A Body of Work: An Anthology of Poetry and Medicine edited by Corinna Wagner and Andy Brown (Bloomsbury, 2016)
Following our initial call for clinical and academic reviews of ‘A Body of Work,’ Dr Marion Lynch offers her perspective as a Deputy Medical Director at NHS England. You can see the accompanying review offered by Dr Ashleigh Blackwood here.
A Body of Work is a timely publication and adds to current debates on how we embrace twenty-first century medicine, such as developing medical education and supporting continued innovation. The structure of the book is organised into eight clinical subjects and themes — allowing the reader and teacher to locate suitable supportive pieces of poetry and prose. This book has already been used by NHS England and Health Education England in attempts to influence patients’ and colleagues’ well-being, as well as clinical education processes and policy. Clinical educators and policy leaders have developed the theories to inform the training of GP Trainers, included in the work with people with diabetes, and a range of poems in the work on education for dementia. The educational opportunities from the book will be featured in three medical education conferences in the Autumn of 2016.
Poetry helps us make sense of paradoxes. The metaphors and multiple meanings presented as truths bound up in meaning of illness in our lives and we are surrounded by paradoxes. As always we will start with the patient paradox: As healthcare professionals we aim to cure and care, not harm and scare. However, as the poets point out, sometimes those in most need are neglected, and even if they do receive treatment, this may be the wrong answer. Such dilemmas can be difficult to define and discuss. Poems give us the language to do so. For example the anthology enables us to take a poetic approach to patient care by sharing experiences in a format not possible with clinical language. For example the experiences shared through ‘My Mammogram’ (p. 270) and ‘Having it out with Melancholy’ (p. 115) bring the lived reality of suffering and sadness to life.
The poems ‘In the ‘Theatre’ (p. 333) and ‘What I Would Give’ (p356) are poems that express similar calls for human-to-human contact. This is our reality and influences how we are as a person, professional and educator. We need the skills to apply our knowledge and heed the message that, regardless of your context, country or educational content; “Educational change depends on what teachers think and do—it’s as simple and complex as that” (p. 9). Clinicians are immersed in stories from their patients and colleagues, balance taking a history and hearing a patient’s story. To connect with patients we need to be clinically competent and compassionate both in the personal consultation and in the political setting. Arthur Kleinman (1988) states that we need to ‘move beyond clinical interrogation to listen attentively to their patients’ narratives of illness’. This may be via poems, which show us how to see other views. Policy decision makers may be helped to understand the consequences their choices (Steiner 2005). Alternatively, sometimes it is preferable to not overtly know the clinical picture and to put intuition and uncertainty above such reason and knowledge. Our reality is never the same as another’s reality and poems allow us to hold these multiple truths.
As our health demographics change to living longer but not necessarily healthier lives (NHS England 2014, Stubbs 2016), our role may be to bear witness to the story or ‘be’ with people rather than fix them We need this capability. Poetry can help. No one must fix a poem, we are encouraged to just be with it and all interpretations are valid. Such an idea may be strange to health professionals. As educators our writings on capability often include competence and this is no exception. Narrative competence is defined as ‘the set of skills required to recognise, absorb, interpret and be moved by the stories one hears and reads’. Such competence comes from connecting with poems (Charon 2004: 863).
Poetry enables you to appreciate other means, see experiences of illness in the context of a person’s life. The book is a text, the poem a text, the patient a text (p. 2). A text is anything that can be interpreted and there are many ways to read it. By reading poetry one notices the shifting context of a text, not the static content of a text. Roland Barthes in Death of the Author (1977) (p. 2) announced the birth of the reader, arguing that texts gain meaning from the point of view of how they are received and interpreted.
‘Alzheimer’s’ by Bob Hicok (p. 113) speaks as an adult with their parent. Such ways of capturing caring or suffering and connecting with a condition with sense and sensibility is happening with our patients all of the time. Introducing the idea of poetry triggered further curiosity and so we found Andy Tysoe and others on Twitter. He so struck by the words of a person with dementia he wrote a poem, he shared the poem with the family of the patient and created a positive memory. This poem went viral via NHS Fab Stuff tweets. David Gilbert, a Patient Director and part of Patients as Partners has been sharing a poem a day to highlight his experiences of health and health services. General Practitioners have been sharing a Haiku a day to express their feelings too.
Through reading and writing poetry patients and professionals may share how they see things differently and explore the consequences of each other’s actions as such I have used this book in mental health clinical education to explore the mind and body. This book will help the readers appreciate this aspect of interpretation, this aspect of humane care. Poetry, as Coleridge said is all the best words in the best order. We may put the passion and the person back into the professional. the policy, the care plan, the person centred care.
The purpose of medical education is to benefit patients by improving the work of doctors. Patient centeredness is a centuries old concept in medicine, but there is still a long way to go before medical education can truly be said to be patient centred. Ensuring the centrality of the patient is a particular challenge during medical education and is crucial in particular when students are still forming an their identity (Bleakley et al. 2011). Poetry can enable teachers, policy makers, researchers and clinicians to put the patient at the heart of their work and this anthology makes it possible.
Reviewed by Dr Marion Lynch, an Associate GP Dean with Health Education England and Deputy Medical Director for NHS England South Central, the middle of England from the M25 to Wales. She is responsible for designing and delivering clinical education as well as leading the systems and processes which assure the public that GPs are up to date and fit to practise. Her doctorate challenged the current approaches to medical education and the expected outcomes and explored how poetry can help. She races big sailing boats which results in big bruises and small wins. She originally trained as a nurse and a public health specialist.
Works cited:
Bleakley A, J. Bligh, and J. Browne. 2011. Medical Education for the Future: Identity, Power and Location: Springer.
Charon, R. 2004. Narrative and medicine. New England Journal of Medicine, 350 (9): 862–4.
Kleinman, A. 1988). ‘The Illness Narratives,’ in J. F. Steiner, (2005) The Use of Stories in Clinical Research and Health Policy. Journal of the American Medical Association, 294 (22): 2901.
NHS England. 2014. Five year forward view.
https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf.
Stubbs, E. 2016. Health of the Nation. Civitas. London