Yale Medical School Alumni/Program for Humanities in Medicine Event: YSM Alumni Doctor - Writers - The Thomas P. Duffy Lecture

Transcript

• 00:00First.
• 00:02And then write.
• 00:03And then, you know,
• 00:05I was always a writer.
• 00:06I mean, producers
• 00:09producers do a lot of
• 00:11writing.
• 00:12When I got to medical
• 00:13school,
• 00:15medicine is all about storytelling.
• 00:17And so I didn't know
• 00:19it at the time, but
• 00:19that was really what appealed
• 00:21to me. And so
• 00:22telling these stories, which was
• 00:24a great opportunity,
• 00:25you know, it just seemed
• 00:27natural to me. It was
• 00:28not a plan, like
• 00:30like, so much of my
• 00:31life and probably most people's
• 00:33lives,
• 00:34luck and circumstances
• 00:36played a huge role, and
• 00:38I was lucky enough
• 00:41to be able to,
• 00:42get this gig. Can I
• 00:44tell you, the the untold
• 00:46story?
• 00:48So
• 00:49so I had told my
• 00:50husband, who is a writer,
• 00:51these stories,
• 00:53about what I've seen, you
• 00:54know, because I thought diagnosis
• 00:56was an amazing story.
• 00:58And
• 00:59so,
• 01:00I got a call from
• 01:02a friend of my husband's
• 01:03who was an acquaintance of
• 01:04mine, and he said,
• 01:06I think that,
• 01:09that the Times Magazine could
• 01:11really use
• 01:12some medical stories. And and
• 01:13I wondered if you had
• 01:14any ideas about what doctors
• 01:16can write.
• 01:17And so I'm like, oh,
• 01:18yeah. There's one story. We
• 01:20write it every day. It's
• 01:21called an H and P,
• 01:22and it's really a story
• 01:23about diagnosis. And so I
• 01:25told him this whole thing.
• 01:27I sent him, you know,
• 01:28articles
• 01:29from, like,
• 01:30the New England Journal, you
• 01:31know, their cases, and JAMA,
• 01:33their cases.
• 01:34And he called me back.
• 01:35He goes, well, this is
• 01:36really great. Let me get
• 01:37a real doctor writer to
• 01:38write it. Thanks so much.
• 01:42About a year later,
• 01:43I get a call from
• 01:45my friend's replacement
• 01:47who had found his notes
• 01:49on this idea that never
• 01:50really panned out. And he
• 01:52said,
• 01:53do you think he had
• 01:55gone to a doctor writer,
• 01:56and it hadn't worked out.
• 01:58He said, do you think
• 01:59you could write one of
• 02:00these stories that you tell?
• 02:01And I said, sure. He
• 02:02goes, good. Because the deadline
• 02:04is Thursday.
• 02:06So that was my totally
• 02:08by accident, totally by luck.
• 02:11I'm thrilled.
• 02:15Well, great. Thanks,
• 02:17everyone for having having me
• 02:18and having us, back here.
• 02:20You know, as someone who
• 02:21spent a lot of time
• 02:22at Yale, it's always just
• 02:24such a blessing to come
• 02:25back and be able to,
• 02:27just feel what a special
• 02:28place it is. And it
• 02:28really is a special place.
• 02:29And, you know, I'll get
• 02:31to I'll get to your
• 02:31question, but I just I
• 02:32wanna just give a shout
• 02:33out. I mean, you talked
• 02:34about doctor Duffy and doctor
• 02:35Mercurio and doctor Hughes are
• 02:37all some of my mentors
• 02:38here. And,
• 02:40as someone who has been
• 02:41thinking about health policy for
• 02:42the past, I guess, decade
• 02:44or or so now,
• 02:46you know, I had this
• 02:47belief
• 02:48that,
• 02:49we just had to get
• 02:50the incentives right in the
• 02:51health care system. And we
• 02:53had to
• 02:54figure out how to pay
• 02:55people better and incentivize them
• 02:56and pay for performance.
• 02:58And one of the things
• 03:00that I've changed my mind
• 03:01about, although we need to
• 03:02change the incentives,
• 03:03is how important,
• 03:06just apprenticeship is and having
• 03:08the right role models. And,
• 03:11so much, you're never going
• 03:12to be able to incentivize,
• 03:14the type of care
• 03:16that you observe,
• 03:18people or senior physicians or
• 03:21your mentors, your role models
• 03:22giving. And so
• 03:24I just wanna put a
• 03:24plug out there that, this
• 03:26is a special place because
• 03:27of people like doctor Mercurio,
• 03:29doctor Hughes, and and, and
• 03:30doctor Duffy, of course.
