Hi, everybody. We're going to go ahead and get started. Thanks for being here. Today, we have a great privilege of getting to hear from Dr. Suzanne Koven about bringing books to bedside and how literature might be able to save medicine. So it should be a great talk. 

But to give a brief introduction of Dr. Koven, she is an assistant professor of medicine at Harvard Medical School, the Writer in Residence at Massachusetts General Hospital, and also serves as a primary care physician in the Partners Health System in Boston. She got her MD from Johns Hopkins. She stayed there for internal medicine residency, was a chief resident there before migrating north to Boston to join the Harvard system. She got a master's of liberal arts and creative writing and literature from Harvard and went on to get an MFA from Bennington Writing Seminars in Bennington, Vermont and has kind of taken her Writer in Residence position to a really dynamic group of exercises across the Harvard system and currently serves on the Executive Committee on Arts and Humanities Initiative for the Harvard Medical School. 

Her publication "Letter to a Young Female Physician" got tons of acclaim in 2017 as The New England Journal editor's pick for one of the articles of the year. And over the last couple weeks, the internal medicine residents have used this article to talk about the dynamics of imposter syndrome. And Dr. Koven was with us yesterday for our medicine noon report to talk about imposter syndrome. So please join me in welcoming Dr. Koven in what promises to be a great talk. 

[APPLAUSE] 

Well, greetings from the Great North where it's 53 degrees and raining. Thank you, Sumner, and thank you, Dr. Becker, for inviting me here and making me feel so welcome yesterday between the resident report and several meetings with faculty. I met engaged, interesting, warm people. And I just can't remember-- so stimulating and enjoyable a day. It was very special for me. And you got yourself a really special community here, so kudos. 

Now, at the resident report yesterday, I said that I used to say that I was a primary care doctor who added on a second career as a writer. But I stopped saying that because, in recent years, I've seen these two things as not different. I've seen them as really two parts of the same fundamental base, which is storytelling. So it seems only appropriate that I should begin by telling you a story. I'll steal a line from one of my colleagues who said, I have nothing to disclose other than that I sing show tunes in the shower, which is also true of me. 

So here's the story. It's one I heard many, many years ago when I was a medical student. And it concerns an intern who was very, very unhappy. I know this never happens now, but this was a long time ago. 

And as the year went on, he became more and more miserable. And by about April or May, he found a way to express his misery, which was that he started carrying around a novel on morning rounds. And when he was feeling particularly alienated, as the patients were being presented, he would lean against the wall and read. 

Now, I don't know 100% for sure whether this story is true. By the way, this was the novel. 

[LAUGHTER] 

It's sort of a great brick of a thing, one of those unread classics of literature. Here's the plot. A young man wants to be a painter. He realizes he has no talent, so he goes to medical school. That doesn't work out either, so he becomes a shoe salesman. And that actually doesn't work out very well either. 

So I don't know if the story is true. And I can't say which aspect of this novel in particular spoke to this unhappy intern if it is true. What I do know is that the implication of this story as it was passed around was that there was no more seditious thing an intern could do than bring a novel into the hospital. 

This is no longer true. And, in fact, here and at Harvard and at Columbia and in India and in Sweden and really just about everywhere, there are medical humanities programs, literature and medicine tracks, and so forth. And yet, even as these programs have proliferated, it's still not been entirely clear what the role of the humanities is in medical training and practicing. 

And this became abundantly apparent a few weeks ago when this article came out in JAMA, which some of you may have seen. "How to Fix the Premedical Curriculum, Another Try." The proposal in this piece was that pre-medical students should not be allowed to be pre-meds. No science majors need apply. 

And the author was riffing off of a New England Journal essay from 40 years earlier by the great essayist and medical scientist Lewis Thomas, who wrote a piece called "How to Fix the Premedical Curriculum" in 1978. His proposal was even more draconian. He argued that, in fact, pre-meds were ruining liberal education. 

And somebody is nodding. Yes, they are. I was in college at the time. And I remember what was called grim pre-professionalism, the idea that the great universities were being turned into farm teams for trade schools. Yes. "The influence has been baleful and malign, nothing less." 

