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Join Arthur Lazarus, an adjunct professor of psychiatry and the author of Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine. In this episode, we delve into the profound significance of storytelling and narrative in the medical field. Lazarus sheds light on the challenges faced by physicians in today’s ever-evolving health care landscape, addressing topics such as burnout, physician advocacy, and the healing power of resilience.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA.

He discusses his book, Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Arthur Lazarus. He’s an adjunct professor of psychiatry, and he’s the author of the book Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine. Arthur, welcome back to the show.

Arthur Lazarus: Thanks for having me back, Kevin. Appreciate it.

Kevin Pho: So I was just looking back, and we last had you on over two years ago. For those who didn’t listen to our first episode together, just briefly share your story and journey to where you are today.

Arthur Lazarus: So two years ago we discussed an essay that I had written about Simone Biles. I had questioned whether she would be as well received among the medical profession as she was among the general public, the people who understood that she was struggling with mental health issues. They took her under their wing, she got proper treatment, and look where she is now, better than ever, right? So I questioned whether we would treat our residents, our medical students and even practicing physicians in the same way, or whether the medical profession would not be as kind. We discussed that a couple of years ago, and actually that became one of the essays in the book.

Just to backpedal a moment: Around the time of the lockdown, that is, COVID-19, 2019, like many folks I had more time on my hands. I know others were busy on the front lines and practicing, but I was in an administrative position, so I wasn’t practicing at the time, and I was actually laid off from that position. Suddenly I had a lot of time. I was deciding whether to retire or not to retire. I decided to apply for a few jobs, was rejected from several or didn’t hear back, and I started to think, well, maybe it’s my age, because I was around 65 at that time. And then I started to read about age discrimination, also known as ageism.

The long story short, Kevin, is that with all this time on my hands, I started to write. I had done a lot of writing in my career, but it was mostly professionally and academically oriented. I worked in the pharmaceutical industry for a dozen years, so you know how scientific writing is. It’s a lot different from what we now call narrative medicine writing. And I got interested in the field of narrative medicine. I had never heard of it until I literally stumbled upon it a few years ago, realizing that it was an outgrowth of Columbia University and a couple of big names in the field who are synonymous with the narrative medicine movement. Medical schools now offer writing courses for students, residents and faculty.

With all this in mind, I began to write about a lot of the things I was confronting at the time, including possible age discrimination, unemployment and whether I would ever work again, and a host of issues, really, that I guess had just been bottled up over a decade or two. My style of writing was so conducive to what you put on your wonderful, wonderful website: a thousand words, give or take. That was my wheelhouse. I found myself writing essays, sometimes opinionated but not always, like an op-ed. A lot of the essays included what I would call memoir, experiences I had had over my career that I incorporated into my essays simply to make a point, but I wasn’t trying to write my autobiography.

And here’s where my son comes in, my lovely son, who lives in Hawaii. I visit him and his family a couple of times a year, and he is a writer. He’s a poet at heart, but he went through a complete education, with an MFA degree and a PhD in English, and he’s a writer and a teacher at the University of Hawaii for a living. He says to me, “Dad, why don’t you write an autobiography?” I said, “Josh, no way, nobody wants to read about me.” People don’t want to read autobiographies in general. They tend to be kind of boring, I think. It’s an adventure.

And then I realized, as I was writing these essays, so I started in 2019, and fast-forward to 2021, 2022, when my son and I had this conversation, that I had a lot of memoir in my essays. So I decided to collate these essays from 2019 up until early 2023. I’d say 50 percent of them, Kevin, appeared on your website, KevinMD.com. I found that there were two other websites that were also very simpatico with what I was doing. One of them is MedPage Today, and they accepted a fair number of my essays, and the other is Doximity.com. What I ended up doing was cataloging them and realizing that I could sort them into themes. Some were professional issues, some were physician issues, and some were related to education and training.

I had 76 essays online at that time. I collated them and worked with the American Association for Physician Leadership, which is a great organization that, as you may be aware, really is the home for physicians like myself who over their careers have gravitated into nonclinical roles. They’re also a publishing company. They further edited my essays and published it, and the book just came out a couple of weeks ago. I was the one who came up with the title. They said they reserved the right to title it the way they wanted to, but I think they liked my title. I think it was right on; it hit the spot. I titled it Every Story Counts, because I literally believe that every story counts. Every one of us has not only one story but many stories to tell, and we should write much more often than we do. And then the subtitle, Exploring Contemporary Practice Through Narrative Medicine, because I realized that’s really what I did: I explored all sorts of things that affect physicians and students and residents today.

Kevin Pho: Now, your book, like you said, is Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine. So what are some of the major messages that you want readers to come away with after reading the essays in your book?

Arthur Lazarus: Writing is therapeutic. I want them to understand the value of writing narratives. As Rita Charon, the physician at Columbia who really started the movement, said in the title of her book in 2006, narrative medicine honors our patients’ stories. And I think it’s important for physicians to not only honor their patients but also encourage their patients to write narratives as well. They’re so much more revealing about their illness and their station in life than the information that we can normally obtain in the course of an office visit. There’s a drill that Columbia devised, which has been adapted and modified in many other narrative medicine programs, known as close reading, where physicians will look closely at the narratives written by their patients, or they will share their own narratives, and really try to draw from that close reading the important aspects of this patient’s story: Where is she going, how is she coping and handling the illness? So basically I would like physicians to understand more about the field and the importance of it, for themselves as well as for their patients.