• 03:33My own experience,
• 03:35was a little bit different.
• 03:37I, I unfortunately didn't have
• 03:39a glamorous TV career before,
• 03:41before I went to medical
• 03:42school.
• 03:42But I, so my father
• 03:44was a physician or is
• 03:45a physician. And
• 03:47as everyone knows, it's a
• 03:48very strong risk factor for
• 03:49your child going into medicine.
• 03:51And so I kind of
• 03:52knew that I was gonna
• 03:53be a doctor, but I
• 03:53was very interested in
• 03:55the system around medicine and,
• 03:58the many factors that influenced
• 04:00the doctor patient relationship and
• 04:02the way that we deliver
• 04:03care. And so I knew
• 04:05that I wanted to think
• 04:06about the system,
• 04:07at that level, not just
• 04:08deliver care,
• 04:09but also,
• 04:11figure out how to create
• 04:12the policy and the environment
• 04:14in which, good care could
• 04:15be delivered.
• 04:16And so I wasn't sure
• 04:17what form that,
• 04:18would take, and I'm still,
• 04:20you know, in some ways
• 04:21figuring that out.
• 04:22But I was so inspired
• 04:23by my writers like like
• 04:25doctor Sanders and, Toul Gwande,
• 04:27Jerome Groupman, Oliver Sacks, people
• 04:29who could
• 04:30bring to life
• 04:32the
• 04:33the challenges and the beauty
• 04:34of medicine and help people
• 04:36understand really complex
• 04:38phenomenon in simple ways. Not
• 04:40simplistic ways, but but really
• 04:41simplify in a way that,
• 04:43it would it would get
• 04:44across. And not just simplify
• 04:45it, but,
• 04:46create,
• 04:48a certain interest and excitement
• 04:50narrative propulsion around,
• 04:52getting people interested in these
• 04:54ideas and and and and,
• 04:56making them want to read
• 04:57more. And so that was
• 04:58very inspiring to me. I
• 04:59wanted to figure out how
• 05:00to do that. I I
• 05:01spent, you know, many years
• 05:03here at Yale, and then
• 05:04I I did a master's
• 05:05degree at the Kennedy School
• 05:06at Harvard.
• 05:07And I took one, you
• 05:08know, I took one,
• 05:10writing class there. And as
• 05:11part of that class, you
• 05:12had to
• 05:13submit five op eds over
• 05:15the course of the semester,
• 05:16and you could submit them
• 05:17whenever you wanted. You could
• 05:18submit all five on the
• 05:19last day that wasn't recommended.
• 05:21But the idea was if
• 05:22you saw something in the
• 05:23world and you thought it
• 05:24was important,
• 05:25you should have the discipline
• 05:26to sit down, think about
• 05:27it, write about it.
• 05:28And so that's the way
• 05:29that I I, you know,
• 05:31published my first, couple articles,
• 05:33and then kind of got
• 05:34addicted to the idea that,
• 05:36you know, you could write,
• 05:37you could be, you could
• 05:38engage, be in communion with,
• 05:40an audience in that way,
• 05:41receive feedback, understand how people
• 05:44are receiving your work, and
• 05:45and hopefully contribute to a
• 05:47to a to a broader
• 05:47conversation. So I was I
• 05:49was freelancing for for many
• 05:50years. And then during the
• 05:51pandemic,
• 05:53was caring for patients during
• 05:54the beginning of the pandemic
• 05:55in in New York City.
• 05:56And and, obviously, people wanted
• 05:58to know what was going
• 05:59on,
• 06:00in that period. And I
• 06:02ended up writing basically a
• 06:03series of journal entries to
• 06:04kind of diary entries, for
• 06:06The New Yorker, and,
• 06:08and and that's the way
• 06:09kind of I ended up
• 06:09at The New Yorker. Now,
• 06:11kind of have branched out
• 06:12into many other areas of
• 06:14of health care and medicine,
• 06:15but all with this idea
• 06:16of, you know, how do
• 06:18we
• 06:18create,
• 06:19an environment
• 06:20in which people can receive
• 06:22and deliver high quality care.
