When he visited UAB last year, Abraham Verghese opened his talk with the statement that if one no longer read fiction, the brain would die. His strong words offered reassurance that at least some medical professionals value literature. Further, the statement suggested that he makes time for it and would allot time for it for others. Indeed, at Stanford, he spends his afternoons brainstorming within a thinking room instead of a laboratory. Verghese’s declaration also intimated an underlying concern that too few people read fiction. Numerous obstacles in undergraduate medical school and on clerkship engender the atrophy and withering of many students’ and doctors’ brains. They are not razed because the value of reading fiction escapes many practitioners.
Maintaining, let alone building, the habit of reading fiction often decays once a student enters medical school. The first two years represent a continuous cram session of biochemistry, physiology, pathophysiology, pharmacology, and epidemiology. Mornings consist of lecture while afternoons and nights fill with reading transcripts, scribbling notes, listening to audio recordings of lecture, and reading textbooks. Students struggle to make time for exercise, social activities, and time for family and friends. Reading fiction likely does not even rank as a priority. On clerkship, students encounter many similar responsibilities. They spend early mornings and late afternoons rounding on patients, presenting to attendings, performing procedures, and, at night, reading research and journal articles. Reading and composing histories and physicals and progress notes exert the same deleterious effect — they promote skimming, the employment of jargon, and fragmented compositions. Some of these habits carry over into other forms of reading. Many who read online develop the F-pattern, which some argue is just another form of skimming. After a long, fatiguing day in the classroom or on the wards, few students find reading research or journal articles easy and instead skim. Further, especially for students in their first two years of medical training, only a small number deem reading, even fiction, a recreational break or respite, after having spent most of the day reading notes and textbooks. Studying and reading are inherently asocial activities, and, thus, reading more, lengthens that isolation. Few residents and attendings discuss reading fiction. They, too, face time-consuming duties and likely do not find time for it. Since reading fiction often connotes reading for pleasure, some go further and contend that it squanders time better spent learning more about a disease or treatment. Hence, a culture in which fiction is not read springs forth, and alternative reading materials and styles become entrenched.
Reading fiction only appears to lack immediately tangible pragmatic use superficially. Its breadth of application and permeation of cognition make it seem diffuse and nebulous. Reading fiction sharpens the use of language and enables readers to see and understand the interior lives of characters and, by extension, real people. When she submitted her first paper to her professor at the School of Public Health for feedback, a classmate observed that the professor expressed happiness that the draft was in complete sentences, citing that many submissions from doctors consisted of bullet points. The habits of the workplace had spilled over into other professional domains. To forestall such developments, reading, depending on one’s choice of fiction, immerses readers in the richness and, critically, the fullness of language that is lost in the haste of the medical classroom and workroom. The qualities derive from the deliberation of the authors and the revisions of the editors. Diction and syntax are chosen, evaluated, and then amended. The reader receives a polished product. In contrast, rounding and clinic notes by design deliver information fast in merely sufficient form. Journal articles, though they go through an intense revision process, concern themselves with data and outcomes, not clarity of expression or penetrating insight, and bound themselves with obfuscating jargon. Subsisting on such documents for one’s reading material consigns oneself to mediocrity. Aspiring writers are urged to read writers they admire—the implication being that they will adopt the style and substance of their role models. Effective communicators do likewise in their choice of reading. Their speech and writing improve because they surround themselves with quality speech and writing.
Many doctors and students are accused of losing touch with the humanity of their patients and reduce themselves to treating disease while the patient benefits incidentally. Endeavors such as humanism in medicine have arisen to combat these ills. However, their broadness leaves them open to dismissal. The hardened, driven physician or student sees little immediate point in the apparent flimflam of humanism, declaring that of course each person is human. Moreover, humanism is not apt to appear on an exam or to be billed for by insurance. However, reading fiction supports the thrust of humanism and has tangible effects on the business of medicine and the hurdles of training. The reader of fiction attunes himself to the mental workings of characters. An extreme, and some, even English aficionados, would deem punishing, example would be a Henry James novel in which little external action occurs but, in painstaking and sometimes painful detail, shifts in characters’ thoughts, motives, and emotions are recorded and examined. Assimilation of such texts serves as practice for real interactions with patients. In an old story, surgeons who face the most malpractice suits are those who have the worst bedside manner, not those who make the most mistakes. Hence, a humanistic skill has noticeable effect on business and medical outcome. Movies and TV shows often struggle to capture the interior lives of characters and thus cannot function as a substitute. They can only depict externalized manifestations. One of the criticisms of the well-regarded film The Far Side of the World contended that a main character, the naval surgeon Stephen Maturin, was too vocal and active in comparison to his literary depiction. The filmmakers could do little else though to portray Maturin; when the novels feature heavily his inner monologues, film can only translate them into vocalizations, thereby changing the fundamental nature of the character into someone new. And doctors and students well know they do not regularly treat telegenic patients. To prepare for the patient not ready to express every single thought on his or her mind, one reads fiction so that one may become proficient in inferring from expression, body language, and experience gleaned.
The field of medicine, largely due to the volume of work, paucity of time, and competing traditional activities, renders itself unfriendly to reading fiction. Verghese employed such strong language to convey his adamancy about the necessity of reading fiction. Perhaps the brain does not die, but a significant part of it atrophies and the owner of that brain loses important skills in expression and in their ability to treat patients effectively. Lastly, reading fiction is fun. When away from the professional repercussions and alone simply with one’s personal inclinations, how many doctors and students pick up the New England Journal of Medicine instead of The Hunger Games?