1. Harpham, Wendy S. MD

Article Content

For the first time since I'd retired in '93, I was back in my office, magically cured of the aftereffects of my treatments. It was only a dream, but a happy one. I was thrilled to be caring for patients again.

WENDY S. HARPHAM, MD... - Click to enlarge in new windowWENDY S. HARPHAM, MD. WENDY S. HARPHAM, MD, an internist, cancer survivor, and author, has been writing this award-winning column since 2005. Her books include

The shocker of that dream was the realization that my experiences as a writer could have improved my work as a clinician. If only I could turn back the clock and care for patients again, this time knowing the insights and tips that guide my writing.


For example, I remember all the times I'd see the name of a longtime patient on a chart and relax as I opened the exam room door, feeling free to focus on the problem(s) that prompted the visit. I already knew the patient's past medical history, as well as the family and social histories. I'd already figured out if the patient was a minimalist or preferred using the latest high-tech. And I knew the patient's wishes regarding end-of-life.


Today, if I were wearing a white coat and saw a familiar name on a patient's chart, a writers' warning would put me on alert: You don't know what you don't know.


I can't tell you how many times I used to sit down at my computer to write my next "View" column, expecting to knock it out quickly, only to have my writing stall. My efforts to articulate the issues for the Oncology Times audience forced me to revisit certain facts and beliefs that had guided me for years. Invariably and frustratingly, my laptop's "delete" key suffered more hits than any other until insights emerged that changed my understanding of a topic I thought I knew like the back of my hand. Only then could I write something worth keeping.


Now when I open a blank document, the initial writing is driven by an anxious blend of curiosity and humility. Not knowing where the piece will go, I wonder what I'll learn. What fact or idea have I never fully appreciated? What truth have I totally missed for years?


Rest assured, when I was a young doctor caring for patients, I strived to keep an open mind and pick up every clue. But the writers' warning-You don't know what you don't know-might have helped my history-taking with longtime patients by putting me in a state of new-patient alertness that motivated me to keep...


* Looking for things I may have missed or misunderstood;


* Creating openings for patients to share secrets; and


* Checking if patients had changed their views (e.g., about alternative therapies or the wishes outlined in their advance directive).



Along with listening to patients, clinicians do a lot of explaining. A second writers' tip might have improved that aspect of my care: Let go of your darlings. Based on a somewhat cruder quote from Stephen King's autobiography, A Memoir of the Craft, that tip has saved me oodles of time while improving my writing. King's words push me to cut my emotional ties to favorite phrases and literary hooks-my darlings-that I yearn to keep in an essay, but that weaken my message or risk losing my audience.


What do "darlings" have to do with patient care? Clinicians naturally develop a repertoire of spiels that work well with most patients in specific situations. I can still recite some of mine, each filled with metaphors and examples to clarify complex ideas in compassionate ways.


If I were to return to patient care, I'd still use practiced explanations. But I'd be more circumspect, first assessing if I should modify a "darling" for a particular patient or even abandon it. My ability to let go of favorite words as a writer would free me to find better words as a physician.


Yet even the most personalized explanations can miss the mark with patients. Another writers' tip can help: Obtain feedback. The curse of writing is that I can never read my own words as if seeing them for the first time, just as I cannot listen to a familiar tune as if hearing it for the first time. Knowing this, I ask for candid feedback from my squad of readers-and I trust their reactions and criticisms.


What follows is a cycle of rewriting and obtaining feedback, again and again, until my readers report the feelings and ideas that I intended to convey. If I were a clinician again, I'd ask for feedback: "Explanations don't always work well. Please tell me your understanding of your condition and my recommendations."


Yes, I know: That takes time. Here's the thing: Misunderstandings take more time.


And today's clinicians never have enough time. Even decades ago I felt pressed to make every patient interaction productive. I'd see-saw between listening and talking, filling every minute with the exchange of information.


Then when I became a writer, I often found myself staring at my computer screen or deleting nearly everything I'd just written. One day I complained to a writer-friend after a totally unproductive day, "I made no progress. I wasted my time." She told me, "Wendy, when you're not writing, you're writing."


That writers' tip led me to my final tip for clinicians: Give patients time to process. Patients don't need the hours a writer needs. They just need a few seconds, like those provided by rests in a musical score and pauses in a motivational speech. Well-placed moments of silence help patients process the facts and ideas you just presented, so they can then ask meaningful questions. So they can remember what you say.


Whether as a writer or as a clinician, the ability to communicate clearly and with compassion offers one of life's greatest joys: to improve another's life with a few well-chosen words.