Reading, Writing, and Doctoring: Literature
and Medicine
RITA CHARON, MO, PHD
ABSTRACT: Literature and medicine share an inherently
enduring relationship. Doctors turn to literature-both
its plots and its forms-to understand what occurs in
their patients' lives, to increase their own narrative com-
petence, to interpret accurately the texts of medicine, to
develop empathy, and to deepen their capacities for
reflection and self-knowledge. Together, these skills,
attitudes, and bodies of knowledge contribute to the
effective practice of medicine. Literature is now taught
in almost three quarters of the medical schools in the
O n weekend hospital duty for my internal med-
icine practice, I see an elderly gentleman with
widely metastatic adenocarcinoma of unknown pri-
mary cause who is awaiting transfer to the hospice.
He is jaundiced, ascitic, slightly dyspneic, slumped
in a chair, groggy but arousable. I am surprised at
how young he looks: younger, as we say, than stated
age. Believing that he will die in a matter of days, I
am tender with him, talk softly, touch him gently. I
feel humbled and awed in the presence of his immi-
nent death. Even though I do not know this man
except for his name and his horrible diagnosis, I feel
that I can be a witness to his extreme suffering; I
sense the sacredness of these last days of his life.
When I ask, "What can I do for you now?" he opens
his eyes and looks steadily at me to say, "I want to
watch the river." The nurses' assistant helps me to
move his chair so it faces the Hudson, and I join him
for some time, silently staring at the winter-grey
water, wondering at his journey.
Doctors join their patients on journeys of living
and dying. Sitting in their offices or doing rounds in
their hospitals, doctors do their best to imagine what
their patients go through, using empathy as a clin-
ical instrument to understand a patient's situation
accurately. They listen to the stories that patients
tell, those chaotic illness narratives made up of
words, gestures, silences, and findings. Like good
readers, they follow the narrative thread of the pa-
From the College of Physicians and Surgeons of Columbia
University, New York, New York.
Correspondence: Rita Charon, M.D., College of Physicians and
Surgeons of Columbia University, 630 West 168th Street, PH 9-East,
Room 105, New York, NY 10032 (E-mail: rac5®Columbia.edu).
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
United States. Different goals, agendas, and methods are
appropriate at each developmental stage of a physician's
training, from the premedical curriculum to the continu-
ing education of a practicing physician. A vigorous and
growing scholarship and body of experience is propel-
ling the field of literature and medicine to understand all
the more clearly how acts of reading and acts of writing
might illuminate acts of doctoring. [Am J Med Sci
2000;319(5):285-91.]
tient's story, adopt his or her point of view, register
the unsaid as well as the said, and allow themselves
to be moved by the predicament of another human
being. If medicine's central duty is to provide a
coherent pathophysiological plot to explain the pa-
tient's signs and symptoms, medicine's central re-
ward is to behold the lives of patients well enough to
apprehend their meanings. Literature can help doc-
tors to fulfill their duties and reap their rewards.
History of Literature and Medicine
The relation between literature and medicine is
enduring because it is inherent. Hippocrates under-
stood his medical effectiveness to rest on his ability
to tell, in words and stories, what his patients
seemed to have been going through. 1 William Osler
recommended a rigorous schooling in great literary
texts for all doctors.2 Sigmund Freud recognized
that his case histories "read like short stories" and
that his clinical reports revealed "an intimate con-
nection between the story of the patient's sufferings
and the symptoms of his illness."3 Many great liter-
ary texts-King Lear, The Divine Comedy, Mid-
dlemarch, The Wings of the Dove, The Magic Moun-
tain, The Sound and the Fury-are attempts to
make sense, artistically, of illness and death. The
tradition of the physician-writer-John Keats,
Franltois Rabelais, Anton Chekhov, William Carlos
Williams, Walker Percy, Richard Selzer, Ethan Ca-
nin, among many others-reflects the overlap be-
tween the methods and concerns of literature and
medicine. Ultimately, both literature and medicine
follow individual characters or patients from their
origins to their destinies, answering, in somewhat
285
Literature and Medicine
different ways, the urgent and universal questions
of human beings, "Where do I come from?" and
"Where am I going?"