• 06:25So both of you, you
• 06:26write about very different things.
• 06:28You've been doing more health
• 06:29policy lately. You're doing your
• 06:30diagnosis.
• 06:32But you both find great
• 06:34characters.
• 06:35And I'm interested
• 06:37in knowing well, from Lisa,
• 06:39as I was telling you
• 06:40before, your stories are wonderful
• 06:42because they end with this
• 06:44broad
• 06:46view. What are the ramifications?
• 06:48Is it because, oh, this
• 06:49is why this patient wasn't
• 06:51diagnosed for so long because
• 06:52people were in their silo,
• 06:54and they forgot to do
• 06:55the thyroid check. Or
• 06:57nowadays, doctors can put it
• 06:59out there on the Internet
• 07:00and say, does anyone have
• 07:01any ideas? And they did.
• 07:03So there's always, like, a
• 07:04big,
• 07:06overview of, like, why are
• 07:08you telling me telling us
• 07:09this story? What would you
• 07:10want changed, or what's wrong
• 07:12with medicine?
• 07:13Do you ever do you
• 07:14think about theme and then
• 07:16go for story, or you
• 07:18hear a story and think
• 07:19about theme? And do you
• 07:20ever have someone tell you
• 07:21some great story, and you're
• 07:23like, we did that theme
• 07:24before?
• 07:26No. If I hear a
• 07:27great story, I'm gonna write
• 07:29the story.
• 07:30No. I'll I'll find something.
• 07:32Right.
• 07:33I don't really you know,
• 07:35I
• 07:36when I hear a story,
• 07:37I think, what is interesting
• 07:39about this story to me,
• 07:40if it's interesting?
• 07:43And then I just wanna
• 07:44share that. I want my
• 07:46whole motivation
• 07:47in writing about diagnosis
• 07:50is so that people could
• 07:51see how
• 07:52complicated
• 07:53and,
• 07:55interesting,
• 07:57it is and see
• 07:59what why
• 08:01why it's not mass,
• 08:03why it's not four times
• 08:05six is always twenty four,
• 08:06so fever and a rash
• 08:07is always,
• 08:09you know, the measles. Although
• 08:10these days, it might be.
• 08:13So
• 08:14I I'm interested in the
• 08:16stories, and and then I
• 08:18just try to share what
• 08:19I take away from the
• 08:20story. I mean, I think
• 08:21there's a lot to learn,
• 08:23but the point is not
• 08:24the point. The point is
• 08:25the story. Right. And then
• 08:27then you'll come up with
• 08:28a point. Yes. Exactly. You
• 08:29always do. You always have
• 08:30a great point that you
• 08:31come up with that
• 08:33that does fit the story.
• 08:34And and I I kind
• 08:35of take the opposite approach,
• 08:36which is which is interesting.
• 08:37I mean, sometimes I I
• 08:38come across a good story,
• 08:39and I feel like I
• 08:40I wanna tell it. But
• 08:42often, I'm starting from the
• 08:43opposite perspective, which is there's
• 08:45this, like, broad, vague idea
• 08:47of something that I wanna
• 08:48write about. It could be
• 08:49how is AI going to
• 08:51change drug discovery or, you
• 08:53know, why are ultra processed
• 08:55foods good or bad for
• 08:56you? They're bad for you.
• 08:59But,
• 09:00but I'm trying often to
• 09:02cast about for
• 09:04the right character, the right
• 09:05people through which to tell
• 09:07that story so it doesn't
• 09:08read like a textbook or
• 09:10even an academic article,
• 09:12that there's
• 09:13some person trying to figure
• 09:14something out about the world,
• 09:16and you can kinda take
• 09:17the reader on that journey
• 09:18with with you. So, you
• 09:20know, as opposed to,
• 09:21even if I feel like
• 09:22I know the answer,
• 09:24or I know the idea
• 09:25that I'm driving towards,
• 09:27a lot of the work
• 09:29is just
• 09:30finding who is going to
• 09:32be a compelling character or
• 09:33set of characters, the through
• 09:35which to tell the story.
• 09:35So it's it's really interesting
• 09:37to hear that we kind
• 09:37of come at it from
• 09:38from opposite perspectives there.
• 09:42When you were writing for
• 09:43The New York Times, I
• 09:44think you it was more
• 09:45likely you talked about some
• 09:46of your patients.