Now, Lewis Thomas didn't get any response on Twitter. But those who wrote the piece in JAMA did. And here was a case where Android and iPhone seemed to be in great agreement. There was a lot of pushback. 

So iPhone said, "A simplistic solution. Doctors are not more compassionate because they read Homer in the original Greek. That trait is probably already entrenched before they begin their undergraduate career." And Android had a thing to say about Homer as well. "How about the fact that I love science? I chose a bio degree because that's what I enjoy. Compassion, empathy, art of medicine. I've learned through curriculum, volunteering, social interactions, and actual life changing events, not reading Homer's Iliad." 

Well, I personally think that college students should be allowed to study whatever they want to study. However, this talk today I hope will persuade you that Homer is anything but irrelevant to medical training and practice. And that's my message today. 

Now, it's worth noting that the conversation between JAMA and Dr. Thomas over the past 40 years extends, in fact, hundreds of years before that. And it has to do with two strands in medicine, which were particularly distinct before the Flexner Report in 1910, which was that you had physicians-- and they were all men, by the way, so I'll use he-- physicians who were educated men, who knew Greek and Latin and Homer and Shakespeare, and then uneducated journeymen essentially. 

And this isn't ancient history. My own great uncles, my grandfather's older brothers, went to NYU Medical School at the turn of the last century as teenagers having never gone to college. They were uneducated men. And a medical historian colleague of mine tells me that in the 1870s, a proposal was brought up that written exams should be administered at Harvard Medical School. And it was rejected because too many of the students were illiterate, which is a historical tidbit that some may find satisfying, especially if you, like me, were rejected by Harvard Medical School. 

Now, the University of Virginia has a chapter in this saga. And it concerns Thomas Jefferson's physician, Robley Dunglison, who was quite passionate about the idea that medical students should study history and particularly the history of medicine. And his grandson, from whom this preface is drawn, compiled his lectures, which, for many years, were part of the UVA medical curriculum. 

Now, I don't know what Dr. Dunglison was trying to fix. He doesn't use the heading how to fix the early 19th century medical curriculum. But clearly, the impulse to bring humanities into medical training and practice is coming from a desire to fix something. 

So I ask you, if you were thinking about some stuff in medicine right now that needed to be fixed, what would you think would be on the list of things that need to be fixed in medicine right now? 

[INAUDIBLE] 

OK. So we need more humane working conditions, particularly for trainees. Effective feedback and mentoring. The cost of medical school. 

The cost of board exams. 

The cost of board exams. How about-- 

[INAUDIBLE] 

Right, by which you mean epic. 

All right. 

All right. OK. I fixed it. Yes. 

Yes, time crunch. And then how about not just from our perspective as trainees or physicians, but medicine broadly drawn including from our patients' perspectives? 

Cost, access. Good list. OK. Something is out of whack in our beautiful profession. 

And these are among the things that make it feel out of whack. Provider or caregiver burnout and patient burnout and family caregiver burnout, by the way. Cost of medical education and of health care. Health disparities. Our relationship to the computer screen. And I also thought about fragmentation of care. 

Now, some of you in this room are already working on these problems. Some of you will be working on some of these problems. For me-- and we all have to, I think, work on the aspect of improving our profession that we feel passionate about individually-- for me, what underlies all of these things is a deterioration in the quality of what's going on between the clinician and the patient. And that came home to me in a single interaction. And I wrote about it. 

What happened was a few years ago, a patient of mine came in, a woman in her 30s. She'd had a little diarrhea on and off. It wasn't comfortable, but it certainly was nothing tragic about it. And as she was describing her symptoms to me, she was on the verge of tears. And she was literally sitting on the edge of the exam table, her posture mirroring her emotional state. I was sitting on the edge of my seat, my posture mirroring my emotional state, which consisted of this. 

If I asked her what was really wrong, I would fall hopelessly behind. I would have a terrible day. And I would get more burned out. If I didn't ask her what was really wrong, if I gave her some Imodium and a cup, then what was I doing there in the first place? And I would have existential angst, which would make me more burned out. 

