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Doctors who write

By The Book

THIS STORY APPEARED IN

January 22, 2012|By Suzanne Koven

(matthew callahan/globe…)

The day I graduated from medical school, a family friend who’s a nurse handed me a gift-wrapped megapack of Bic pens. “You’ll need these,’’ she explained. “Doctors write a lot.’’

In the 25 years since, keyboards have mostly replaced pens, but what she said has held true. Daily, I write visit notes, progress notes, admission notes, death notes, and letters to patients and colleagues. There are few other professions whose members do so much writing.

And - surely this is no coincidence - is there another profession outside of writing that has produced so many great writers? Rabelais, Keats, Oliver Goldsmith, Thomas Browne, Chekhov, Conan Doyle, Somerset Maugham, Carlo Levi, William Carlos Williams (who wrote poems on prescription pads), and Walker Percy were all physicians. Today, it seems, more doctors are writing than ever.

All doctors - whether they are published authors or not - share a common narrative heritage: the case history. The case, an arcane and rather stilted recounting of a patient’s symptoms, physical signs, and lab data, has been taught to every first-year medical student for well over a century - and has roots going back at least to ancient Egypt, from where the oldest known written medical histories survive. One such case, written on a papyrus in hieroglyphs, translates roughly: If you examine a man with a head wound and the skull isn’t split open then you should apply meat, grease, honey, and lint every day until he recovers. If you go to the emergency room with a closed head wound today, the treatment will be a bit different but the format of the written record of your case will resemble that of the unfortunate ancient Egyptian’s: identification of the patient followed by a description of his particular problem, and then a proposed plan.

The format of the case history is nearly as rigid as that of the sonnet or villanelle. First comes the “chief complaint’’: A 60-year-old man comes in after one hour of chest pain. Next is “history of the present illness’’: He’d felt well until earlier in the day, when he became short of breath while shoveling snow. Then there’s the “past medical history’’: He’d had hypertension for many years, as well as diabetes and high cholesterol. And, finally, after an accounting of the patient’s lab and X-ray results, comes “assessment and plan’’: The patient was admitted to the coronary care unit where he was found to have had a myocardial infarction.