What Patients Taught Me is your memoir of medical training. What inspired you to write the book?
As a pre-med, I devoured medical school memoirs. In general the accounts were pretty negative. The authors described an environment where medical students were transformed into these arrogant people with no listening skills, no sense of the human condition. So I came to medical school thinking I would be totally changed by this dehumanizing system of training.
That’s not quite how it worked out. Many of my clinical rotations were in remote parts of the Pacific Northwest. I worked closely with small town doctors who were incredibly smart and who were really good with patients. It was so different than what I had read about. And I wondered if it was the remote setting. Small towns are very democratic in certain ways. You run into patients at the grocery store, the football game, at church. In a city you’re less likely to run into a patient on a social basis unless you know them already. Being part of a community puts a different twist on the doctor-patient relationship.
In these small towns we were on our own a lot. So this was a time of incredible personal change and there wasn’t always a peer to talk to. I kept a journal to help process things I was seeing and doing on these rotations. Writing became part of my development as a doctor in training.
Can you explain that, how writing was part of your development?
For me writing is one way to decompress and understand life. I kept a journal in medical school. I wasn’t being deliberate about it, but now I can see that writing enables you to see a story from a variety of points of view. That’s something that can be hard to do in the hustle of a busy clinic or hospital day. So for me writing was another form of listening to what patients were saying about their experiences. I was all too aware that I really had no idea what sick people were going through. Writing was a way to get closer to that knowledge without having to have a baby or get diagnosed with cancer myself.
In recent years, it’s become very popular to nurture the writing and storytelling skills of medical students. The thought is that this will somehow bring back the empathy that’s missing in the modern doctor. I think there’s some validity to the idea, but of course being a good doctor requires much more than that.
Describe the process of writing the book.
When I went to work in Africa during my fourth year of medical school I emailed selections from my journal to friends. The list of readers kept growing, and someone told me, “This could become something.” The idea of writing a book had indeed occurred to me, but sometimes you need to hear that encouragement to believe it can be true. I took a year off after finishing my clinical rotations with the plan to write the book.
After a year I had about four chapters to show for myself. It wasn’t very much. In hindsight I realize I spent a lot of that time just learning to write. I also spent a lot of time reading, which always informs your writing. Then internship started. I pitched the book to a couple of editors at major houses in New York and received a bit more encouragement. Later I signed with an agent. He suggested some changes, such as finishing the book, and the rest is history.
The book is about a training program for rural primary care doctors. Why did you decide not to practice in a rural area?
When I was finishing residency and looking for my first job, I considered working in both Alaska and Montana. But I ended up with a job that was more accommodating for my personal life. For one thing, I was thirty and single, and I didn’t want medicine to become my entire life. I had been in school or training for twelve years and wanted to be able to travel and write for at least a little while. I wasn’t interested in making big bucks. Later I married a person who lived in both Alaska and Montana, and we contemplated moving to a small town. In the end it didn’t make sense because of his career. Two physicians with whom I now practice in Seattle are people who quit small town practice to be able to spend more time with their families. It takes a special person to be a small town doctor.
There’s a huge shortage of good doctors in rural America. It’s a problem the federal government has been trying to address for thirty years, and they’re not making very much headway. The quality of life in cities is just so different than in small towns, and for better or for worse, that’s important to many doctors.