• 09:48You occasionally will say they
• 09:49came to see me in
• 09:50my office, but not often.
• 09:53We have a lot of
• 09:54future
• 09:55with you in the audience
• 09:57today and maybe on Zoom.
• 10:00How do you navigate if
• 10:01you are gonna write about
• 10:04your patients?
• 10:06Is that a weird power
• 10:07dynamic or the patient comes
• 10:08with a good story?
• 10:10In one of your pieces,
• 10:11I think you said we
• 10:12will call her Sally, so
• 10:14it's obviously a pseudonym. Did
• 10:15the New Yorker then go
• 10:16back and fact check her?
• 10:18So you had to tell
• 10:19them what her name was.
• 10:21So and so I'm curious.
• 10:22And would you ever use
• 10:23composite characters?
• 10:25Just say, you know?
• 10:28Me? No. I would you
• 10:29know, I mean,
• 10:31first, I never use names
• 10:32in any of my stories
• 10:34because I never tell I
• 10:35never use a patient's name.
• 10:36First of all, the New
• 10:37York Times doesn't let you
• 10:40assign people names.
• 10:41I guess maybe you can.
• 10:43I haven't it never occurred
• 10:45to me to do that.
• 10:47But
• 10:48so the the patient is
• 10:50never named. The doctors are
• 10:51always named because I asked
• 10:52them to give me a
• 10:53lot of their time and
• 10:54their medical records.
• 10:57And I get
• 10:59very clear
• 11:00explicit
• 11:02consent from them. I have
• 11:03a form that, you know,
• 11:04some lawyer looked at and
• 11:05said it was okay. It's
• 11:06mostly in English.
• 11:09You know, but I just
• 11:10the story that I'm doing
• 11:11now is a patient that
• 11:12I was seeing. And,
• 11:14as I was seeing her,
• 11:15I thought, oh, this is
• 11:17a really great story.
• 11:20So I asked her if
• 11:21I could write about her.
• 11:22And,
• 11:23you know, she said, oh,
• 11:24sure. Because, you know, I
• 11:26think a lot of times
• 11:27people think this terrible thing
• 11:28that happened to me ought
• 11:29to do somebody some good
• 11:30somewhere.
• 11:32And so I find that
• 11:33people are very generous.
• 11:35Or, you know, maybe she
• 11:36felt cowed by me, but
• 11:37I don't think so. I
• 11:38didn't make the diagnosis. She
• 11:39came to me with the
• 11:40Right. That was part of
• 11:42her past medical history. So
• 11:44I don't know. I find
• 11:44that people are are
• 11:47are happy to share. I've
• 11:48only I've been writing this
• 11:49column since two thousand and
• 11:51two, and I've only been
• 11:53had two people turn me
• 11:55down when I said, I'd
• 11:56really like to tell your
• 11:56story.
• 11:57And and only two said
• 11:59no. And, you know, okay.
• 12:02I get it. It's it's
• 12:03fine. I'm not sure I'd
• 12:04be that happy to share
• 12:05my stories.
• 12:07But,
• 12:08so consent is super important.
• 12:10And it used to be
• 12:12that I had fact checkers
• 12:14fact my fact check my
• 12:16stories. Now I have for
• 12:18the last few months, I've
• 12:19had to fact check my
• 12:20own stories, and it let
• 12:21me just say it's very
• 12:23anxiety provoking.
• 12:24I much prefer somebody with
• 12:26a very careful eye for
• 12:27detail calling up everybody and
• 12:29go and so and this
• 12:30is how you spell your
• 12:31last name? And and the
• 12:32and you live in this
• 12:33town?
• 12:34And,
• 12:35and just make sure I
• 12:36don't
• 12:37make any dumb mistakes, which,
• 12:40you know, I still make
• 12:41dumb mistakes. I hope I
• 12:43catch them all before they
• 12:45go into print, but, I
• 12:47I miss fact checking.
• 12:50Yeah. I feel very fortunate.
• 12:53I I have a very
• 12:54scary fact checking department,
• 12:56that, goes over everything that
• 12:57I write, and,
• 12:59and it's a real it's
• 13:00a real blessing. I mean,
• 13:01they, you know, if I
• 13:02describe something as magenta, they're,
• 13:04it's actually fuchsia. You know,
• 13:05like, they'll it's like it's
• 13:07yeah. You really gotta document
• 13:08everything.
