Late 19th-Century Russian writer Anton Chekhov might be best known for his plays like The Seagull and The Cherry Orchard, but he also had a pretty consuming day job… as a physician. He noted that his work as a doctor informed and enriched his work as a writer, and vice versa. So why has it taken medical schools so long to catch up to the idea that humanities are as important as science?
Traditionally, medical school prerequisites lean heavily towards the physical sciences, with humanities electives earning the derisive nickname (in Canada at least) “bird courses.” But in reality, the humanities can help shape doctors’ empathy. North American medical schools are beginning to embrace literature in medical curriculum and this trend has now expanded, with physicians attending courses in the spin-off field of narrative medicine.
The idea of blending science with story is not as out-there as it may sound. When patients visit a doctor they usually begin by telling a story. In those moments, patients are vulnerable, especially when ill or receiving a diagnosis from a near-stranger in what is seemingly a one-way exchange. How doctors hear and process those stories can have a significant effect on their abilities to help their patients. Integrating literature helps develop “whole person understanding” for healthcare practitioners in ways that science alone may not.
Narrative medicine uses tools and techniques beyond the sterile listening and recording of a patient chart. Some curriculums have medical students read novels, plays, and poems, and even write their own, hoping to build students’ ability to be self-reflective. Some writers suggest that integrating literature and medicine “…make visible the struggles our own and others’ values, beliefs, and behaviours … and how we remain permeable to change and orientations different from our own.” By ensuring that physicians are not just listening but are receiving stories, literature can equip healthcare practitioners with the ability to take patient narratives and recognize when the story can inform a diagnosis, even silences.
Chekhov is perhaps the patron saint of narrative medicine. He was passionate about both, describing medicine as his “legal spouse” and literature as his “mistress,” writing about changing up the routine between his professions thus: “… tired of one, I go sleep with the other one.” Chekhov, like many physicians, brought this personal experience into his work. According to BMJ, he was “seriously ill (with peritonitis, probably tuberculous) at the age of 15, and was devotedly nursed through this illness by the school doctor, whom he always remembered afterwards with admiration and gratitude.” He became a doctor, treated peasants and working extra hard during epidemics of cholera and typhoid fever.
Chekhov proceeded to use literature as a medium to convey stories of people in distress, some including doctors as characters: “His profession certainly provided him with a very wide field of observation, and he liked portraying doctors in his plays,” including Ivanov and Uncle Vania. Perhaps his sensitive and thoughtful bedside manner (even at his own deathbed) was aided by his writerly understanding of people and story: “Until his last moments Chehov preserved his sense of humour and his capacity for detachment: on the eve of his death he made his wife laugh at the amusing tales he spun out for her as she sat by his bedside.”
Chekhov’s unique legacy echoes through the resurgence of medical humanities, where he remains a powerful influence on both literature and medicine. Physicians and medical schools alike are concerned with empathy. With the knowledge that stories humanize a patient beyond a chart, with an intimate connection between a patient and physician, perhaps human to human connection through stories is the only way forward. As Chekhov said before dying: “You don’t put ice on an empty heart.”