May 17, 2007
Dr. Emily Transue’s ‘On Call’: Physician-author says stories enhance patient care
Dr. Emily Transue, UW clinical assistant professor of medicine, wrote On Call: A Doctor’s Days and Nights in Residency during her residency at the UW. Here she discusses the power of patient stories in patient care and the importance of leading a balanced life.
Q: Why did you write your book, On Call: A Doctor’s Days and Nights in Residency?
A: As a third-year medical student, I started writing as a way to deal with what I was going through — really new and very emotionally intense experiences — watching people die, for example. One of the things that bothered me was the fear of losing a common reference with people I was close to who were not in medicine. Writing down the experiences and e-mailing them to my friends was a way to get those experiences out of my system and to look at themmore objectively.
I continued writing in residency, which is what the book is about. The habit of writing became a part for my experience of doing medicine — to take that step back and to think about people’s stories and write them down.
Q: How important are people’s stories to their care?
A: I think they are really important. People don’t have illnesses; they have experiences in their lives of something happening to them. If you don’t appreciate what that means to them as a story, it’s very hard to understand what they need and how to help them through that. I think that seeing it as a story makes you appreciate the idea that this isn’t just a piece of pathology that needs to be dealt with, it’s an event and something that needs to be incorporated into someone’s life on a lot of different levels and in a lot of different ways. To hear it as a story lets you do that.
Q: Do you incorporate this philosophy into your teaching?
A: I’ve occasionally gotten the feedback from medical students that it seems that I’m spending a significant amount of time just chatting with my patients and that seems odd to them. But, I think in a lot of ways the connections that you build through that “chatting” and the understanding that you get of what matters to somebody gives you a lot as you’re trying to take care of them. You have to ask, “What does that person love to do?” If somebody loves to play tennis and has a bad knee, it’s really different than if the person has a bad knee and doesn’t really do anything that involves the knee. You take care of them differently. When big crises do come along, you need to be able to help people connect to what their support structure is, what they love, and what they value. Is family the most important thing? Is religion? When you’re sitting with someone and you’ve just told them they have cancer, you need to know all that.
Q: How do you find the balance between what you give and what you receive in the practice of medicine?
A: Everybody finds it differently. You have to find a way to hold on to the parts that you love because there’s so much extraneous stuff — there’s so much paperwork and just the daily frustrations of trying to make things work from an administrative perspective, and so on. You just have to find a way to hold on to the parts that really give you pleasure.
I remember doing an oncology rotation as a resident and being really unhappy, depressed and discouraged about everything. I realized that one of the problems was that I was just getting my work done and leaving. Then I started going back at the end of each day to spend a couple of minutes with each person just to chat. Even though I spent an extra half hour at the hospital, it was something that put the heart back into my experience. Sometimes it takes a deliberate intervention to revisit what brought you to medicine in the first place. What I love is the human contact, and if I’m giving that up, it’s not going to work for me or the patient.
Q: Today’s health care system doesn’t provide much time to interact and get to know patients. Are students being taught how to provide more patient-oriented care under enormous time constraints?
A: Time is always the biggest challenge — figuring out how to get done what you need to get done and still have the time for that real interaction and that deeper level of connection — that’s tough. I think that’s the hardest part of what I do.
There is value placed on developing good relationships with patients in medical training. On the other hand, there are a lot of pressures operating against it, including direct time constraints, and the movement of people in and out of health plans and insurance plans. Doctors also are much more likely to leave jobs and go here and there than they used to. So it becomes harder to have that year-to-year connection.
Q: In light of all the pressures on today’s physicians, how do you plan to survive and continue to provide the kind of care that you value?
A: I started out working full time and now I work 60 percent. That was one of the compromises for me, part of finding the balance. I had to say, “OK, I can do this three days a week, but I can’t do it all those days. It’s just too hard.” When you get really tired or burned out, you don’t want to carry anybody else’s emotional burdens and you keep people at arm’s length. To stay present and open to people takes a lot of energy and focus. It’s rewarding, but it isn’t always easy.
Also finding other things in life that give you a lot back or renew you is important. Writing for me is one of those. I think writing is a really good way to enable yourself to look at your thoughts — to take them out of your head and put them down on paper. Then you can really think about them in a different way; you can look at them more objectively. Once it’s down on paper you can have more insight sometimes into what’s going on.
I also love the teaching part of it, and I think that gives a lot back, too. We all find our ways.
Q: Other than writing, what are your other forms of self-care?
A: Music has always been really important as well — I play the piano. Having some nonverbal forms of outlet is important. During the hardest emotional times, I actually played the piano more than I wrote because it was something that I didn’t have to process as much to get the emotion out. I could just sort of pour it out through my fingers without having to formulate it in the same way. It helps to have different kinds of outlets in your life, because the nurturing you need varies at different times.
Q: As a clinical assistant professor, what’s your advice to your students in terms being a good doctor?
A: I think that the best way to teach is to have students be with you and show them what your version of good doctoring is. They’ll take what they can from that. I’ll probably have things that they don’t agree with — and they’ll take something from that, too. Clearly, I really do love what I do and showing people that is important and more powerful than telling it to them.
The biggest pieces of advice that I have are really that people need to find what they love and do what they love. Medicine can be really a hard profession. I think the thing that sustains you in it is the love of what you’re doing.
Q: You also teach a writing course for medical students. What’s the name of the course?
A: The course is called “Medicine 555-Mind, Body, and Pen.” I co-teach it with two medical students. Each week we have a syllabus with writings about a particular topic. There will be a discussion around the topic and then people write during class. Students can then read aloud. It’s not a writing techniques class; it’s really designed as a way to provide an outlet for people to think about and talk about the things they’re going through and the experiences that they’re having. Usually, during the first class everybody always says something like they haven’t picked up a pen since they were an undergraduate and can’t imagine actually writing anything. And then, of course, they write all these beautiful things.
Q: You started writing your experiences in medical school in e-mails, and now you’re a well-known published author. Was that surprising?
A: It’s very surprising. When my first book came out, it had not occurred to me until it was actually in the hands of a patient in my office that my patients were going to know about it and read it. I don’t know how that slipped my attention. But the response has been very positive. And now I’m working on a second book, which should be out next year.
I think it’s another example of if you follow the things that call to you, they’ll take you somewhere. You may not know where that’s going to be, but doors will open if you follow the thing that you love. I certainly didn’t sit down to write a book. But these things seemed to need to be written down, so I wrote them down and then things followed from there.
On Call: A Doctor’s Days and Nights in Residency (St. Martin’s Griffin, 2004) is available at the University Book Store and other bookstores in the Seattle area.
