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Join Laya Jalilian-Khave, a physician and post-doctoral fellow in psychiatry. Laya shares her profound journey from medical school in Tehran to practicing medicine in diverse settings, including the border regions of Iran and Afghanistan. Discover how she found solace in the power of storytelling as a means of coping with the emotional challenges of health care. We delve into the transformative potential of narrative medicine and its role in fostering empathy, communication, and personal growth among health care professionals.

Laya Jalilian-Khave is a physician and a psychiatry post-doctoral fellow.

She discusses the KevinMD article, “Physicians can write their way to increased empathy.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, get CME for this episode by clicking on the CME link in the show notes. Today we welcome Laya Jalilian-Khave. She is a physician and a psychiatry postdoctoral fellow. Today’s KevinMD article is titled “Physicians can write their way to increased empathy.” Laya, welcome to the show.

Laya Jalilian-Khave: Hi Kevin, and thanks for having me. Excited to be here.

Kevin Pho: So we’ll talk about your KevinMD article in a little bit. Just first off, briefly share your story and journey.

Laya Jalilian-Khave: So I’m Laya, and I’m currently a second-year postdoc fellow at Yale psychiatry. But I was born and raised in Iran, and so I did my medical school back there. And after graduating I did almost two years of service at a remote hospital on the border of Iran and Afghanistan, and then I moved here, which is less than two years now, at Yale.

But parallel to this world of medical school and everything, for years I’ve been calling myself a writer-to-be. I don’t think I’m still there, but writing has been this huge part of my life. And I think only recently I’m finding this shared space where these two passions of mine can join and actually have a platform to be more loud about it. And it’s just recently that I’ve been writing pieces and publishing in places with a broader audience, and the piece I had in your lovely platform was one of them. So here we are.

Kevin Pho: All right, and you talk more about the dual passion, writing and medicine, in your KevinMD article, “Physicians can write their way to increased empathy.” So tell us what this article is about.

Laya Jalilian-Khave: So the article is kind of relevant to my own journey in medical school and after that. I love telling stories of everything, but when I went to medical school, stories of my patients, and maybe it was kind of an organic habit of me to write about it, and the challenges I was having, or the challenging patients. There are so many really hard emotions in our career, as we know, and so that has been kind of my coping mechanism that I carried out in medical school.

But I think working with a number of organizations and friends out of the medical field kind of made me more conscious of the way that what we’re dealing with, the number of traumatic events, the deaths, the suffering and everything, it’s not just normal to say, it is a big deal. But I think there was a lot of pressure in the medical system to kind of sweep that under the rug and not mention those hard emotions, to seem professional or something.

So I think it made me conscious that there’s something not exactly right, and so it kind of made me dig deeper. And I found that back then I didn’t know all these terms that have come up lately, like burnout and moral injury, all those. And it was way before COVID that kind of brought these terms much more out. But I found all these resources that were telling that medical students are experiencing depression and anxiety at much higher levels than their peers and the other professions and majors. And it was almost like one in four or one in five, one in three even, are experiencing high levels of depression and anxiety, which is up to five times more than their peers.

So that was kind of the alert that there is something to address. And my way of addressing it has been writing, and I was like, if it’s helping me, why not advocate it, and maybe it will help more students like me or physicians in early careers.

Kevin Pho: Now can you give us an example where your writing helped you as a coping mechanism? Give us an example or story of that.

Laya Jalilian-Khave: I think where I really leaned into this writing skill about medicine, I mean, before that I was just sharing it with close friends, or just as a tool to reflect on my own. But the experience I had as a physician at the border, it was very unequipped and a very remote village hospital, which was very hard, extreme hard conditions, and so that was the place that kind of pushed me to even write more and then share it with more people.

And it was kind of the way that I could thrive in that condition, and also introducing a group of people, it was a very poor area, so we didn’t have almost any stories from that sort of place, and kind of introducing them from another lens and scope. So I think that was one place that I was convinced that this is working. Before that maybe it was more in my personal bubble and friends. And then here at Yale I’ve been given many chances to share my stories, and people have been connecting with areas or contexts that they were not familiar with before. And I think I became sure that you can actually do this double thing, and it works.