Programmatically, medical educators and physi-
cians have recognized the concrete contributions
that the study of literature can make to the practice
of medicine. The contemporary field of literature
and medicine emerged in the early 1970s, a time
when medicine became increasingly attentive to the
human dimensions of medicine, primary care, and
patient-centered practice. The inclusion of literary
studies in medical schools, it was then learned,
helps to teach doctors and medical students about
patients' experiences of illness, to understand the
power and meaning of what occurs in medicine, to
develop empathy, and to reflect on what they them-
selves do as physicians. 4
The impressive growth of the field in the past 25
years attests to the urgency and timeliness of liter-
ature's contributions to medicine. According to the
1998 -1999 Curriculum Directory of the Association
of American Medical Colleges, 74.4% (93 of 125) of
U.S. medical schools teach literature and medicine;
in 39.2% of U.S. schools, such study is part of a
required course. 5 A growing number of faculty posi-
tions in medical schools, scholarly journals (Litera-
ture and Medicine, published twice a year by Johns
Hopkins University press, is the premier journal),
scholarly books published by university presses, so-
cieties and conferences, training programs, gradu-
ate programs in major universities, and a research
effort on an international scale have established this
subdiscipline of literary studies as a robust and
credible intellectual discipline. 6 An extensive anno-
tated bibliography of literary works with medical
themes is available at the New York University
Literature and Medicine site (http://endeavor.med.
nyu.edullit-medllit-med-dbltopview.html), as are ac-
tual syllabi of literature and medicine courses
taught all over the country.7 A long-standing e-mail
discussion group (or listserv) on literature and med-
icine hosts on-line conversations among practitio-
ners of the field (to subscribe, send an e-mail mes-
sage to lit-med-request@endeavor.med.nyu.edu with
the following message text: subscribe lit-med). The
study of literature has been recognized as a serious
and vital component of the medical school, providing
medical students and doctors with the narrative
skills necessary for effective medicine and with sto-
ries resonant with the human meanings of illness. s
The Rationale for Teaching Literature and Medicine
How can medical educators justifY the time and
effort to teach literature to doctors and medical
students? Even if a faculty member wants to intro-
duce the study of literature into a medical school or
hospital, how does he or she overcome the resistance
of doctors and scientists against the "soft" or "warm
286
and fuzzy" humanities? The rationale for teaching
literature in medicine requires a delineation of the
specific "doctorly" knowledge, skills, and attitudes
that are obtainable through rigorous reading and
writing and a catalogue of specific examples that can
spell out exactly how this occurs. The most effective
approach to "resistant readers" might be to spell out
these goals, emphasizing their practicality and their
overarching commitment to increasing the clinical
effectiveness of individual physicians and physi-
cians-to-be.
The following 5 categories encompass most of the
goals of teaching literature and medicine:
The Study of Literature Can Help Doctors to
Understand What Happens in Patients' Lives.
Reading stories calls forth not generalizations or
abstract principles but earthy, full, forgiving under-
standings of human actions, intentions, motives,
and desires. Literary texts do this by mobilizing a
particular form of knowledge, called narrative
knowledge, that is required for comprehending both
the imagined stories of literature and the actual
stories of peoples' lives. 9 ,10 Whether the text is a
newspaper story, a verse of Scripture, War and
Peace, or a hospital chart, acts of serious reading
require strenuous observation and relentless hy-
pothesis-testing as one pays attention to the charac-
ters in the work, the telling of the tale, and the
response experienced by the reader. When the liter-
ary text is about illness or doctoring, the medical
reader's dividends multiply. Such literary texts can
provide doctors and medical students with clearly
articulated descriptions of human sickness that con-
vey, through art, the profound human sentiments
and desires that surround sickness, suffering, pain,
and death. Leo Tolstoy's "The Death of Ivan Ilych"
portrays unforgettably the savage regret of the dy-
ing man who realizes how empty his life has been
and the meaningfulness, for him, of his attendant's
honest empathy. D.H. Lawrence's "The Odour of
Chrysanthemums" presents the point of view of the
widow of an asphyxiated coal miner to demonstrate
how a death radically transforms the lives of all
survivors. James Joyce's "The Dead" describes one
man's epiphany in recognizing the universal human
connections among all the living and all the dead.
Skillfully reading stories about illness can change a
doctor's or medical student's way of caring for sick
patients, for the reader has experienced, if only
vicariously, the fear and rage and need of patients
close to death.
The Study of Literature Increases Doctors'
and Medical Students' Narrative Competence.
Mastering literary methods can endow readers with
specific skills that contribute to effective medical
practice. The skilled reader pays attention to the
form (ie, the structure, the images, the style) as well
as the plot of stories, absorbing information about a
situation by noting both what is told and how it is
May 2000 Volume 319 Number 5

told. Gradually, the reader learns to tolerate ambi-
guity and uncertainty, for stories have no black-and-
white messages but rather have changing, shifting
meanings. The reader is voraciously curious as he or
she orders the events of a plot into some form of
meaning, lives with multiple characters long enough
to make out how each one might view the world,
understands one story in the light of others told by
the same teller, wonders "Why is the author telling
me this now?" or "Who does this character remind
me of?" or "Why does this story make me feel so
sad?"
