groups. But after that, that that was supposed to be a one off because he wasn't going to come back every year, but I was so excited about it and about the possibilities and just saw the level of interest that I basically just said, can we keep this going? Can we try it again? And we tried it again and here we are 20 years later. We just celebrated our 20th year. So that is how the the writing workshop portion got started and kept going. And I have to say, there were some years when it was suggested maybe it's not going to work. People weren't signing up. I reached out to residents I knew. I said, don't you want to do this? This is really fun. But now, now we always we always fill. So it's kind of taken root over all this time. And then in terms of the running the medical humanities program that I enjoyed going to the talks for many years. And, and then it just happened that the person who was running the program, doctor Tom Duffy, was ready to retire. And so it was just kind of the timing was right.
Tyler Johnson: [00:11:44] So I think it might be helpful to people who are not, who maybe have not been in this world to know what is a writer's workshop like. What does that mean? If someone were to sign up for something like that, what does it entail?
Dr. Anna Reisman: [00:11:57] Good question. Because people you're right, people don't know what that means. And it can mean a lot of different things. The writer's workshop that I'm talking about and that I've described is focused on personal essays for the most part, although some people, some residents choose to write short fiction, but it's a it's a workshop that's focused on the craft of writing. So learning how to write, learning how to craft good sentences and how to improve the structure and how to write succinctly and all of that for many residents with with the goal of publication. And so it's really it's a true writer's workshop. And in fact, Abraham Verghese again, when he did that very that the initial one, he he talked about something called the fictional dream, which he had told us he had learned at the Iowa Writers Workshop. And that's become something that we've incorporated, which is you know, now I have to describe it because I mentioned it. When you have a piece of writing and that you're reading a piece of writing. Does it sweep you away? Does it kind of get you out of your out of the world and the day to day life that you're experiencing all around you? And does it kind of create a movie that that just fills your attention, that demands your attention? Or is there a point in that where you're in that kind of happy fictional movie dream like state, and then something snaps you out of it? Maybe a mixed metaphor or a dialog, a line of dialog that sounds clunky or structure that just seems wrong.
Dr. Anna Reisman: [00:13:22] And so those kinds of things can be really useful for writers to say to each other, you know, I was in the fictional dream until this point because it's often something you don't necessarily sense yourself as a writer. So anyway, so that's the writer's workshop. I also teach op ed writing workshops to different groups of people and and trainees. And so op editors are really very different. There is craft involved, but it's much more there's kind of an almost an algorithm. There's a format, a structure for writing an op ed. So we teach that and then there's reflective writing. And reflective writing is not writing for publication, at least not. That's not the point of it at the beginning, but it's an opportunity for people to often reflect on a prompt and just kind of write stream of consciousness type writing and just pour out feelings on a page. It's almost like writing in a diary or in a journal.
Tyler Johnson: [00:14:19] So let me ask you a sort of a meta question then. Or well, before I ask you why I should ask you, do you think, I mean, an argument can be made that it's, you know, good for everybody to write, right? I think there are I think there are probably uses for writing for everyone. But what about medicine, do you think makes writing as a medical professional or as a doctor, especially important. And also, do you think that there might be things about being a doctor that would equip people to do very well in writing? Like, is there a symbiotic relationship between the two things, and if so, what do you think that looks like?
Dr. Anna Reisman: [00:15:00] Well, first, you know, most obviously the content is is just so interesting in so many ways, right? Medicine can be a puzzle. It can be a diagnostic dilemma. It can be like my colleague Lisa Sanders, kind of a Sherlock Holmes approach. That kind of thinking is always of interest to people. But also, you know, the the human side and the emotional side. And we spend a day in clinic or in an office in the hospital, and we just we have the opportunity and this privilege to experience, along with our patients these like this crazy range of, of emotions. Um, and So it's kind of a gift to be in this profession where you can see people going through all kinds of shit, to use the technical term.
Tyler Johnson: [00:15:50] That comes out of the writer's workshop, that's another one of your technical technical reference points.
