Why Doctors Need Poetry

Doctors need poetry to bring them closer to their patients. But even as I write these words I can hear my colleagues groan, “There’s an AIDS epidemic, I can’t afford my malpractice insurance, the obstetricians have stopped delivering babies, and you’re going to tell me I need poetry?”

I’ll be the first to admit that convincing physicians to read poetry in our age of evidence-based medicine is going to be a hard sell. Our premier medical journal, the New England Journal of Medicine, doesn’t discuss poetry in its editorials, and poetry will not be the focus of the next meeting of the American College of Surgeons. But I’d wager that if you ask a thousand patients to choose between two physicians with equal medical knowledge, the patients would choose the doctor who reads the poems of William Carlos Williams.

“Doc Williams”, a poet and physician, considered poetry to be crucial for our survival: “…men die miserably every day for lack of what is found there.” At times of crisis, we seek out poetry that speaks to our most intense feelings, a phenomenon we witnessed in the aftermath of 9/11. As the poet-doctor Rafael Campo reminds us, poetry incorporates the rhythms of our bodies, the heartbeat and flow of breath, rhythms as deep and ancient as life itself.

In our pre-literary history, before the written word, culture was transmitted through the language of poetry, and poetry was the language of the gods. Robertson Davies, a novelist who “detects and identifies gods in modern life,” once asked an audience of physicians at Johns Hopkins University Medical School, “What do you look like to your patients?” After allowing a moment for the audience to reflect, Davies responded, “You look like a god!” Although there are some doctors who have no difficulty assuming the godlike persona, this view is clearly out of line with contemporary medicine’s scientific, non-hierarchical, information-sharing style. Yet, as Davies points out, the great symbol of medicine, the Caduceus, belonged to Hermes, “the god of the intellect in its farthest reaches.”

In mythology, the Caduceus was created when Hermes came upon two warring serpents and thrust his staff between them. The serpents remained intertwined around the staff, always in conflict, but held in balance by the staff’s great power. And who are the warring serpents? Knowledge and Wisdom. Knowledge: Medicine’s scientific-technical domain; Wisdom: the humanistic ability of doctors to use empathy to apply their knowledge to patients, the emotional link that unites sufferer and healer. And poetry fuels empathy.

Randall Jarrell suggested we orient ourselves to a poem the way doctors might engage a patient: “…with an attitude that is a mixture of sharp intelligence and of willing emotional empathy, at once penetrating and generous.” But according to a study by J. Kenneth Arnette, Ph.D., pre-medical students begin medical training with “empathy deficits” which increase during a medical education that teaches detachment rather than generosity, and guides trainees to view people as “complex biophysical systems” rather than as individuals with their own personal histories. T.L. Luhrmann, an anthropologist, has described the way young doctors finish their internships “with new knowledge and a clear sense of the difference between doctor and patient: patients are the source of physical exhaustion, danger, and humiliation and doctors are superior and authoritative by virtue of their role.” Doctors in training (who literally have miles to go before they sleep), are nourished by the serpent of scientific knowledge, but when they learn to view the patient as “the enemy,” their loss of empathy deprives them of the wisdom to understand their patients’ suffering and shame.

Aaron Lazare, a psychiatrist and Chancellor at the University of Massachusetts Medical School, has written and lectured extensively about how shame and humiliation are universal affects people experience when they are sick. Poetry can help doctors become better healers because poems teach us to see the world from the emotional viewpoint of another person. As Steven Dobyns writes, “A poem is a window that hangs between two or more human beings who otherwise live in darkened rooms.” Poetry contains many of the aspirations doctors cherish, what Cesar Pavese called “an absolute will to see clearly,” and Czeslaw Milosz described as “the passionate pursuit of the real.” And after twenty five years as a doctor, I have come to experience the practice of medicine the way Pablo Neruda experienced poetry, a domain that includes “the decrees of touch, smell, taste, sight, hearing, the lust for justice, sexual desire, the sound of the ocean, nothing deliberately excluded, nothing deliberately accepted, entrance into the depth of things in a headlong act of love.”

Once again, I hear my beleaguered colleagues remind me they have no time for ““a headlong act of love” when care must be provided at the rate of six patients per hour. But some of my most tender moments with patients have occurred when they brought poetry to their office visit: a poem they had written themselves, a quote from Shakespeare, or the work of a poet whose words captured their emotional predicament. One of my patients discovered the poem “Wild Geese” by Mary Oliver and recited it to me: “…You do not have to walk on your knees for a hundred miles through the desert, repenting. You only have to let the soft animal of your body love what it loves…” The gift of the poem allowed me to understand my patient’s struggle in a new and more powerful way.

So here are my prescriptions. For patients, choose a favorite poem (or a poem that describes your situation) and give it to your doctor at your next office visit. For doctors, remember that poetry is like treating patients, what Wallace Stevens called, “a response to the daily necessity of getting the world right.” Or consider Sir William Osler’s advice to doctors: “Nothing will sustain you more potently than the power to recognize in your humdrum routine…the true poetry of life.” And remember, as William Carlos Williams said, “If it ain’t a pleasure, it ain’t a poem.”