I’m judgemental. It is my job to express opinions. Is it cancer? Is this patient about to break down? Will antibiotics cure this cough? Will this person be well in a week?
So is it right for me to write about my work?
I certainly don’t want to write about the patients who annoy me, nor those who make me lose sleep. Apart from that, medical opinion makes good copy. Everyone is interested in health and some of the world’s greatest authors were physicians. They understand suffering and the human condition.
My earliest literary hero was Sir Arthur Conan Doyle. His Tales of Adventure and Medical Life made a big impression on me. Some of his stories were so bizarre yet Conan Doyle understood the patients he described. Medical practise is a rich seam of colour and life: a writer’s goldmine.
As a physician I dare not express all I am thinking. I want to be honest with my patients and readers while considering the worst possible diagnoses, imagining the worst nightmare and fathoming what is likely. Some, I try to shock into taking responsibility for themselves. I want to say, ‘Do you think I’m a freaking magician?’ or ‘Do you really believe there is a pill to make you lose weight?’
I strive to tell an entertaining story and like including humour, but I must take care not to be seen as laughing at my patients.
A flabby young man had awoken with stiff aching muscles. He’d asked for an emergency appointment. He’d wanted to ‘get healthy’ and had been to the gym the previous day. My sporty sons often talk of DOMS – delayed onset muscle soreness. My Pa, who was also a very active man, described it as stiffness: that healthy ache you get the day (or two) after taking unaccustomed exercise, or after using muscles you didn’t know existed.
I explained DOMS to my overweight patient. The explanation made sense; he had suspected a connection with going to the gym, but decided that he had some special medical condition that precluded taking exercise. He wasn’t allergic to exercise, even if his high body mass index implied he could be.
It is a huge privilege to be a physician, but it is a privilege that comes with responsibilities. Good doctors enjoy their patients’ trust and confidence and we must do nothing to undermine that. We must reassure those who worry about wasting the doctor’s time. We must take time to discover why some come with symptoms that seem trivial. Are they harbouring a deeper understandable anxiety?
I know one GP colleague who has published stories about his patients. He writes under a pseudonym; he has never been able to personally promote his book, or talk about it in public. He has of course disguised the identity of his patients but is that good enough? It may not be. The problem is that readers identify themselves, even if they are not in the author’s mind as he writes.
My solution is to distil and record the essence of people. Once separated out, fascinating quirks and idiosyncrasies can then be transplanted into other bodies. That, I hope, makes for convincing characterisations.
The doctor in me also wants to empower people to try a reality check, to get out more. I hope that others might see how to avoid making painful mistakes. So do I tell a good moving story, save others from awful fates but risk alienating a patient who might misinterpret my writing and feels that I have betrayed their confidence or compromised their privacy?
It definitely isn’t enough only to anonymise any anecdote. It is also – I believe – essential to show respect in telling someone’s story, so that if they see themselves in the writing, they should be pleased and even ideally helped by it. Humour especially in English writing is often about criticising and pointing out deficiencies or ignorance in others. If there is some teasing in my writing, it might be about some trivial matter. The safest humour has to be self-mockery; I do some of that.
When I set out to write Snowfed Waters I had long entertained a silly dream of sending some of my neediest or laziest patients to live in a village in a remote part of Nepal where they would have to poo in a hole in the ground and pull water from a squeaky museum-piece hand-pump. There would be no electricity, internet or even a phone signal. They would be surrounded by true material poverty yet experience a life more real than any reality TV.
My central English character was pathetic but she had to be likeable too. Readers needed to care about her. She was in part me but also contained elements of patients I know well: patients who had gone through awful times. People who had been betrayed, bereaved or broken down by what life had flung at them.
Their stories moved me. As I wrote, I wondered whether those patients would see themselves in the book. I hope they will; recognising themselves might help them see that life can change for the better.
Even so, I remain ambivalent about what is and isn’t all right to write about patients. It is a thin and delicate line. I just hope I get it right most of the time.
Dr Jane Wilson-Howarth is a general practitioner working in the city of Cambridge (UK) where she is also medical director of a travel immunisation clinic. She worked for 11 years on health promotion and child survival in several Asian countries. She has written two travel narratives (about Nepal and Madagascar), three travel health guides and a novel set in Nepal; she is a regular contributor to Wanderlust magazine.