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Neil Gorsuch.

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Elizabeth Hay. The Tenderness of Stones. Marion Fayolle. On the Other Side of Freedom. DeRay Mckesson. The Nature of Life and Death. Patricia Wiltshire. At Home in the World. Thich Nhat Hanh. Leonard Bernstein. Atkins, please enlighten us with the story of your patient, Mr. I presented in the time-honored way.

Black Man in a White Coat

Learning to obtain a history and present a case—in both written and oral fashion—lays much of the groundwork for the doctor-writer. On one end we have the most-objective clinical reporting and on the other, personal narrative and finally fiction. Similar to popular non-fiction and fiction, the medical record as a repository of story serves multiple purposes and has multiple readers.

All of which must be considered when leaving a note in a medical record. The histories we write lay out the clinical data upon which we arrive at our diagnostic impressions and conclusions.


What we write needs to be clear so that a colleague covering in the middle of the night knows what is going on. Just as when writing a novel or non fiction book, I need to consider my readers whenever I document in a chart. The medical record requires a particular type of storytelling. It must be factual and free from editorializing. Judgment-laden words and phrases like, patient is manipulative , non compliant , difficult, should be eliminated.

Just stick to what happened, what was observed. Even with this attention to the facts, the medical record is highly subjective. From the case presentation or case study we come to the jumping off point that separates clinical writing from narrative and fiction. For physician-authors this leap is not far or difficult. Take the following examples of a standard History of Present Illness, which is then rewritten as a personal narrative it could also be viewed as the inner monologue of a character in a novel.

Patient is a 48 year old Caucasian man brought by ambulance to the emergency room following a near fatal suicide attempt by carbon monoxide poisoning in the context of multiple recent stresses—loss of job, separation from spouse and children and severe financial difficulties. For the past four weeks the patient has experienced worsening symptoms of depression including diminished sleep with difficulty falling asleep, early morning awakening and mid-night arousal, feelings of worthlessness and hopelessness and increased thoughts of suicide with a plan to kill himself, which he attempted earlier today.

Client was discovered by a neighbor who was concerned by the sound of the car engine in the closed garage.

The Best Contemporary Fiction and Nonfiction by Doctors

Case 1: Personal Narrative:. Everything inside me feels dead. I should be looking for a job. Others got laid off—I know this—but how do you not take it personally? I feel like a total failure. I lay there, the same thoughts over and over through my head, everything is coming undone. I get up and even the television is too much. I used to laugh all the time. Every day, every hour I think about the car and how easy it would be to do this.

Once across this divide, how far we go as writers is limited only by our interest, perseverance, talent and skill. My interest as a novelist has been to take psychiatric and forensic topics and explore them in fiction. When Damon Tweedy begins medical school,he envisions a bright future where his segregated, working-class background will become largely irrelevant.

Instead, he finds that he has joined a new world where race is front and center.

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The recipient of a scholarship designed to increase black student enrollment, Tweedy soon meets a professor who bluntly questions whether he belongs in medical school, a moment that crystallizes the challenges he will face throughout his career. Making matters worse, in lecture after lecture the common refrain for numerous diseases resounds, "More common in blacks than in whites.

As Tweedy transforms from student to practicing physician, he discovers how often race influences his encounters with patients. Through their stories, he illustrates the complex social, cultural, and economic factors at the root of many health problems in the black community.

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These issues take on greater meaning when Tweedy is himself diagnosed with a chronic disease far more common among black people. In this powerful, moving, and deeply empathic book, Tweedy explores the challenges confronting black doctors, and the disproportionate health burdens faced by black patients, ultimately seeking a way forward to better treatment and more compassionate care.

In this unsparingly honest chronicle, Tweedy cohesively illuminates the experiences of black doctors and black patients and reiterates the need for improved understanding of racial differences within global medical communities. Essential reading for all of us in this time of racial unrest. Damon Tweedy is unafraid to dissect both the intriguing and disturbing elements of becoming a doctor.