These narrative, or story-related, competencies
are exactly the skills that the attentive doctor uses
as he or she listens to a patient. ll •12 The doctor
absorbs all that can be learned from the patient's
words, gestures, and silences, trying hard to estab-
lish a chronological sequence and looking for a diag-
nostic "plot" that might unify an otherwise random
collection of events. Whatever the daughter or the
social worker or the ER attending says is collated
judiciously with what the patient says. The doctor
remembers how the patient coped with the last
crisis or loss in her life and acts in view of that local
knowledge. And the doctor identifies his or her own
affective state in the patient's presence as a diag-
nostic clue, paging through that marvelous internal
glossary that the good doctor develops (do we not all
know with biological accuracy when we are in the
presence of psychosis, depression, somatization, or
even a history of abuse?). This is not to suggest that
real people are as simple as imaginary people in
books but rather that one can practice and
strengthen the skills of observation, perception, and
interpretation by reading, and that these skills then
carryover to one's involvement with patients.
The Study of Literature Develops Skills in
Accurately Interpreting the Texts of Medicine.
Medical texts are extraordinarily complex docu-
ments. The hospital chart is a unique document: it is
an authoritative first draft; it is written without the
use of the pronoun "I"; it is put almost entirely in the
passive voice; it is handwritten; and it can have 20
or 30 coauthors, each with his or her own fiercely
defended point of view. Other such written forms as
referral notes and discharge summaries and office
charts have their own rules and structures. Oral
forms like medical interviews and case presenta-
tions are similarly complex. By its dual attention to
plot and form, the study of literature trains medical
students and doctors to explicitly notice the multiple
aspects of how clinical stories are built and how they
act.1 3 These skills increase the transparency ofmed-
ical texts. Whether the story is a rapid-fire presen-
tation on work rounds or the richly detailed erudi-
tion of a New England Journal of Medicine
clinicopathologic conference, the skilled reader in-
terprets it in full view of who the teller is, what
points of view are enacted, what points of view are
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
Charon
excluded, what images govern the story, how the
temporal sequence configures events into plot, and
what gives the story its closure. 14 If doctors learn to
read their own texts with due skepticism, with an
awareness of the multiple perspectives warring
within a text, with the realization that the medical
text works rhetorically on its readers, and with the
curious reader's uncanny ability to read between the
lines (or at least to identify the gaps and silences in
the text), they will collect a wealth of information
about the patient, about what the patient endures at
the hands of sickness, and about the practice of
medicine itself.
The Study of Literature Can Help to Develop
Empathy. Perhaps the most important skill
achieved from reading is the capacity to adopt the
point of view of another. This skill can help doctors
to develop empathy and, along with empathy, the
power to bear witness to another's suffering. Empa-
thy is not pity that drives one to tears or sympathy
that diminishes its object. Rather, empathy is a
powerful force that allows the reader to "make out"
what a character is going through. A 70-year-old
woman sitting in Houston in 1999 understands,
with great power and accuracy, what the life expe-
rience of a 45-year-old administrative judge dying in
Moscow in the mid-19th century might have been
like. A 20-year-old man in Boston experiences the
angst of a middle-aged woman in turn-of-the-cen-
tury Ireland whose alcoholic husband has just been
killed in a coal-mine accident. So automatically done
that it seems unwilled, adopting a character's per-
spective is the key to accurate and skilled reading.
George Eliot thought that empathy (she called it
sympathy, but referred to what we now call empa-
thy) was the enabling social sentiment, by which she
meant that empathy is what binds human commu-
nities together, letting one person care about what
happens to the next.1 5 Without this enabling empa-
thy, there is no human society, no altruism, no
service, certainly no medicine. Very simply, one rea-
son to encourage doctors and medical students to
read is that, by reading, they are practicing acts of
empathy and strengthening those forces ofimagina-
tion, self-disregard, blessed curiosity about another,
and transport into the world-view of another that
are absolutely required of the effective doctor.