• 13:09So a couple things. I
• 13:10mean, I think if I
• 13:11know that I'm gonna be
• 13:12writing about a patient, then
• 13:13then obviously, I talk to
• 13:14them and I ask them
• 13:15and get consent. And, you
• 13:16know, right now, I'm writing
• 13:17a story, for instance, about,
• 13:18patient with progeria,
• 13:20this kind of premature aging
• 13:21disease and spending a lot
• 13:22of time with them. And
• 13:23so they obviously know kind
• 13:24of the drill, and they
• 13:25know that I'm recording things
• 13:27and taking notes. And so
• 13:28they're they're totally on board.
• 13:30You know, sometimes
• 13:32it's something that's happened many
• 13:33years ago, and and I
• 13:34may not even know the
• 13:35patient anymore. So a lot
• 13:36of that is from memory.
• 13:37And if I have,
• 13:38you know, documentation of it,
• 13:40then, of course, we can
• 13:41go back to the patient.
• 13:41Otherwise, it's you know, I'll
• 13:43have something, in there that's
• 13:45like, you know, I remember,
• 13:46I recall just just to
• 13:47make clear that, you know,
• 13:48we haven't, been able to
• 13:50speak with the patient.
• 13:51And I don't you know,
• 13:52we don't do kind of
• 13:53composite,
• 13:54characters, but, but we can
• 13:56do pseudonyms. And so, you
• 13:57you know, sometimes in this
• 13:58last article that you just
• 13:59read from, the patient, you
• 14:01know, was I just made
• 14:02up a name, for the
• 14:03patient. That that seems to
• 14:04be okay.
• 14:05But I think, you know,
• 14:06whenever possible,
• 14:08I've had a very similar
• 14:09experience to Lisa's, which is
• 14:10most people are quite happy
• 14:12to share their story and
• 14:13and be vulnerable. And and
• 14:14part of it is,
• 14:16sometimes developing that rapport with
• 14:17people. Sometimes it takes a
• 14:19couple conversations to get them
• 14:20comfortable with you and helping
• 14:22them understand the purpose,
• 14:24of of telling their story
• 14:25and,
• 14:26kind of the broader point
• 14:27that you're trying to make,
• 14:28through through that story.
• 14:30But I've also found that
• 14:32people have been very generous.
• 14:34Well,
• 14:35recently,
• 14:35my mother who's ninety one,
• 14:37who's doing well, was in
• 14:38the emergency room. She had
• 14:39a little blip of not
• 14:40being able to breathe, but
• 14:41then she was fine. And
• 14:42as they're saying her vitals
• 14:44are fine,
• 14:45the emergency room doctor said,
• 14:47oh, wait. You're at Yale.
• 14:48Do you know Lisa Sanders?
• 14:49And I said, yes. She
• 14:50said, I've got a great
• 14:51story about me for you.
• 14:53And at first, I'm like,
• 14:55I don't know. And then
• 14:56she told me her story,
• 14:58and I texted Lisa, and
• 14:59she made it in. She
• 15:00actually
• 15:02and she was a doctor.
• 15:03So yeah. So my mom's
• 15:04just lying there, and we're
• 15:05like, oh my god. You're
• 15:06kidding. What happened?
• 15:09Yes. So, yeah, so it
• 15:11was it was a good
• 15:11thing that my mother had
• 15:12that little blip of not
• 15:13I don't know that I
• 15:14would say that it was
• 15:15a good thing. But
• 15:16But you got a story
• 15:18out. I've got a story
• 15:19out. Right. Exactly.
• 15:20That's what's most important at
• 15:22the end of the day.
• 15:22Right. Exactly. Exactly a good
• 15:24story.
• 15:25So
• 15:26The doctor wouldn't have had
• 15:27time to tell you the
• 15:28story if it was anything
• 15:30but a good news for
• 15:31your for your mother. Right.
• 15:32We're all just kind of
• 15:33hanging out. I think at
• 15:34that point, my mother said,
• 15:36oh my god. I haven't
• 15:37done Wordle yet today. And
• 15:38then we thought, okay. She's
• 15:39doing okay. She's doing okay.
• 15:41Now now onto you, doctor.
• 15:43What's your issue that should
• 15:44be in the New York
• 15:44Times? And she did get
• 15:46in.