Now, my antidote for this, which involves, in a way, all of these problems that we've mentioned contribute to that moment, and everybody in this room who practices has experienced this moment in some form. Do I want to open myself up and risk engagement? Or do I want to close myself off and risk loss of meaning, not to mention not helping the patient? 

Well, my personal antidote to this moment of crisis is literature. And some 10 years ago, I started leading a literature and medicine discussion group at Mass General. And we have just expanded and expanded and expanded, and it's across roles. And we meet in a room adjacent to the hospital cafeteria under the fluorescent lights, and we eat cold, mediocre pizza. And it is magic. 

We read things that are medical. We read things that are not medical. And, yes, I inflicted Of Human Bondage on them after we had been at it a few years. 

We send out surveys twice a year. And the participants report that they feel an increased sense of collegiality, job satisfaction. They feel more compassion for patients. And they feel a renewed sense of connection to the reasons that they entered the medical profession. 

Now, I've asked myself many times why this should be. And there's a fair amount of literature about this. And most of it involves the word empathy. And you've probably seen these sorts of articles in the lay press and in the medical press that reading, particularly reading fiction, makes you more empathic, makes you just a better person. 

And I think that's true. But still, I wonder why it would be true if it's true. And I think that the writer Leslie Jamison explains this very well because what she does is challenge our notion of what empathy is that empathy is not simply I feel what you feel. We don't need to be diabetologists to be good caregivers of patients with diabetes. We don't need to experience what patients experience. But we do need to be curious about our patient's experience. 

She says, "Empathy isn't just listening. It's asking the questions whose answers need to be listened to. Empathy requires inquiry as much as imagination. Empathy requires knowing you know nothing. Empathy means acknowledging a horizon of context that extends perpetually beyond what you can see." 

She also-- as a shared with residents yesterday-- she calls empathy an asymptotic quality. It's something you aspire to but need to acknowledge as part of the act of empathy that you can never reach it because not to acknowledge that is facile. 

So reading, which, when you think about, is rather a strange thing to do, isn't it? Fiction. Or even, say, just binge watching a show, there's a bunch of people who don't exist. And you get completely absorbed in wanting to know what happens to them. It's a very interesting thing, isn't it? 

What if we brought that level of absorption to our patients' stories? What if our patients were as interesting to us as Breaking Bad? What if we saw a patient with that feeling of, I got to watch the next episode. I got to watch the next episode. Now, of course, I'm being a little hyperbolic. 

But my point is that the inquisitive mind that we bring to reading, the act of imagination that tells us that we should care about what happens to someone else is very relevant to our work. But even that-- this whole reading makes you a nicer person thing-- that still didn't feel like it answered for me the question of what is it about this activity, the reading and the getting around the table with the cold pizza and talking-- what is it about that that feels like it helps us as clinicians? 

And then I came across this interview. And that's President Obama giving Toni Morrison the Presidential Medal of Freedom. And this is a quote from an interview he gave with the chief book critic of the New York Times just a couple of days before he left office. And he was talking about the novels he had read while he was in office. 

And he said, "Fiction was useful as a reminder of the truths under the surface of what we argue about every day and was a way of seeing and hearing the voices, the multitudes of this country." And I read that, and I said, that's it. 

We run around this hospital. We run from room to room, from bedside to bedside. And particularly with our current administrative pressures, we don't have time to dive beneath the surface. And literature provides a way to do that. 

So when I was training, everybody was always talking about from bench to bedside. And it made me feel very left out because I didn't know what a bench was. So I decided that I would have my own term. I want our internship applicants to start coming into interviews and say, I'm going to be a triple threat. I'm going to take care of patients. I'm going to read poetry. And I'm going to teach. I'm waiting for the first one. 

And this is kind of what it looks like. Here's an example. So we read JM Coetzee's novel Disgrace about a university professor who has an affair with a student and is found out and is fired and is in a state of disgrace and humiliation. And we got to talking that night about the role of shame in medical care, the shame that we as clinicians feel when we can't help our patients adequately, the shame of being ill. 