Dr. Anna Reisman: [00:15:57] So yeah. And then I mean, I think also it's just like I said earlier regarding keeping a journal, I think that there's it can be especially early. I think it can be so overwhelming to have all of these experiences and emotions flying around and people's going through all kinds of stuff in their lives that you don't have time to process it. Yeah, in the moment you can't, you can't, you can't say, I'm going to just take a moment and reflect on, you know, this this poor guy just got this terrible diagnosis, and now I need to step out and immediately go to something else, or somebody died, and you need to go to something else. And I mean, for me, I just found that if I just wrote it down, even when I got home that evening or morning, whatever it was, and just wrote down what I could remember of these, these moments, they were just down. And then I could go back to them and reflect on them later if I wanted to, but at least they were there and kind of captured my mindset at the moment. So I think writing as a reflective practice in medicine, at least for me and for many of the people that I've worked with and have taught, has been a critical aspect of it.
Tyler Johnson: [00:17:02] Yeah. You know, I hearing you say that brings to mind a number of different things for me, I think. So when I attend on the inpatient cancer service at Stanford, one of the things that is so strange about doing that, so, you know, these are the cancer patients who are sick enough to need to be in the hospital. And so usually, almost by definition, they are among the sickest patients in the hospital. And whereas on a normal medicine service, it would be very unusual to see someone die while you're on service. On the cancer service. It happens with some frequency, like it would be the exception, not the rule. If I went through two weeks on the inpatient medicine service and did not see a person die, right? Yeah, but one of the things that has sort of grown distressing to me, honestly, is that when I was a very sort of a brand new attending, it was very intuitive to me that when that happened, we needed to stop everything as a team. Right. Because I work with a whole team of of, you know, residents and interns and whatever that we would need to stop as a team. Mark, what had happened, have some space for recognition of the meaning of the person's life and the meaning of their passing. And then, you know, depending on the circumstances, for example, if it was a person that the team had known and taken care of for a long time, maybe even have a discussion about what their death meant.
Tyler Johnson: [00:18:29] And et cetera, et cetera. But the thing that has been distressing to me over time is to recognize that now I have. I guess become the the more neutral word would be accustomed and the more negative word would be calloused. That sometimes it just happens. And it really is like like I've already started on the next task before I. And then I have to like there have been multiple times recently where I've had to be like, it's like I'm two minutes into the next thing, and then it's like, wait, wait, wait, like someone died and we haven't even talked about it. We haven't even had a moment. Right. And and so all of that is to say that I think if nothing else came from writing, one of the reasons that it is important as a doctor to write, it's an embodied way of witnessing what has happened. Right? It is to stop the flow of time for a minute and to say a thing has happened that is worth being observed. And that strikes me as powerful and important. The other thing that I was thinking while you were talking is that I also feel like there is a sense in which, not that all doctors do this, but, you know, you mentioned a moment ago Lisa Sanders and the idea of sort of, you know, Sherlock Holmes as a doctor.
Tyler Johnson: [00:19:56] I think that, you know, this is arguably less true, or at least less necessarily true in the era of CT scans and MRIs. And, you know, every lab test in the universe that gets done in the emergency department. But there was a time when being the, you know, because the the famous thing like if you've watched the the most recent, I think it was a PBS version of Sherlock Holmes with Benedict Cumberbatch that came out a few years ago. Right? They had this very like, stylized way of Benedict Cumberbatch, who was Sherlock would walk into a room and then it would, like show in these kind of funky, this funky way of like highlighting the things that he was noticing from across the room. And then he would, like, put the clues together and say, oh, because of the way that the tread of the shoe is worn this way and they have this particular lint on their pants, then, you know, whatever. And then that was how he would, like, crack the case. But all of that is to say that I think there is at least this ideal of a doctor as the most observant person, right? Like they're supposed to go into the person's room.
Tyler Johnson: [00:20:56] And actually, I don't know how we've ended up talking about Doctor Verghese so much, but I know when I was a chief resident, he used to make rounds with us, and one of the things that he would do is he would ask us to choose a patient, not to tell him anything about the patient. And then we would go to the patient's room and Doctor Verghese would go in and without asking any questions about the patient's history or looking into anything, he would just chat with the patient for a minute, and then we would come out of the patient's room and he would go through and tell us what he thought the patient's medical problems were. And it was, frankly, pretty astonishing how well he could do that. And I think, you know, partly obviously, he's world famous for his emphasis on the physical exam and the importance of human touch and whatever. And partly he is a very experienced physician who, you know, came up in a somewhat different era, I think, in terms of, you know, other kinds of diagnostics. But all that is to say that I think that if doctors can cultivate that kind of purposeful presence and purposeful space for observation, that I think also can equip people in a really special way to be able to write well.
