by Betsy Burtis, Manager of Training and Development at
Southern NH Health System
They come from all over the hospital: Central Scheduling, Pharmacy, Lab, Labor and Delivery, Patient Education, E.R., Cancer Care. They are nurses, obstetricians, pathologists, social workers, VPs and Executive Assistants. They have the same mission of care but are virtual strangers, even though they may have worked side by side at this same hospital for years. With over 2,000 employees, it’s not easy to really get to know your colleagues, but here in this room once a month something new is happening. Here, they gather, break bread together and discuss ideas and emotions that they may rarely share with anyone else. This is the tableau of Literature & Medicine: Humanities at the Heart of Healthcare at Southern New Hampshire Medical Center.
Hospital cultures are hierarchical and rigid. Among physicians a certain sense of privilege reigns, the healthcare version of the ivory tower (sometimes called the “God Complex”). Nurses are the perceived “real” caregivers and often roles are defined along gender lines. The Literature & Medicine program is designed to gently rattle those towers and shake up those categories. Here in the reading and discussion room everyone is on a first name basis. Individual insight is valued, listening is a virtue, stories take on relevance as readers express their felt response to them, and mutual respect emerges from shared experience, shared mission, and multiple interpretation of the text (and by extension, the patient). To help ensure impartiality and the smooth flow of conversation, the Humanities Council arranges for a non-employee facilitator to help guide the discussions. In many cases, the facilitator is a scholar who brings wonderful insight into the literary side of the discussion.
Research into patient care and patient and employee satisfaction shows that, in simplistic terms, happy employees create happy patients. In turn, happy patients have better clinical outcomes. Part of what drives employee satisfaction are good working relationships and good communication among colleagues. Discussions about literature help promote that positive communication. When you have talked animatedly with someone over dinner about the moral philosophies of authors and their characters, and your own passions and beliefs have become a part of that dialogue, it becomes much harder to bellow at that same person for not passing the scalpel fast enough. As healthcare practitioners learn to work together more respectfully and relate to one another at a deeper level, they also begin to treat patients as people with particular lived experiences and stories, which results in more empathy, more respect for the human condition.
Two books that generated powerful discussions at SNMC are The Diving Bell and the Butterfly by Jean-Dominique Bauby and Final Exam by Pauline Chen. The Diving Bell and the Butterfly is a memoir by a former editor of the French magazine Elle, who at age 43, had a massive stroke that left him suffering with “locked-in” syndrome. He was paralyzed from head to toe and couldn’t speak; the only way he could communicate was by blinking the one eye that was not paralyzed. The book tells of his experiences and thoughts following his stroke written through the painstaking process of dictating to an interpreter by blinking. It is an intensely personal book and evoked a wide range of emotions in our readers. Our discussions probed the meaning of courage, the issues around assisted suicide, the definition of family, and whether socialized medicine works, all topics which impact the care we give patients.
Final Exam is written by a transplant surgeon as she reflects on mortality, both her own and that of her patients. The book opens with Dr. Chen’s sharing her experiences early in medical school with her first cadaver. This issue generated heated dialogue about the training medical students receive, both technical and emotional. We debated the necessity of hardening your heart so each death or other bad outcome can’t tear you apart. What is the appropriate level of caregiver empathy to show? How much personal information should you share with a patient? Dr. Chen writes that each caregiver will experience causing a death, either directly or indirectly. We discussed guilt, and whether blame should be assigned. We shared our feelings of working in a system where “human error,” (the kind we all make on a regular basis) can cause death, and because of the nature of our work, how unforgiving of error our healthcare culture is.
Storytelling impacts our understanding of concepts and our motivation for learning and change much more significantly than a step-by-step list of instructions. This is what makes Literature & Medicine so effective and compelling. We share the story as told by the author, and we share in our colleagues’ experiences by listening to the stories they tell as they relate to the book. Our facilitator encourages us to share stories, in part by providing questions to launch our discussions, but her lack of knowledge about the inner workings of healthcare and her curiosity about the process provides us with a reason to share our own stories. One pharmacy employee shared her story of making a medication error that could have caused someone’s death. She caught the error before it went to the patient, but still harbors feelings of guilt at what could have happened. Another colleague who works in the lab talked about what it is like to be the first to know of a person’s diagnosis of cancer, and yet never have the experience of meeting the person face-to-face.
For many involved in the program, there is nothing more enjoyable than sitting around a table talking about books with people who are thoughtful, intelligent and open. But this program is much more than a book discussion group. The shared stories bring about a deeper understanding of the part we all play in the patient experience and helps people gain appreciation for the work others are doing. It may be the closest we each come to “walking a mile in someone else’s shoes” and ultimately that improves communication, teamwork, and our ability to care for patients with compassion.
The New Hampshire Humanities Council has taken our promise to help create a healing environment to heart through Literature and Medicine, our hospital-based reading and discussion series. The project has ambitious goals: to build collegiality and team cohesion, to increase empathy and communication skills, to investigate tradition-bound roles that hinder best practices, and to refresh the healthcare environment.
With the help of a grant from the Endowment for Health, support from the National Endowment for the Humanities, and with additional funding from our new program partner, the New Hampshire Medical Society, the Humanities Council has sponsored programs at healthcare facilities across the state including New Hampshire Hospital, Littleton Hospital, Concord Hospital, Parkland Medical Center, St. Joseph's Hospital, Southern New Hampshire Medical Center, Dartmouth-Hitchcock Medical Center in Lebanon, and Lakes Region General Hospital.
Linking professional development to non-clinical knowledge is not a new idea, but using great works of literature as a filter through which medical personnel can approach difficult subjects safely and profoundly is unique.
Hospital staffs meet regularly for conversation, to refresh themselves with fun and intriguing discussion of literature, and to grapple with questions about the human condition. A specially trained humanities scholar serves as the facilitator for all discussions and anyone is welcome to participate - doctors, nurses, pastoral counselors, ethics committee members, volunteers, administrators, and support staff.
Program evaluations have indicated that a stronger connection between the world of medicine and the world of lived experience leads to deeper competency in understanding cultural diversity; it breaks down entrenched hierarchies and cliques; and helps transform the healthcare environment into an arts and humanities-friendly space. Ultimately, the discussions promote a healing environment – a goal we can all take to heart.
For more information on Literature and Medicine programs, please contact Kathy Smith
at 603-224-4071 x15.
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