Why Physicians Write?

“Medicine is my lawful, wedded wife, and literature is my mistress”

– Russian physician-writer, Anton Chelrhov

I finished reading Paul Kalanithi’s “When Breath Becomes Air” recently and just started Siddhartha Mukherjee’s “The Gene”. I’m a big fan of Atul Gawande and Abraham Varghese too and have read most if not all their books. I wondered whether being Indian American doctors gave these Physician-writers some unique perspective that doctors of other ethnicities didn’t have in writing absorbing medical non-fiction.

Although I suspect it could just be a case of confirmation bias there’s no denying that in the last decade, popular medical non-fiction is dominated by authors who are Indian-Americans.

A few common characteristics of these authors possibly responsible for their success other than them being Indian-American :

• US is a behemoth in the publishing industry. The sheer marketing muscle of the US publishers is no match to many of their counterparts in other countries.
• All of the doctors in the list have had some training in writing. The US medical school system needs at least a 4 year university degree to qualify for medical school. For example Paul Kalanithi was MA in English Literature before he embarked on a career in medicine.
• All these physician-writers are either alumni of Ivy league medical schools or teaching in them. They are already in a position of influence and hence taken very seriously. Of course all of them are talented and high achievers which is why they have reached those positions of influence. For example, Siddhartha Mukherjee is a Rhodes Scholar who is Alumni of both Stanford and Harvard.
• Pedigree. Most of these physician doctors with the exception of Siddartha Mukerjee are all second generation Indian- Americans – sons of Indian immigrants (most of them doctors themselves). Probably a perspective of a clash of the cultures along with heavy doses of medicine-talk in the family is responsible for the writing streak in these individuals.

However the deeper question is Why do physicians write?

Practice of medicine and writing share many commonalities. Physicians and writers are both curious about people. Both feel the need to communicate their thoughts to others. Arriving at a diagnosis for a physician is much similar to constructing of a plot by a novelist. Both combine their own knowledge, experience, understanding, analysis and creativity to develop a narrative that seems plausible. Both construct the human story– one in the clinic and the other on paper/typewriter/computer. A case report in a medical journal can be just as engaging in a general magazine read by lay people if it excludes tech-speak as is present in academia. A good doctor and a brilliant novelist often have similar communicative skills and analytical minds. A marriage of these two professions is sometimes inevitable.

Storytelling forms the very basis of medicine. We doctors listen to patients stories, construct a narrative and tell other doctors those stories (case presentations, studies and case reports) comparing notes with existing scientific data and collective knowledge (conferences and peer-reviewed journals). Physicians are witnesses of human drama- life, death, suffering, fear, pain and joy- every day. This theater that plays out in front of them sometimes finds catharsis and bleeds onto paper.

Lay persons are often curious about the life of doctors and are often intrigued to know their perspective about life, health and disease. Accomplished doctors writing about things that they know about-the inside story, the clinician’s view- is what people love to know and hence the popularity of medical themes in popular media-movies, TV and print.

In the grand tradition of physician-writers, every generation has had its own set physicians picking up the pen. The examples are numerous from Hippocrates to St. Luke, Antony Cherlhov to William Osler. Arthur Conan Doyle, Sigmund Freud, Carl Jung, Albert Schweitzer, Somerset Maugham, Che Guevera, Micheal Crichton, Robin Cook, Khaled Hosseini, Oliver Sacks, Rajat Deshpande. The list of physician-writers is endless. The present crop of popular physician-writers who write on medical themes are probably some among many. As long as medicine remains a human profession there will be more stories to tell.