Dr. Anna Reisman: [00:22:05] Yeah, I agree. The better we are at observing and mentally collecting data before we make an interpretation and not and resisting the urge to just go with what's in the medical record already. I think that's that's a good thing. It doesn't always happen. I think we certainly it's easy to just fall into reading the note from the patient you're about to see and just kind of accepting all of it as true. And then it's always a surprise. I mean, it's so often when I'm seeing patients in urgent visits, I read, I go back and read a couple of notes, and then I walk in and have this whole image in my head, and then I walk in, and the image that I got from what I read is totally different from what I'm experiencing. So yeah, with a grain of salt.
Dr. Anna Reisman: [00:22:49] I also wanted to just say that, um, I know this is this podcast is on focused on the doctor, but I wanted to tell you about something that I do at the VA with a much more broader group focused on reflective writing. And and so this is a program that is now it was originally called pending the pandemic. And then we've changed the name to VA Writes because we don't want to keep talking about them because we're a little less pandemic right now, although who knows. So it started when we started out, my colleague Pauline Chen. Pauline Chen Halsey, who is in Boston and who wrote the book Final Exam about, um, how medical students deal with and are taught to deal with death that I don't remember when it came out. It's been a while, but. So she and I, we wanted to come up with something during the pandemic to that made use of our writing skills.
Dr. Anna Reisman: [00:23:41] And so we put together a workshop, reflective writing workshop. So again, so reflective writing, meaning not the craft of writing, not writing for publication. So what we do is we we have some sort of either a poem or a piece of art or an excerpt of a story or an article. The group reads it. This is all virtual still, and the group reads it, talks about it, and then there's some sort of prompt. People write and then they share. And what is unique about this group is that it is made up of it is specifically open to clinical and non-clinical staff at the VA. Mm. So the only requirement is that you work at, at one of the VA's and now it's actually national. So anybody at any VA can sign up and just be there, fully present, listening to people responding and occasionally sharing what you write. But I have to say that, you know, we started it thinking that it was pandemic era. So it was for people, clinical people who were dealing with all of the stress related to caring for people with Covid and dealing with it in their own lives. But it became clear that it was it's not only clinical people, everybody was dealing with it and that. But even after after Covid, people like we're all people. Like everybody has things to to, to share and to think about and to reflect on. And so it's been it's really enriched the whole process and the whole group to have this broad swath of of people. We don't ask people what they do at the VA. So there are all kinds of, you know, 50 different professions, and it's just really cool. We're all just kind of human beings sharing our stories.
Tyler Johnson: [00:25:28] Yeah You know, it's really interesting because I read this article recently in The Atlantic that, you know, every once in a while you stumble on an article, at least I do, where I read about something and I think, oh my gosh, I never even considered the fact that that was like a thing to be thought about. And this article was all about the like, construction, function and purpose of a street. And, you know, I mean, I, you know, I just streets are what cars drive on, right? I mean, what else is there to say about that? But what this article talked about was that although now that is largely true for many, many years, not only was that not true sort of tacitly or by default, but it was very actively made to not be true. So that there were I don't remember all the details, but in effect there were sort of both by like custom and sort of by zoning laws. It was just understood that streets are not principally for driving cars on streets are for living, right? Like streets are for sort of. They are the space in not just in front of, but between houses. They're like a connective tissue between the homes. And so what would happen is because a lot of streets were either just so inconvenient to most cars that cars would never be there or were sometimes actually shut off from cars.
Tyler Johnson: [00:26:46] Being able to drive their streets became these sort of communitarian spaces where people would go out and in effect, tell their stories. But now that almost never. I mean, maybe if you live in some particular very suburban or rural or whatever place, but but for the most part, now streets are about getting somewhere, right? They are. They are a means of efficiency. They're a means of arriving somewhere else. And they are almost never about what's going on there at that place. And, you know, some people would argue that, you know, maybe there is some sort of virtual commons social media that has replaced that. But I think especially as social media evolves further and further and is more sort of ruled by algorithms. All of that is to say that I feel like that space for sharing stories meaningfully. And even if social media did somehow do that, it's still not the same as being physically embodied with other people and seeing them tell or hearing them tell the story and seeing their reactions. When I tell the story right, I feel like that writing in a group like that is a beautiful means of trying to recapture some of that magic.