Secondarily, what I’d like physicians to come away with is an understanding that the medical profession is in crisis right now, and they don’t need me to tell them that. All they have to do is read the essays and op-eds on your own website, and you’ll see that we are a profession in crisis. I discuss a lot of these themes in my book, from burnout to demoralization to moral injury to the corporatization of America, to the medical-industrial complex run amok. All of these things have contributed to demoralization. I was just reading a study that came out within the last couple of days, a survey of over 2,000 medical students and nurses, a global study, not only in the U.S. but in other countries around the world, done by the publisher Elsevier, and over 54 percent of medical students had strong ideas about graduating from medical school and going into nonclinical careers. I think that number was beyond surprising. It’s astounding. Most physicians who enter nonclinical careers usually wait until midcareer or later, but the pressures on our medical students are significant, and we need help as a profession. And I hope that others read this book, not only physicians and trainees. I hope health care administrators read the book, and I hope politicians and lawmakers read the book as well and understand the gravity of the situation.

Kevin Pho: Now, one of the themes that you write about is the importance of physician advocacy. So tell us more about that. Why is that so important, and how can we do it?

Arthur Lazarus: It’s a great question. I mean, the why is obvious. We are just so outnumbered, Kevin. There was this famous study that showed that for every physician there were 20 or more administrators. We’re just so outnumbered, and we have a weak voice. On top of that, we’re in the midst of an internecine war. In other words, we are a house divided. We have so many specialties and subspecialties, and our goals are different; they’re not unified. It’s dysfunctional, just like Congress: We can’t agree among ourselves on what direction we ought to go in, and so forth. And so it’s gotten to the point where KP went out on strike a few weeks ago. That is a form of advocacy.

It’s very difficult. I’ve often thought about it. There are things that we can be doing, joining professional organizations like the AAPL and others that also advocate for us. The AMA is a huge advocate for us. But again, we’re not unified, and I think it has to start with the unification of the profession, perhaps a unionization of the profession, in order to make the gains that we need.

Kevin Pho: Now, can you share a personal story or an anecdote from your own experiences that propelled you to collect all your essays and publish them formally in a book? Was there a singular event that said, you know, people need to read what I have to say?

Arthur Lazarus: It wasn’t a singular event. There were just many events at times in my life that crystallized certain ideas, or a realization that the profession needs help, that our trainees need help, that physicians in practice need help. And then there were other situations that were strictly related to the doctor-patient relationship and my own experiences with certain patients.

So as I’m talking to you, one comes to mind, and it’s in the book. I was a resident at the time, and I was seeing a patient in psychotherapy. It was her first appointment with me, it was a relationship issue, and I thought that the initial session went quite well, Kevin. At the end of the session I gave the standard line, same time next week, and she looked at me and said, “No, I won’t be coming back to see you.” I was a little shocked, and I asked why not, and she said, “Look at your plants in your office.” I did look around, and she said, “They’re all wilted. If you can’t give your plants a little TLC, how are you going to take care of me?”

So I admit I didn’t have a green thumb. I left the gardening to my wife; she enjoyed that, and I just didn’t enjoy gardening. But that’s no excuse for not at least watering the plants in my office. They didn’t look alive, and so she didn’t want to see me again, if that’s the way I treated my plants. That was a pretty eye-opening experience: Patients look beyond just the clinician, your nonverbal actions are important, and so are the other things patients take in through all their senses. From that time on, I obviously made it a point never to let my plants go dry. And it just struck me also that, especially in psychiatry, in my field, we really need to be omnipresent, always present for our patients, and make sure that we impart empathy at all times.

Kevin Pho: We’re talking to Arthur Lazarus. He’s an adjunct professor of psychiatry, and we’re talking about his book Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine. Arthur, let’s end with some take-home messages for the KevinMD audience.

Arthur Lazarus: Buy the book, please. That’s the only promotional message I’ll leave you with. As I said earlier, writing is healthy, it’s good for you. Maybe take a graduate-level course in narrative medicine writing if you don’t work in an academic environment that offers that type of program. Be more open yourself, with your colleagues and with your patients, while obviously always respecting privacy and boundaries.

The way I’ve been inscribing the book for a few people is something to the effect of, “I hope you see reflections of yourself in my stories.” And I think most people will, because, as the great Maya Angelou said, we are more alike than unalike. That was really another inspiration for writing the book. I don’t think I’m a unique individual. I think we are all more alike than unalike, and we need to begin sharing our stories. We need to begin telling our stories, and we need to be forming bonds together, to realize that we are all in this together for the common purpose of helping our patients. And for those of us who are suffering and need additional help, let’s get them that help as soon as possible, and prevent one physician per day from taking his or her life.

Kevin Pho: The book is called Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine. Arthur, thank you so much for sharing your time and insight, and thanks again for coming back on the show.

Arthur Lazarus: Always my pleasure. Thank you.