A randomized controlled trial can tell us that a treatment reduces mortality by a measurable percentage. It cannot tell us what it feels like to receive that treatment, to wait for its results, or to watch someone you love decide whether to accept it. That gap, between what medicine measures and what patients actually experience, is where fiction has always done work that research papers cannot.

Consider Tolstoy’s The Death of Ivan Ilyich, written more than a century before palliative care became a formal discipline. The novella does not offer a treatment protocol. It offers something a clinical paper structurally cannot: the interior experience of a man realizing that his physicians are treating his disease and not him. Ivan Ilyich’s doctors ask about his kidney, not his fear. Modern medical humanities programs now assign this text specifically because it captures something decades of patient satisfaction surveys have struggled to quantify with the same precision.

Samuel Shem’s The House of God does something different but equally instructive. Where Tolstoy renders the patient’s interior world, Shem renders the physician’s, the exhaustion, the gallows humor, the slow erosion of empathy under a system optimized for throughput rather than care. Written by a psychiatrist under a pseudonym in 1978, it remains uncomfortably relevant in medical education precisely because it does not flatter the profession. No study on physician burnout has matched its ability to make readers feel, rather than merely understand, how a well-intentioned resident becomes numb.

Atul Gawande’s Being Mortal occupies a useful middle ground, narrative nonfiction that borrows fiction’s tools without abandoning its clinical grounding. Gawande’s case studies of patients navigating terminal illness function less like data points and more like short stories, and the book’s influence on how physicians discuss end-of-life care owes more to its narrative craft than to any statistic it cites. It is proof that the line between “evidence-based” and “story-driven” is thinner than medicine’s culture usually admits.

Margaret Edson’s play Wit pushes the patient’s interior view even further than Tolstoy could, staging the experience of a literature scholar undergoing an experimental chemotherapy protocol for ovarian cancer. Vivian Bearing narrates her own case with the same rigor she once applied to John Donne’s sonnets, and watching her translate clinical language into private terror does something a consent form never could. The play won the Pulitzer Prize in 1999 and has since become a fixture in medical school curricula, assigned specifically because it renders what a chart note calls stage 4 as a lived unraveling of dignity, control, and time.

Abraham Verghese’s novel Cutting for Stone approaches the same territory from inside the operating room rather than the hospital bed. Verghese, a physician himself, follows twin brothers born into a mission hospital in Ethiopia and raised into surgery, and the novel’s long passages on technique read less like exposition than confession, a surgeon explaining what his hands know that his training never fully articulated. It suggests that medical fiction is not only useful for patients trying to be understood. It is useful for physicians trying to understand themselves.

More recently, a novel called The Care Illusion by MARTYS has taken up this same territory from a different angle, following a health system optimized so thoroughly for measurable efficiency that the humans inside it, patients and clinicians alike, become nearly invisible to its own metrics. It is a reminder that this tension between what gets measured and what gets missed is not a historical artifact confined to Tolstoy’s era. It is a live problem, one contemporary fiction is still finding new ways to dramatize.

This is not a case against evidence. Randomized trials remain the best tool we have for establishing whether an intervention works. But “whether it works” and “what it means to the person receiving it” are different questions, and medicine has increasingly organized itself around only being able to answer the first one.

There is a growing body of evidence, ironically, that literature itself improves clinical practice. Studies on narrative medicine, a field formalized largely through the work of Dr. Rita Charon at Columbia, have found that training physicians to engage closely with narrative form correlates with improved diagnostic accuracy and patient rapport. Reading fiction trains a specific cognitive skill: the ability to hold another person’s internal state as real and worth attending to, even when it cannot be directly observed. That is also the skill a physician most needs at a patient’s bedside.

Where research papers compress, fiction dilates. A trial reports a five-year survival rate. A novel can spend two hundred pages inside the six months after diagnosis, rendering the texture of a single life reorganizing itself around uncertainty.

None of this argues that fiction should replace evidence in clinical decision-making. It argues something narrower: that medicine’s near-total emphasis on quantifiable outcomes has left a gap in how physicians are trained to understand the people behind those outcomes, and that literature, taken seriously, is one of the more efficient tools available for closing it.

The research paper will always tell us whether the treatment worked. It will take a novel to tell us what the treatment cost.

Matt Hasan is an economist, AI strategist, and founder of aiRESULTS. He advises health systems, payers, and life sciences organizations on the strategic implications of artificial intelligence, digital transformation, and emerging technologies. Over a career spanning more than four decades, he has held leadership and advisory roles with organizations including AT&T, IBM, Deloitte, Capgemini, and Citigroup, and previously served on the faculty of New York University’s Stern School of Business.

Dr. Hasan’s work focuses on the intersection of technology, institutions, and human decision making, with particular emphasis on how AI is reshaping medicine, governance, leadership, and professional practice. He is the founder of The AI Humanist Movement and an advocate for Human-AI Synergy, a framework that views AI not merely as a tool, but as a cognitive partner capable of extending human capabilities.

His writing includes “A Profession at the AI Frontier: Medicine Must Reinvent Itself or Cede Ground,” published in Health Affairs Forefront. He shares updates on LinkedIn and Medium.