Dr. Anna Reisman: [00:27:55] That's fascinating.
Tyler Johnson: [00:27:56] But but let me ask you a question that goes along with that, because I do worry about this. I have to say, you know, to put it mildly, the cultural milieu in which medicine happens now is dramatically different from even ten, let alone 20 or 30 years ago. Right. And we see that in multiple ways. Much has been written about the fact that medical students often now and, you know, residents, whatever spend much more time in front of computer screens than they spend in front of actual patients. Much of the diagnostic acumen that previously was the only way of getting to a diagnosis, I think many people would argue, has been in many ways almost supplanted by a whole, you know, array of diagnostic tests. And it's also the case that, you know, now, many visits actually happen over video so that you're not even in the same physical space as the patient that you're interviewing. So all of that is to say, given all of those factors that seem to be making it a steeper and steeper uphill climb, how do you try to still teach medical students and other trainees to continue being the observant kind of doctor that once upon a time they needed to be to do their job, but which now may seem more like a sort of a almost an ancillary function. If you're just going to order a CT scan anyway or whatever.
Dr. Anna Reisman: [00:29:26] Yeah, it's definitely a challenge as as you have aptly described. I guess I would say when I can tell that they have a connection with a particular patient, when they are kind of delighted to see them, even if they are, you know, not maybe it's not an easy situation, or maybe it doesn't always go smoothly, but they're still delighted to see them because they have that connection and they pay attention to details. And I can just tell how much they care, right, about the things in their in their actual lives that are not, quote, typical medical issues or social issues. I mean, personally, I just encourage that and I give them feedback on how great that is or if they're really if I see somebody, if I observe somebody with a patient and I just see great rapport, I give I give a lot of feedback on the stuff that I think they don't get enough feedback on because I want to encourage it.
Tyler Johnson: [00:30:19] Sure.
Dr. Anna Reisman: [00:30:20] And it's not like you ordered the CT scan. Really well.
Tyler Johnson: [00:30:25] Right. Yeah. That that is, that seems to there's less of an art to ordering CT scans. Right. Than, than the other stuff. Yeah. Let me ask you this question. If if there were a person out there who was listening and thought to themselves, you know what, I feel like I could have great writing inside of me, but I don't, you know, live in near New Haven. I can't I don't have a writer's workshop to go to and I don't really know, like, how do I start building those muscles? What do you think that a person who is not yet a writer, or at least doesn't see themselves as a writer, but feels like they might be able to become one? What can they do? Let's start with the person, let's say, who's in training and is kind of living in the hospital right there, right in the thick of internship or something, let's say, what could a person in that kind of situation do to try to cultivate within themselves the kinds of habits that might eventually lead them to becoming a good writer.
Dr. Anna Reisman: [00:31:26] When you're in training and you're just surrounded by the maelstrom of stuff going on, I think a big part of it is being aware and being open to thinking, oh, whatever is going on there is pissing me off and it doesn't seem right. So let me jot that down and maybe I can think about that later. Or there's a particular emotional moment that went well or didn't go well, or it feels like it. I think I think often it's, it's the, the moments that where you feel unsatisfied, something didn't go as well as it should have, or something just doesn't feel right. This shouldn't be happening to that person. It's not fair. It doesn't. This is not equitable, whatever it is. Things that don't sit well, I think those are the kinds of things, especially that people can think about jotting down in a little notebook or sending an email to themselves when they have like a spare second, just to kind of remember the, you know, even if it's a few words, that'll work. Sure. Don't we all carry around little scraps of paper with a few words of things we want to remember? So I think just kind of keeping keeping in your mind kind of open and aware for situations that that offer those unpleasant, the difficult, the, the challenging moments are the ones that I think are the richest to write about. Because those in the process of writing when when this person does have time, you. I mean, for me, I learned through writing and trying to unpack a situation. That's how I kind of figure out what I think about something.