And a nurse practitioner wrote me this email the next day. And she said, you know, I saw this young woman. And she had a hemorrhoid. And she was all upset about it. And I thought, you know, like, dude, it's a hemorrhoid. 

And then I realized it wasn't the hemorrhoid. It was the shape that was causing her suffering. And if we hadn't read that book and talked about it, I wouldn't have had that insight. And it made me care for her better. And this is the point I want to leave you with. 

As I said yesterday, we're not talking about mushy, squishy, your chocolate after your broccoli after school special stuff. We're not talking about, like, yoga to help your burn out, though I'm all for it. We're talking about the essence of medicine here. 

So here are a few other thoughts about how literature-- examples of how literature helps us dive beneath the surface. It enables difficult conversations. We have been able talking about a novel, a poem, an essay to talk about racism in medicine and sexism in medicine and homophobia and what doctors and nurses really think about each other. That was a very interesting discussion. Very illuminating. 

And yet, can you imagine inviting some colleagues over and saying, hey, guys, we're going to have some pizza, and we're going to talk about racism. You good with that? Or how about, nurses and doctors, why don't you guys tell each other what you really think? No. Wouldn't work. Wouldn't work. The magic sauce is the literature. 

It also breaks down barriers. Here was a great example. One night, we read the wonderful graphic memoir by Roz Chast, who is a longtime cartoonist for The New Yorker. It's called Why Can't We Talk About Something More Pleasant? And so when Roz was in her late 50s, she's an only child of much older parents. They were in their 90s. They weren't estranged, but she hadn't exactly been visiting them too often. 

And she goes and visits them. And she realized the apartment's a mess. They're a mess. They've made absolutely no provision for what's supposed to happen to them next. 

And she tries to sort of move the conversation down the field by saying things like, so do you guys ever talk about things, right? So that particular night, we talked about this memoir. On one side of the table was a retired doctor who was feeling really ambivalent about selling his house after his wife died-- oh, because, by the way, we go really quickly from talking about the book to talking about clinical care to talking about ourselves. And, in fact, it effaces the boundaries between our personal and our professional lives, which is part of the magic of it. 

On the other side of the room was a 23-year-old administrative assistant who was freaking out because her 50-year-old parents were talking about selling her childhood home and moving into a condo. And all of a sudden, the hierarchies of position, gender, and age flattened. 

Literature sharpens our narrative skills. Ours is a narrative art. What is narrative? Narrative is a fancy name for story. 

OK. So if you were explaining to a Martian what a story is, the things you have to have to make something a story, you would say in a story, there's-- there's people, or animals if they can talk. No, there's people. There's usually one really important person, like the main character, right? OK. 

There's a setting. It happens somewhere. Something happens. And not only did something happen, but something happens and then something else happens and then something else happens. And this thing couldn't happen until this thing happened. And this thing couldn't happen until this thing happened, which I didn't make up. Aristotle did. 

And what else? Somebody said an ending, a beginning, a middle, and an end. Right. Time. There's a passage of time. It may be a single day, as is the case of James Joyce's Ulysses. Or it could be an infinity of time, as is the case of War and Peace. Or maybe it just seems that way. Anyway. 

Sequence leads us very quickly to a sense of cause and effect, which leads us very quickly to a sense of meaning or perhaps even moral. So that's what a story is. 

Now, a few years ago, I went to graduate school, and I learned about something called the Freytag pyramid. And it just sort of reduces all stories to this schematic. You have an exposition where you meet the character, Cinderella. 

Her mother died. Father married mean woman, means stepsisters. There was going to be a ball. And then there's a rising action. You know how that goes. And then there's a climax, 12 o'clock, pumpkin, mice. 

Then there's a falling action. The glass slipper goes all around the kingdom. Oh, it fits Cinderella. There's a [INAUDIBLE]. She marries the prince. Happily ever after. When I first saw this, I thought, hmm, this sounds very familiar. 

[LAUGHTER] 

Isn't this our case presentation? What would happen if you got up on rounds and you just started giving a bunch of random data out of order? You didn't actually say-- these guys are like, yeah, we've done that. 

