They figured they had better offer a few carrots when they first decided to start a book club for physicians in 1989. So the founders in the Division of Medical Ethics, jointly sponsored by the University of Utah School of Medicine and LDS Hospital, told would-be participants, "You can bring your spouse," because heaven knows a medical practice never leaves enough "couples" time. "And we'll feed you."
Nearly 20 years later, the book club, inspired by one at the University of Chicago, thrives, drawing close to 20 people each month out of a pool of dozens of participants. Occasionally, a spouse comes, but most attendees are psychologists and neurologists, anesthesiologists, ophthalmologists, pediatricians, gerontologists, plastic surgeons, nurses, residents and other health-care providers.
They come for the discussion lively, thought-provoking and, usually, medicine-centered, even if the book under review is not. They draw parallels to their practices and their doctor-patient interactions.
The discussion group is a place where physicians have ethical discussions they might not have easily elsewhere, says Dr. Jay Jacobson, an infectious disease expert and medical ethicist, who helped found it. Often-taboo topics are safely couched in literature.
The book "Atonement" by Ian McEwan, for instance, centers on a mistake and everything that flows out of that mistake. "We make mistakes in medicine, and they're difficult to talk about and acknowledge," Jacobson says. "How do we come to grips with mistakes? Conceal them? Disclose them? Tell a partner? The book is not about medicine, but it is about human experience."
That kind of thoughtful consideration is the goal, actually. The description of the "Physicians Literature and Medicine Group" says, "The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice."
The goal, it concludes, is to offer "fresh opportunities for respectful, empathic and nourishing medical care."
In the book club setting, which moves around a bit to make all practitioners feel welcome, physicians and others talk about their successes and failures, their concerns and anxieties.
"The doctors get together and talk about large human issues," says U. English professor Brooke Hopkins, one of the longtime moderators.
It's also a chance for physicians to meet others whose paths they might not normally cross, Jacobson says. "Once in a while we get lucky and get some medical students and residents who heard about it and manage to find time to come. They bring fresh perspective, although they don't have as much experience yet. One may be fearful of an encounter of a kind they haven't had yet, but around this table, there are people who have had that experience."
Good books tend to "tease out the complexities and the obstacles to communication," says Therese Jones, associate professor in the Department of Internal Medicine, who coordinates the group. "Good literature, art, even film puts us all in touch with our stereotypes and prejudices. I think often we don't know why we have a reaction or think in a certain way about a person, until we look at ourselves. Art gives us the opportunity to look at that.
"I think it's an opportunity to consider in a more thoughtful and reflective way the experience of illness, rather than the presentation of disease. This enables everybody at the table to investigate all the dimensions of human experience psychological, spiritual, social. All those things you and I bring with us when we go to see a physician but find difficult to talk about or are not often asked about."
In Pat Barker's "The Ghost Road," a psychologist wrestles with the ethical dilemma of helping traumatized soldiers recover so that they can go back to war. In "Slow Man," J.M. Coetzee's bicyclist character is hit by a car and must undertake a slow and painful recovery. The essay "About Alice" is author Calvin Trillin's memoir of raising children with his remarkable late wife. It's all fodder for discussion.
"I enjoy hearing what people's opinions are," says Ann Wennhold, a retired psychiatrist who has attended for years. "The school I went to was very involved in colloquia, discussions, reading. It's something I really enjoyed a lot."
Each year, Jones and other facilitators, many of them from the U. English Department, select a theme and the books, then announce the reading calendar. Occasionally it's a play or poetry or even a film. The facilitators do not "lead" discussions.
"There's a difference between an English professor teaching a book and this," Jones says. "Because everybody around the table is a grown-up and has had incredibly rich life experiences, it's a matter of presenting a little background of the book, then kicking it off with an opening question and watching it go."
And go it does, says Jacobson, discussion wending its way through ethical dilemmas and shared experiences and memories of patients and situations and victories and regrets.Information about the group is online at www.utahmedicalethics.org.
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