Tyler Johnson: [00:33:01] And I should just say, for you, dear listener, who is not sitting in the room, this is the rare instance when I'm actually sitting in the room with the person that I'm talking with. There are literally four notebooks, or maybe some of them are actual books, I don't know, but they look like four kind of Moleskine notebooks sitting in front of Doctor Reisman. So for whatever that's worth, I'm just saying.
Dr. Anna Reisman: [00:33:20] And I will add also, my phone is also sitting here and it has the handy Voice Memos function. And it's fun to kind of just dictate tiny little bits of things to yourself. Also, I have a ton of those in my phone. It's so it's great. And then when you're sitting, when you finally find yourself with time and you're like, what am I going to write about? I don't know what to write about. You go to your phone, go to your voice memos and listen to some of those things. And I'm sure that there's all kinds of good stuff.
Tyler Johnson: [00:33:51] And the other thing I will actually say, this will sound a little bit weird. And now I'm I don't usually get into my own. I don't think of it as craft, but I guess when I do some of my own writing, what I have learned recently is that actually, and I promise I have no Apple stock or anything else but the Apple voice to text function in the last, just in the last six months. I don't know if there are the beginnings of AI inside of it or whatever, but it has become Astonishingly good. It's not quite perfect, but I would say that I tried it a couple of years ago and the accuracy was maybe in the 90% range, but 90% might as well be 2%, because there are so many mistakes that it takes longer to like, go back and fix the mistakes than to just, you know, type it out. But now I would say it's like, especially if you, you know, are in a relatively quiet place or can have the mic close to your mouth, it's more like 98%. So the errors are rare, which is just to say. So sometimes. Now, like if I have an idea for a thing that I want to write and it's in my brain, I will sometimes dictate voice to text in, like just the notes function in on an iPhone, like in the car or whatever.
Tyler Johnson: [00:35:01] And it's very efficient. And like you say, it just it is a crystallization of whatever happens to be in your mind in the moment. Okay, okay. But so now I want you to pretend for a moment for those of our listeners who may never get to go to a writing workshop, let's say that someone does that. Let's say that they they're going through residency, for example, and whether it's by carrying around a little notebook or whether it's the voice app, voice memo app on their phone or whatever it is, they jot down a bunch of thoughts. And now maybe they're a third year resident, and the pace of things has slowed down a little bit. And they have a little bit of discretionary time. And they look back through that collection of moments and they think, oh, this particular one would be perfect. Like, I feel like there's something here to be written. And so now they are sitting at their desk with the laptop open in front of them, a thing that they feel like is worth writing about, and they have no idea where to go from there. Where should they go?
Dr. Anna Reisman: [00:35:59] They should put their fingers on the keys and start typing. And stop obsessing about how what is the right way to start. And this opening isn't working. Just like start writing, and getting a first draft down is the hardest part, but it doesn't have to be hard if you just kind of like allow the stream of consciousness, then you go back and then you start revising and figuring out where to start. But the chances that you that you are going to keep your opening of your first draft as the opening of whatever it turns into is very low. So.
Tyler Johnson: [00:36:35] So you think you should just jump in and just start typing something.
Dr. Anna Reisman: [00:36:38] Start typing something and see where it takes you.
Tyler Johnson: [00:36:42] So again, let's say that I'm sitting down. I have the computer open in front of me. I'm I'm ready to write something like, how would you tell me how to think about what am I trying to accomplish when I write? Like, how do I think about what is even sort of the point of writing about some, you know, even if I have some really interesting or provocative or difficult or whatever thing that I experienced on the wards or what have you, like, what's the point of writing about it?
Dr. Anna Reisman: [00:37:14] Well, that's a question you have to ask yourself. I can't tell you the point of why you're writing about something. You may not know that until you start writing. Um, sometimes you think this emotional experience feels like it's going to turn into a personal essay. You start writing it and you realize this is actually more of an op ed, or somebody tells you after they read it, this this sounds more like an op ed. You're trying to change something. This is about a policy that should change so you don't know until you have something down and until you show it to somebody usually.
Tyler Johnson: [00:37:48] So in other words, I think one thing that I hear you saying in your answers to the last few questions, which I think is counterintuitive to a lot of people, is that it is not the case that you have to have sort of written out in your brain the more or less fully formed final version of what you want to write before you sit down and you start writing, you may actually discover what you're going to write as you're writing it.