[LAUGHTER] 

You didn't actually say the name or the age or the chief complaint of the patient. And you didn't, in the end, make any sort of conclusion about the events that had occurred. That would have been really bad storytelling, which would have led to really bad patient care. 

Literature enlarges our view of our patients' experience. And this is my favorite rabbit hole to go down. This is from the first edition of Kafka's Die Verwandlung, The Metamorphosis. Anybody read it in high school or college? All right. I'll summarize the plot for you. 

Oh, no. I'm a bug. Oh, no. You're a bug, the family says. Yay, you're dead. Good. 

OK. So here's a slightly longer version. A young man named Gregor Samsa, who is a clerk, is the sole support of his parents and his younger sister, a teenage girl named Grete. One day, he can't get up and go to work. Like, he literally can't get up and go to work. And the reason he can't get up and go to work is because he's been transformed overnight into a giant insect. Bad, right? Bad. OK. 

Now, this book, which was written by-- Kafka was a Czech Jew who wrote in German-- was written in the '20s has been read as an allegory of anti-Semitism in early 20th century Europe because, of course, Jews were called vermin. It has been read as an allegory of the plight of the worker in the aftermath of the Russian Revolution. 

But I think it's also a medical allegory, and Kafka invites us to consider this because where do the Samsas live? In the shadow of the hospital. And this is a ballet version where Grete was the only one who willing to touch the bug, and that includes his parents. 

Kafka says, "She came in on tiptoe, as if she were visiting someone seriously ill, or perhaps even a stranger." What a beautiful encapsulation of the isolation and alienation of being a patient. 

Now, if you are entering Gregor's case in Epic and you're a good primary care doctor, you might address the fact that he has a physical deformity. He is really bummed out. And he's disabled from work. And the family, in the light of this transformation, is falling apart. And if, as a good primary care doctor, you addressed all of these things-- you got in the physical therapist and the social worker and the psychologist, you had a family meeting-- you would think you were doing a good job, wouldn't you? 

Except that when you read The Metamorphosis, you're reading it mostly from Gregor's point of view. And his needs and his experience of this are much broader. Yes, he's worried about all of that. He also can't eat. He can't read. 

He can't have sex. He feels disgusting. He's ashamed. He feels guilty. He's worried he's going to get fired, which, in fact, he does get fired. He feels lonely. He feels angry. He feels abandoned. 

These are the things that wouldn't make it into the chart. And, yet, these are the things that he is living with. And if you have ever been a patient and compared your experience with even the best chart version of the experience, it's profound how little they have to do with each other. 

I learned this myself a few years ago when I had my own little metamorphosis. One day, I slipped in the rain, and I fell on my right palm. And I fractured my humerus and my glenoid, and I dislocated my shoulder. And I tore my rotator cuff. But I got a few publications out of it. So clinician writers, let no fracture go wasted. 

Well, even though it was clearly not a psychosomatic illness-- I have the CAT scan to prove that-- it was a psychosomatic experience. What bothered me wasn't so much the pain. What bothered me was that I was out of work for weeks. I grew afraid that my practice mates would move from sympathy to tolerance to disinterest to that I would lose my practice. My husband said, honey, you're a primary care doctor. Nobody wants your practice, which was very reassuring. 

During that time, I couldn't eat. I couldn't read. I couldn't turn pages. I had to buy a Kindle, which I detested because I associated it with my own sense of deformity. 

At one point, the helpful nurse practitioner in the orthopedist office handed me a Polaroid and said, here, you want to see one of the interop pictures? And there was a blue and white nylon thread. And on the way out of the office, I threw it in the trash. And I thought to myself, I didn't want to see that. I will never be fully human again for the rest of my life. I will never be fully human again. 

Now, you might think that's a little oversensitive. And I should be grateful. Still hurts a little. And yet, that was part of my experience of suffering about which my absolutely wonderful orthopedist team doctor for the Patriots-- OK, come on, don't be like that-- that he couldn't empathize with because he was totally unaware of it. Didn't even know how to ask me about it. And I didn't even know how to tell him about it. 