The Study of Literature Can Help Doctors to
Develop the Capacity for Self-Knowledge and
Reflection. In medicine today, when emphasis is
laid more and more frequently on either highly spe-
cialized expertise or high-volume efficiency, doctors
need timely and tested methods of systematically
reminding themselves of the fundamental human
needs of sick people. They need methods to reorient
themselves to the commitments to altruistic service
with which many of them began their professional
lives. The more frantic medicine's work pace and the
more pressured doctors' daily lives become, the more
287
Literature and Medicine
doctors hunger for ways to reconnect to their own
commitments to be healers.
Those who teach literature in medical settings
have learned how important narrative writing can
be to the developing physician's sense of identity and
commitment. 16 All doctors are trained to write ac-
cording to the strict rules of "charting," choosing to
write down certain aspects of what they know about
their patients. All good doctors know a great deal
about their patients that does not belong in the
medical chart, and yet such knowledge becomes
available to the doctor only when it is put into
words. And so doctors have historically written this
knowledge down, in fiction or poetry-if the doctor is
blessed with a writing gift-or in personal journals
of all kinds. Writing in ordinary language about
patients and their care allows doctors to pause, to
reflect on the meaning and consequences of their
interactions with patients, and to acknowledge their
own complex responses to experiences of illness.
Such reflective pauses are required for examining
the meaning of one's actions; to let one's thoughts
achieve the status oflanguage by writing them down
is the critical step in making the reflections avail-
able for growth.
How to Teach Literature and Medicine
At all stages of education in medicine-from pre-
medical college courses, first-year and second-year
medical school seminars, psychosocial curriculum
for clinical clerks and house officers, and faculty
level reading groups-literature seminars in medi-
cal settings have developed wide latitude in choos-
ing texts and teaching methods.1 7 Because the goals
of literature-and-medicine teaching differ according
to stage of training, each stage is discussed sepa-
rately below.
Premedical Education. College students con-
sidering a career in medicine can use guidance in
appreciating the relation between medicine and hu-
manities. Challenged by a heavy science course load
and a competitive "premed syndrome," undergradu-
ates often feel discouraged from exploring their own
personal beliefs about health and illness or from
recognizing the emotional or social or spiritual se-
quelae of disease. LitElrature and medicine courses
for pre-meds have been extremely successful in
bringing rigorous, disciplined attention to these
matters. By introducing college students to great
works ofliterature that address issues of illness and
loss, and more generally by schooling pre-meds in
specific narrative skills, these courses prepare stu-
dents cognitively and culturally for their medical
studies and early clinical experiences. Westmont
College in Santa Barbara offers courses in "Litera-
ture and Women's Health" and "Autobiography of
Illness," Brown University offers an interdiscipli-
nary course for undergraduates in "The Literature
288
of Mourning," and The University of Arkansas
teaches college students about "Illness and Healing
through Texts." Like much activity in this field,
pre-med courses are often taught by interdiscipli-
nary teams-professors of English along with phy-
sicians from the medical school-who can embody
the conversations that must go on between the sci-
ence of medicine and its related arts.
First- and Second-Year Medical Students.
Literature and medicine courses are required in
some schools and elective in others; several schools
require that students participate in a Humanities
and Medicine seminar and offer a menu of seminars,
several of which will be in literature. 5 Seminars for
first- and second-year medical students include the-
matic studies of particular illnesses (cancer, depres-
sion, AIDS), seminars on works of particular au-
thors (Homer, Dante, physician-writers), and
courses focusing on particular genres or literary
concepts (the short story, autobiography, readings
from theatre).6,18 Goals vary from seminar to semi-
nar, but most preclinical courses in literature and
medicine aim to equip medical students with inte-
grative skills to balance the highly reductionistic
thinking with which they are confronted in their
other medical school courses and to give concrete,
specific illustrations of particular experiences of ill-
ness. The humanistic goals of "putting a human face
on illness" can be fulfilled by teaching literary texts
about illness, and the equally humanistic message
that doctors need such things as the imaginaton and
interpretive flexibility can be conveyed by the very
teaching of literature. More fundamentally, most
teachers of first- and second-year medical students
realize that they are conveying the conceptual skills
of reading to be used not only as a ballast for hu-
mane considerations but also as basic training for
accurate medical practice.