Dr. Anna Reisman: [00:38:18] I mean, that's I can only speak for myself, and I am definitely in that latter latter category. I remember going to a talk years ago and Edward P Jones, who wrote The Known World. He said it took him. He spent ten years thinking about his characters and the plot, and he basically had the whole book written, the entire 300 something page novel in his head, and then he just wrote it down. But I'm not like that. And I think a lot of people are not like that, but that's pretty amazing. So no, I learned by but but, you know, on the other hand, I guess you could say if there's a resident who wants to apply to our writing workshop, you need to submit a 1200 or so word personal essay. So that's, you know, that structure may help somebody kind of think just having that idea of length. And then it is a personal essay, a personal story that may be helpful, it may make it more difficult. And but I still say just starting out with the, as Lisa Sanders says, vomiting onto the page.
Tyler Johnson: [00:39:24] And just let me then ask, because I think that one of the things is that writing is one of those things that you may have heard about. You may have had colleagues or even mentors who have done it, but because there are not that many people who do it, even if you feel like you might be good at it, or let's say maybe you did some of it in college and, you know, you worked for a literary magazine or whatever. Figuring out how to do it in medicine may be a little bit tricky. Let's say that, okay, now I've taken your first two recommendations. I have my little notebook. I'm taking my, you know, notes of of experiences that I have. And let's say that I even got over that initial hurdle. And now I have a draft down on the page. Then what comes next? Like how? Meaning? You know, it's one thing if you have you or you know, someone who's known to be a medical author at your school with you or whatever, then maybe you approach them for help. But if you don't know a person who's obviously there to help you figure out what to do with that draft, where would you take it after that? Like, where would you go next?
Dr. Anna Reisman: [00:40:23] I mean, I didn't have anybody like that. So I would write something and I would show it to a friend or my sister who's also a writer, and I still show her things all the time. You know, somebody, somebody in your life, they don't have to be a, quote, writer themselves, but just somebody who's you think will spend the time and give you an intelligent, um, and helpful reaction. And it takes time to find the right person. You know, some people are just not interested in really reading something carefully. Some people say, this is great. Some people will take it apart line by line. It takes time to find the right person to show it to and or writing group. You know, if there are a couple people that that you know who are also kind of in that stage, a similar stage, you may want to just get together and and share pieces and read each other's stuff and give feedback. So I think, I think having other people is really, really important to have kind of an outside perspective on what is down on the page.
Tyler Johnson: [00:41:24] Okay. So now let's say the one other thing I will say with with that step is that I think we also sometimes may make the mistake if we get to that point, and then at that point we get some really strongly constructive feedback a la, well, you know, you may want to take this all this one part all apart or you need to reorganize the whole thing or it sounds like you're trying to write this as X, but I really think that what you actually mean to say is Y or whatever. Sometimes I think that can feel discouraging, but that may actually be that's often in sort of, even if disguised, some of the most encouraging feedback. Right? Because it means that you have enough on the page For someone to engage with it meaningfully, right? Like you're you're saying something. If someone has something to say back to it, clearly you're saying something to them.
Dr. Anna Reisman: [00:42:16] Absolutely. And, you know, revising is hard. And getting feedback from some when you're hoping somebody will say, this is perfect, don't change a thing. But that's you know, if somebody says that, you should be a little suspect, right. People give you notes and you'll be like, are you kidding me? I mean, this is how I feel every time I ask somebody to look at one of my my essays. But it's always important. Sometimes it just I just have to put it away for a few months before I look at it again. But this is the part of the writing process. Writing is not easy. This kind of writing. If you want to really focus on the craft with the aim towards publication, reflective writing is different. You're not showing necessarily showing it to anybody. You're not asking for feedback.
Tyler Johnson: [00:42:57] So okay, so now as long as we, you know, this has sort of turned into a craft discussion. But but I think that's useful right. Because that's a lot of what you do is you help people hone the craft of writing. So okay, so now let's say that a person has taken your steps, right? They they've got their notebook. They've kept with them. They've chosen a particular encounter. They've sat down and as you put it, vomited onto the page. And now they've even taken it to person A and person B, and gotten a little bit of feedback and sort of honed and polished it. And now they think, well, okay, who knows? I think this is pretty good. Maybe it could be published somewhere. But again, if you don't have a person around you who kind of knows their way in that world, even if you have something like that, I know that a lot of people, it's kind of like, well, okay, but now what? Like, you know, how does that work? So what would you say if someone has a thing like that sitting on their computer and think it might be worth sending it somewhere? How do they actually send it somewhere?