Now, one thing I read once I recovered a little that was very helpful to be was this lesser known memoir by Oliver Sacks, A Leg to Stand On, in which he talks about an accident he had in his 40s. He was hiking. And there was a big sign-- in Switzerland-- there was a big sign at the base of the mountain that said, beware of the bull. 

And he thought, well, that's ridiculous. And, sure enough, there was a bull. And he ran from it. And he completely avulsed his quadriceps. And there were months and months of rehab. 

I had the privilege of interviewing Dr. Sacks about a year before he died. And I told him that I loved this book. And he said, really? I said, yeah. He said, nobody ever says that. And then he inscribed my copy. And he said, thank you for liking this, which was really so lovely. 

Anyway, at one point, at the end of his rehab, the surgeon comes by to discharge him. And Sacks says, thank you so much. Thank you. And the surgeon-- I mean, who was a surgeon plus British-- says, what are you thanking me for? You were disconnected, and I put you back together. But that's not how Sacks saw it. 

He said, "What was disconnected was not merely nerve and muscle but, in consequence of this, the natural and innate unity of body and mind. The will was unstrung, precisely as the nerve-muscle. The spirit was ruptured, precisely as the body. Both were split, and split off from one another." Healing is more than curing the disease than setting the fracture. 

Another diving in. We use so much jargon. We say so many things on a regular basis that we don't even think about what they mean, even though they're important to us, like the word mentor. Everybody here talk about you want a mentor, you had a good mentor, you had a good mentorship meeting, you have your obligatory mentorship meeting, you filled out your mentorship form. 

Does anybody here know what a mentor is? We didn't. We read Sigrid Nunez's wonderful novel, The Friend, about a writer whose mentor dies and bequeaths her a Great Dane, except that she lives in a very tiny apartment in Manhattan that doesn't allow pets. 

Her mentorship becomes a burden to her. And it changes her life. She's actually very funny too. Your whole house smells of dog, says someone who comes to visit. I say, I'll take care of it, which I do by never inviting that person to visit again. 

Now, we sat around the table that night and said, what is a mentor? Is it a coach? Is it a guide? Is it a teacher? Is it a patron? Is it an advisor? Does anybody know where the word mentor comes from? 

Say it with me. 

Telemachus. 

Homer. Yes. So Mentor makes a very brief appearance in The Odyssey and comes to Odysseus's son, the young Telemachus, who has been left in charge of the household while Odysseus is off fighting the Trojan Wars. And it's not going well. 

And Mentor says, "Since you will be neither a fool nor a coward in the time to come, nor are you wholly lacking in Odysseus' wisdom--" talk about damning with faint praise-- "there is every hope of you achieving your goal." And we read this, and we said, that's what a mentor is. A mentor is someone who has a broader vision for you in a particular point in time than you have for yourself. And then, as we started sharing stories of times we felt we had been effective mentors or times we felt we had been effectively mentored, they were exactly in line with this. 

So we got to get back into balance. Here's my way of thinking about it. We need art, and we need science because medicine is much about beauty, empathy, and ambiguity as it is about data, evidence, and objectivity. My favorite recent quote is by the Scottish clinician author Gavin Francis, who says, "Medicine is an alloy of science and kindness." Yeah, that's good, right? An alloy, two things that cannot be separated of science and kindness. 

You don't like this? I'll give you another one. We need to use both our left brain and our right brain to be effective clinicians. I know. Whenever I show the side, everybody is kind of-- OK. We all know where we stand. 

You don't like that? Let's go back to the Greeks. Apollo, not for nothing, was the god of both healing and poetry. 

Perhaps no one exemplified this better than the fellow we talked about yesterday in the resident workshop, William Carlos Williams, who ran his practice out of the ground floor of his house in Rutherford, New Jersey. Those are his prescriptions on which he wrote some of the greatest poems of the 20th century. 

Those of you who were at the workshop yesterday, what happened there? We read a text. It was a poem written in 1918. We all nodded in recognition about what the text said. We all nodded in recognition about what each of us said. 