Concretely, the literature and medicine seminar is
relied on to teach preclinical students elements of
medical interviewing, medical ethics, death and dy-
ing, humanistic medicine, and introduction to the
patient. Literary study provides an unparalleled op-
portunity to examine the conflict of perspectives
inherent in medical situations and to experience the
discomfort of uncertainty and ambiguity, gradually
learning to tolerate them. Oftentimes structurally
integrated into "Introduction to Clinical Medicine"
or "Patient-Doctor" courses offered to first- and sec-
ond-year students, literary study becomes the
method for crossing the gap between human theory
and clinical practice. Short stories are used as well-
written "cases" in clinical conferences, relying not
only on their facts in presenting a patient and a
doctor but also on the creative gifts of the writer in
conveying the intricate relationships among event,
emotion, person, and universal meaning. Students
at Harvard Medical School, for example, read ex-
cerpts ofSolzhenitsyn's Cancer Ward as they master
May 2000 Volume 319 Number 5

clinical material about death and dying; students at
State University of New York at Stony Brook read
short stories by Eudora Welty as they examine is-
sues in aging; students at Loyola University Medical
School stage a reading theatre version of "The Death
of Ivan Ilych" as a preparation for their physical
diagnosis course. 19
By choosing a group of novels or stories or poems
about patients facing certain medical challenges,
thematic literature seminars attempt to sensitize
medical readers to patients' experiences with partic-
ular health problems-for example, AIDS, cancer,
disability, or stroke. In a seminar on aging, medical
students read, for example, May Sarton's "At Sev-
enty," Eudora Welty's "A Worn Path," and Tillie
Olsen's "Tell Me a Riddle." A seminar on death and
dying might, in addition to Tolstoy's "The Death of
Ivan Ilych," assign Henry James's "The Middle
Years," George Eliot's "The Sad Fortune of Reverend
Amos Barton," and Katherine Anne Porter's "Pale
Horse, Pale Rider." A literature and medicine sem-
inar might focus on the works of physician-writers,
reasoning that literary texts written by practicing
doctors would convey difficult-to-articulate aspects
of medicine to readers. Readings might include An-
ton Chekhov's "Ward Number Six," William Carlos
Williams's "A Night in June" and "The Use of Force,"
Richard Selzer's "Brute" and "Mercy," and Susan
Mates's "Laundry."
Second-year students at the College of Physicians
and Surgeons of Columbia University who choose a
literature seminar to fulfill a Humanities and Med-
icine requirement might read such works as Alice
Munro's "The Wilderness Station," Flannery
O'Conner's "The Lame Shall Enter First," and
Henry James's "The Turn of the Screw," works cho-
sen not predominately for their clinical content (they
do not all have clinical content) but for specific
aspects oftheir literary form: narrative frames, mul-
tiple and contradictory points of view, unreliable
narrators, or complex handling of time. By simulta-
neously attending to content and form of these sto-
ries, the students develop their narrative skills to
extract all the meaning from text, attending to plot
as well as to language and image and voice. 20
Finally, many schools have incorporated journal-
keeping or narrative writing into their first- and
second-year curricula. Whether students are asked
to write about their cadavers in anatomy or their
patients in medical interviewing seminars, students
are given permission to use ordinary language to
capture their complicated and often bewildering
early experiences in medicine. 21 .22
Clinical Students and House Officers. A ward
attending circulates a poem or short story at attend-
ing rounds to bring members of the team into the
presence of a full, resonant human drama. 23 The
ethics of end-of-life are examined with the help of
stories by physician-writers. 24 Increasingly, teach-
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
Charon
ers of clinical clerks and house officers turn to liter-
ary texts to embody and examine the situations with
which doctors must become familiar. The tasks of
the ward team or of the clinic staff are highly struc-
tured and directional. Rather than the general re-
flections of the first- and second-year students, the
moment-to-moment decisions of the intern or the
clerk are at stake. Teaching literature at this stage
often concentrates on specific clinical situations.
Ethical dilemmas occupy much of the content. Struc-
tural attention to point of view and the clash among
multiple perspectives is equally productive, for clin-
ical students and house officers daily must adjudi-
cate among the clashing points of view of patients,
family members, and a variety of health profession-
als.