Dr. Anna Reisman: [00:43:51] So, I mean, I think it's great to have writing mentors and people who are experienced in the field, but I think, I mean, I honestly, you just have to read and like a lot of medical journals, have a narrative, a personal narrative kind of column, and you don't learn about those by asking, where should I send this? I read those and find the find the journal where you think that you would. This might be a good fit, or the ones that you think are really admire what they publish. That's you got to do that research. Yeah. You have to do that. And then and then you follow the instructions and send it out, and then sit and wait and twiddle your thumbs and curse yourself for sending it in too soon. And they must be hating it. And if you don't hear back in the next week, you're going to send it somewhere else. And you know, eventually you'll hear and chances are they won't take it and you'll send it somewhere else.
Tyler Johnson: [00:44:48] Exactly. I was going to say, right. And most of the time it will get rejected. And that also doesn't mean that it was wrong or bad. No it doesn't.
Dr. Anna Reisman: [00:44:53] It's all very subjective. Whoever's reading it is a person. And sure, as long as you didn't, you know, there are no typos and any any obvious, you know, you didn't. You didn't. Right? Isn't this like the nightmare of college essays? You just, like, put the wrong college, listed the wrong college, or you listed the wrong journal where you're sending it? Yeah, don't do anything like that.
Tyler Johnson: [00:45:16] Yeah. And I feel like too it's a little bit like when, you know, I advise medical students a lot when medical students are trying to figure out what specialty they want to go into, even though it's trite and has been said a hundred times or a million times, I feel like it is good advice to try to quote, find your people right? And I feel like trying to find a place to publish is a little bit like that too. Like if you have a journal and you read the journal and you think, oh, this is like these people get me right, or I get this or this resonates, that's often a good sign that it's a maybe a good resting place or a good landing place. It doesn't mean that that's that they're necessarily going to take your first piece, but at least it tells you that they're, you know, sort of the right kind of place.
Tyler Johnson: [00:45:57] Okay. Well, we've just got like two minutes left. So I'm going to finish by asking you this question if you can choose if you are going to give some advice, either to the younger version of yourself as a doctor or the younger version of yourself as a writer, or it could be both. What is something that you wish you would have known back when you were closer to the beginning of this journey?
Dr. Anna Reisman: [00:46:24] I think, okay, I could say this and this kind of fits both of those categories, I think. I know we've been talking a little bit about having mentors, and I think that mentorship is not overrated. It's really, really important. And I've had really great mentors from time to time. But it's hard to find a mentor in exactly whatever niche you find yourself focusing. It may be, but it's worth finding people. I think that's at every stage, and I think keeping in touch with mentors like real mentors. Want to know how your career is panning out over many years? And I have sure, you know, I have a few people like that. But I also feel like even now, in my even in my career now as a as a full professor, like, I still wish that I had somebody who kind of like, gets the slightly unusual combination of things that I'm doing unusual in medicine. So yeah, I think I would, I would say look harder for mentors from the outset and find people and, and be willing to realize that not every mentor that you think will be perfect will be perfect. And it's okay to kind of shed people as you go until you find the right person or the right people. And that's kind of a lifelong process.
Tyler Johnson: [00:47:48] Yeah, I agree, I think that that process of kind of usually making your way through some of the people who are not a good fit to find the one or 2 or 3 people who are really good fits, that is incredibly important. Thank you so much for your time. It's been so delightful to be in this beautiful place with you, and we really appreciate you coming on the show.
Dr. Anna Reisman: [00:48:08] Thank you so much. This was fun. Thanks so much.
Henry Bair: [00:48:13] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the doctor's Art.com. If you enjoyed the episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:48:33] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient, or anyone working in healthcare who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:48:46] I'm Henry Bair
Tyler Johnson: [00:48:48] and I'm Tyler Johnson. We hope you can join us next time. Until then, be well.