Hilton Koppe is a genial Australian GP whose talent for engaging an audience can be judged by the fact that he can cajole Aussie orthopods to write poetry. His thesis is that we spend our lives writing down patients’ stories, but are not encouraged to reflect on them or allowed to admit our emotional involvement. He argues that we need a way of making sense of the dramas which we witness, and creative writing offers us that opportunity.
At this year’s WONCA conference in Basel Dr Koppe persuaded a multinational audience of GPs to choose their most memorable heartsink patient and to write down adjectives beginning with B to describe them. Aussies apparently are good at this: ‘b****y crazy’, ‘b****y maddening’, ‘b****y pain in the a**e’. We were then given a simple verse structure – no rhymes required – and ten minutes to write about our chosen patient. Several participants responded to the invitation to read out their work. Most wrote in English, for many their second or third language. One participant explained that he thought that AU against Dr Koppe’s name in the WONCA timetable meant ‘Austrian’ and had he realised that the workshop was being run by an Australian he, a Kiwi, would have joined the session on teenage health in Slovenia. Still, he read out his poem. A GP from Basel explained that she had written in her mother tongue, but was confident we would understand. We did. Few languages can express frustration as satisfyingly as Schweitzer Deutsch.
— melanie jones (@medicsupport) November 23, 2014
We then moved on to consider some event in the past that rankled still. Easy. My first surgical firm as a medical student. Had I not given up so much to go to medical school, I might well have quit training at that point, so negative was the model presented to me of the profession I was struggling to join. Dr Koppe asked us to write in prose without stopping to think, just letting the words flow. I was amazed at the bitterness which poured from my pen. We then had to write from the point of view of the other side. For me, that meant the surgery tutor who declined to teach because it was ‘spoon-feeding’. The exercise was enlightening. And therapeutic.
There is a growing interest in narrative – story-telling – in medicine. And this is happening at a time when we are losing the richness of the historical record. Old patient notes are fascinating social documents, as anyone who has gone back through thick Lloyd George envelopes knows. When they are shredded so is much of our history. Doctors don’t write like that nowadays. Not just because patients now have the right to read what we write. What renders 21st century records so sterile is the medico-legal sword of Damocles. So the kernel of the patient’s story is lost in a thicket of possibly significant negatives. Gone are the days when a doctor conjured up a patient by writing ‘there she sits at the bar looking like Marilyn Monroe but twice as vulnerable’.
GPs are witnesses to events which challenge people’s lives. Perhaps as we leach emotional colour from the medical records we have more need to find outlets for our feelings about the stories in which we play this strange role. Try poetry.
My poem, the first I’ve ever written, was about my heartsink patient, ‘Annie’:
Who’s shaking whom?
Get it together, Annie,
Get a grip.
Get a life.
Get a pair of boots and start walking.
Do all this before I get my gun.
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…