Kevin Pho: So tell us about your writing process. Do you journal on a regular basis? Do you have defined times throughout the year where you just sit down and write and share your story? So how do you come up with these stories, and tell us a little bit about your process.

Laya Jalilian-Khave: Yeah, I think at first it was just something I couldn’t swallow or I couldn’t process, I would just go back to writing it. And I think it’s a very safe space to reflect on what is challenging you, or how you have reacted or responded in a situation with a patient or with colleagues, and then in a safe environment you can just rethink that and reprocess that. And I think it changes a lot in how you actually keep responding to similar situations.

So I think it started with this personal thing, reflecting on myself. And then when I was working in that remote hospital I couldn’t come back home for some time, and I was just in that area, I think it was more about the urge to show this other life of these people, and try to find a community of support for myself and then for these people. And so it kind of shifted from a personal space to more community space, and actually having an audience, talking to people rather than to myself.

And then, I hadn’t published anything in regards to this, but the opportunities I found at Yale, I joined the OpEd Project, which is a writing group, and many other opportunities that Yale kind of pushed me to work on, a more deadline kind of context, and the motivation to publish. So kind of it’s been from personal space to audience space, you can say.

Kevin Pho: Yeah, sure. So you mentioned that you joined groups to help formalize the writing process. As far as you know, during medical training, are there formal courses in narrative medicine? Do they formally incorporate writing into medical training, as far as you know?

Laya Jalilian-Khave: So honestly, I discovered them here, that there have been quite remarkable programs that promote writing in medicine, writing in medical school from the early years on, mostly in leading institutions. But it’s not this nationwide or global movement, it’s mostly limited.

And what I feel is that, while this is a new approach to medicine and how we can actually narrate medicine, we have not so many stories, we need to have much more stories in all fields. Where I came from, school, it was mostly, we always had the problem of resources, and it was always in a resource-limited condition, which doesn’t really make writing or narrating a priority. And I think, as much as we don’t have stories from the medical field anywhere, these physicians and early career medical interns or physicians in resource-limited conditions are the ones who are never heard.

So yeah, there are programs, but it’s very limited. And although I’ve been very interested in this field, I hadn’t heard of them before coming to Yale. So I think it’s just very limited still.

Kevin Pho: You talked earlier about how writing helped you as a coping mechanism to get over or process difficult situations. How has writing changed you as a physician caring for patients?

Laya Jalilian-Khave: I can quote from this OpEd Project that the story we tell becomes the world we live in. I think that the story you tell about your patients eventually will become the kind of care you give to your patients, and the care they’re going to receive in a broader space. And also the story you tell about yourself as a physician will kind of eventually lead to making a new person who is doing that.

So I think it has helped me to reassess my patients and my understanding from several aspects, and try to fulfill their needs, the needs that I might have not seen when I was just having a patient visit. I could reflect on it after that. And also the way I want to see myself as a physician. So I think it helps in that regard.

Kevin Pho: We’re talking to Laya Jalilian-Khave. She is a physician and psychiatry postdoctoral fellow. Today’s KevinMD article is titled “Physicians can write their way to increased empathy.” Laya, let’s end off with some take-home messages that you’d like to share with the KevinMD audience.

Laya Jalilian-Khave: Storytelling is therapeutic and empowering. I think that another way to see this is that by being the storyteller you kind of change your role from just observing to being in charge of narration. And I think that kind of changes your relationship with your surroundings.

And I think when you are the narrator, even in very early stages of medical school and before you’re actually in charge of a patient, and then further on, you kind of get responsible about what you want to see and what you want to report. So I think it kind of gives a sense of control, and maybe motivation to change what you don’t like to see, and therefore change the narration you are narrating.

So I think it doesn’t matter at what stage you are. It may be a very short interaction with a patient as a medical intern, or it might be a very life-changing interaction as a physician in charge. But in all of those, I think if you have that, I’m going to narrate this, in the background of your mind, you’re going to try to narrate the best version of what’s going on. So I think it doesn’t matter if you’re in charge yet or not, you’re in charge of that interaction and that person.

Kevin Pho: Laya, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Laya Jalilian-Khave: Thank you so much.