And I don't know about you, but I felt less alone. And is there any higher order of healing than that? We'll let Kafka get the last word. "A book must be the axe for the frozen sea within us." Despite global warming, there's a lot of ice in this world right now and a lot of ice in medicine right now. And we need all the axes we can get. Thank you. 

[APPLAUSE] 

We have time for a couple of questions if anybody has any. 

Thank you very much. I'm going to ask the obvious question. Can you take someone like the Twitter comment people who say, I don't need no Homer, and feed them novels and change their empathic outlook on life? In other words, the folks who come in with barriers to what you're trying to get across with fiction. 

I think the barriers only exist because of lack of exposure. I think one would feel that way about physiology if one had no exposure to it. And so-- I mean, think about you guys who were here yesterday. There may be folks in that group who studied science in college. They don't need to be fed anything. They don't need to be led to anything. 

These are the beautiful thing about art and literature is that we all own it naturally. We are all natural storytellers. This isn't like the province of English majors, and other people, like, need to catch up. No. This is part of who we are as humans. We only need to be told that it's OK, and it's OK. 

If it's all right, I'll add on to that have you-- and I have had tremendous experience-- had that experience of taking physicians and healers who have been resistant to the idea, had them come through your workshops, and come out differently? 

Yes. All the time. It's the easiest job in the world. It's something we all have a natural need for. We have a natural thirst for it. We only need to provide it. We don't need to be talked into being storytellers. We don't need to be talked into-- you know, Danny Becker asked me, you know, how do you convince people who aren't touchy feely? And I said, you don't have to because everybody's touchy feely. Everybody's touchy feely. 

I was trying to figure out whether you have made a change at your institution. Basically, we are brought up in a system where we are given awards for, are we doing science and other things. But have physicians, I mean, at your system changed such that they give awards for something like what you are talking about? 

Well, I currently make my living doing mostly this. And that's award enough for me. But I don't mean to be glib, but the hospital literally is putting its money where its mouth is because I think that the administration of my hospital definitely gets the connection between this kind of work and quality patient care. And I'll tell you who really gets that is patients. 

So as I shared yesterday, when I've done fundraising among patients to support this work and tell them, like, here's what we do, cold pizza, poetry, all that, they totally get the connection between that and their own care. And I'll tell you a brief, little story that exemplifies that. 

So at Harvard Medical School, there's a course every year in August for incoming students. It's called ITP, Introduction to the Profession, which is-- right-- it's an unfortunate acronym. I agree. But, anyway-- but the good news is they don't know what ITP is, so they think it's fine. 

Anyway, so they have one exercise where they set them loose in the hospital. And patients are preselected to be interviewed. And they're told, you can ask the patient anything you want. But the one thing you have to ask them is, as I am entering my medical career, what advice do you have for me? 

And the response 100% of the time is some version of I'm not worried you're going to know enough. I'm not worried you're going to be competent enough. I'm worried you're not going to listen to me, which is so interesting because, of course, what they're worried about is they won't know enough and they won't be competent enough. 

And what they will continue to worry about through medical school, through residency, and often for many years thereafter is that they don't know enough, they don't know how to do enough stuff, and that the listening part is a gimme because, like, we all learned that in kindergarten, right-- plays well with others-- except that's not what the patient's perception is. The patient's perception is that that's the harder skill. So when I've done fundraising around this, patient's totally get it. 

If you were to prescribe a book to a trainee or to a faculty member getting it, what you talked about-- they don't have to be different-- but what books would you prescribe to us? 

Well, my will be coming out-- 

[LAUGHTER] 

--yeah. I actually have a book coming out in 18 months, Letter to a Young Female Physician, so that might be worth a look. I think there are so-- there are so, so many. I would take a look at Metamorphosis, which is a novella and I think has a lot to tell us about the patient experience of what we're doing. 

And then many in this room have probably read When Breath Becomes Air. It's a beautiful book. And it's a small book. And I think that also has-- the story of the high flying physician who gets laid low as patient is a pretty common literary trope that has been done many times but rarely so beautifully as it was in the case of Paul Kalanithi's When Breath Becomes Air.