Narrative writing is becoming increasingly a part
of standard medical training. Some third-year stu-
dents at the College of Physicians and Surgeons of
Columbia University are asked to keep a "Parallel
Chart" on their patients during the in-patient rota-
tions. Students write in the Parallel Chart about
clinical and personal considerations that are critical
to their care of the patient but that do not belong in
the hospital chart. These students write astonishing
prose about anger, sadness, mourning, helplessness,
and guilt as well as about victory and accomplish-
ment. When they read to one another, in small
groups, what they have written, they realize that
they are not isolated in their profound reactions to
patient care but that they can talk with their col-
leagues and their teachers about their reactions to
caring for sick patients. Third-year students at Har-
vard Medical School are asked to record "critical
incidents" in their training, and they write about
incidents of ethical oversight or emotional power.25
Faculty and Staff. Many teachers ofliterature in
the clinical setting find faculty-level teaching to be
most productive and challenging. Once freed from
the curricular constraints of presenting specific top-
ics for mastery at particular times in the year, the
literature seminar for doctors can range broadly
among genres and content. More and more medical
centers have established reading groups where fac-
ulty and staff come together once or twice a month
for collegial discussions about books. Dalhousie Uni-
versity in Halifax offers monthly evening literature
seminars open to doctors and their spouses, capped
by a yearly weekend retreat at a country inn where
intensive seminars take place. The Program in Eth-
ics at the University of Utah sponsors monthly lit-
erature-and-medicine evening seminars at the
homes of faculty members, open to students and
teachers. University of California campuses at San
Francisco and Berkeley cosponsor a monthly pot-
luck dinner reading group that brings together pro-
fessors of English, philosophy, and religion from the
university and professors of medicine and nursing
from the medical school. Such professional societies
289
literature and Medicine
as the American College of Physicians and the Soci-
ety for Palliative Care include literary workshops in
their Annual Meeting programs.
The "Literature at Work" reading group at Colum-
bia-Presbyterian Medical Center is a collaborative
reading group open to any faculty, staff, or student
at the medical center that meets twice a month at
the hospital. Members of the group take turns choos-
ing the readings and introducing the text and guid-
ing the discussion. Usually, the texts have nothing
to do with medicine. Professors from Columbia's
Department of English are regularly invited to join
the group to offer specific light on a particular work.
An example of the kind of work that only literature
can do is the group's recent focus on novels by
African American authors. By reading and discuss-
ing novels by Toni Morrison, Ralph Ellison, Zora
Neale Hurston, and Richard Wright, this group of
doctors, nurses, and chaplains has found a way to
talk seriously about race, a task otherwise extraor-
dinarily difficult in a multiracial setting. Having a
work of fiction on the table instead of, for example,
the care of a particular patient allows these doctors
and health professionals to talk plainly about white
guilt, black shame, the sequelae of slavery, and the
incommensurability of life experiences of the 2 cul-
tures. Professors from the Center for Mrican Amer-
ican Studies of Columbia University have guided the
group to understand the cultural meanings of black
texts and black textual methods. Talking about race
is but one example of the kinds of very complicated
and threatening conversations that literature, and
perhaps only literature, allows.
There has been an exponential growth in doctors'
narrative writing about their practices recently.
Such medical journals as the Journal of the Ameri-
can Medical Association, Annals of Internal Medi-
cine, Journal of General Internal Medicine, and
many of the journals of state medical societies re-
serve sections for doctors to publish ruminations on
their practice and their patients. (Sometimes, when
I write about individual patients in an effort to
clarify my own knowledge of the patient's predica-
ment, I will ask the patient to read what I have
written: "Did I get this straight? Did I hear you
accurately?" Patients usually respond by disclosing
more information about the true nature of their
distress; they often then bring me poems or stories
or journals that they themselves have written about
themselves. All of this leads to increased accuracy of
understanding and increased opportunities to help.)
More and more physicians are publishing books and
articles in the lay press about their practices, dem-
onstrating that, indeed, patients value their doctors'
perceptions and interpretations of sick persons' jour-
neys in care.
290
Conclusions
The medical actions of diagnosing, prognosing,
developing therapeutic alliances, and choosing fit-
ting clinical and ethical management are, in part,
textual and interpretive actions. Consequently,
these actions depend on the fundamental abilities of
the doctor to make sense of complex narratives and
to understand the multiple meanings of singular
human acts. As doctors become more and more
skilled in narrative capacities, they will improve
their ability to develop accurate and comprehensive
knowledge about patients, to reach patients, to be-
come their trusted advocates, to navigate ethical
uncertainty, and to be moved by all that they are
privileged to do as doctors. To this end is the effort of
literature and medicine committed.
Additional Recommended Readings
Hunter KM. Doctors' stories: the narrative struc-
ture of medical knowledge. Princeton: Princeton
University Press; 1991.
Reynolds R, Stone J, editors. On doctoring:
stories, poems, essays. New York: Simon &
Schuster; 1991.
Booth W. The company we keep: an ethics of
fiction. Berkeley (CA): University of California
Press; 1988.
Brody H. Stories of sickness. New Haven (CT):
Yale University Press; 1987.
Coles R. The call of stories: teaching and the
moral imagination. Boston: Houghton Mifflin;
1989.
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