• 15:47So
• 15:48looking ahead,
• 15:52do you
• 15:53see yourself
• 15:54putting an art like, Lisa
• 15:56has this book diagnosis, which
• 15:58I just put down somewhere.
• 15:59Do you see yourself
• 16:01doing a collection of stories?
• 16:02Do you see yourself writing
• 16:03a book? Do you see
• 16:04yourself running for office?
• 16:07What's next? Do you
• 16:10yeah. No. Definitely not the
• 16:11last one.
• 16:12I don't know. I mean,
• 16:13I I,
• 16:15I would love to write
• 16:16a book at some point.
• 16:18I feel like,
• 16:20you need something that is
• 16:21so gripping that you wanna
• 16:22spend a couple years of
• 16:23your life
• 16:24devoting yourself to. And I
• 16:26haven't found kind of the
• 16:27one idea that I wanna,
• 16:29do that with.
• 16:30You know,
• 16:31right now, I'm just trying
• 16:32to get better at the
• 16:33craft of narrative journalism and,
• 16:36figuring out how to write
• 16:37long form. And, you know,
• 16:39when I initially started doing
• 16:40this, it was all very
• 16:41short, you know, either op
• 16:43eds and columns.
• 16:44It was focused on COVID
• 16:46nineteen and, you know, various
• 16:48aspects of that. And so
• 16:50now I'm really enjoying,
• 16:52being much more exploratory.
• 16:54Like, I just wrote a
• 16:55piece about what happens to
• 16:56the human body in space,
• 16:57which is not something I'd
• 16:59thought about, until, you know,
• 17:00a couple months ago and
• 17:01then spent time at NASA
• 17:03and working with people. And
• 17:04and so for me, it's,
• 17:06the best way I've ever
• 17:09figured out about how to
• 17:10learn something is to write
• 17:11about it because you really
• 17:12have to if you're gonna
• 17:13put your,
• 17:15ideas on paper, you realize
• 17:16all the holes, in in
• 17:18what you thought. It was
• 17:18kinda like teaching. You know?
• 17:19You have to really understand
• 17:21something at a very deep
• 17:22level to be able to
• 17:22teach and and to write.
• 17:23And so,
• 17:24you know, for now, that
• 17:26is kind of the focus
• 17:27of what I, am doing.
• 17:29You know, my day job
• 17:31is as as a health
• 17:32services researcher, and so that's
• 17:33that's kind of, the main
• 17:35thing that I do is,
• 17:37previously,
• 17:38NIH funded work, and and
• 17:39we'll see what what what
• 17:40is what it is in
• 17:41the in the future.
• 17:42But,
• 17:43but, you know, I love
• 17:45seeing patients. I love,
• 17:47thinking about health policy research
• 17:49in a kind of a
• 17:50critical and rigorous way and
• 17:51then being able to communicate
• 17:52that to to people outside
• 17:54of health care. And I'll
• 17:55just ask one more
• 17:57second. But,
• 17:59so your styles developed differently
• 18:01from the New York Times.
• 18:02I know the New York
• 18:02Times has a very different
• 18:03style from the New Yorker.
• 18:05Are there things it sounds
• 18:07like you have a great
• 18:07relationship with your editors. I
• 18:09mean, you're not gonna tell
• 18:10us here if you didn't.
• 18:11But,
• 18:13is there something that you
• 18:14would could share that you
• 18:16learned? Because it is such
• 18:17a different mentorship
• 18:19editor, writer,
• 18:21and their editors are thinking
• 18:22different things than when you
• 18:24were with doctor Mercurio, and
• 18:25he was talking about patient
• 18:26care. So are there things
• 18:28that those of us here
• 18:29who aren't working with editors
• 18:31with what's come through that
• 18:33you were like, oh, yeah.
• 18:35I have to think about
• 18:36that. Yeah. I mean, I
• 18:37think, people often think about
• 18:38editors as someone who fixes
• 18:40the semicolons and commas, and
• 18:42that's not at all what
• 18:43what the editor does. And
• 18:45in at least my, you
• 18:46know, my case, it's it's
• 18:47much more of a thought
• 18:47partner. Someone who you're going
• 18:49to have a conversation with
• 18:51about whether this is interesting
• 18:52or not, whether this is
• 18:53the right character or not,
• 18:54whether this topic has been
• 18:55beaten to death, or this
• 18:57topic is fresh and novel.
• 18:59And, and so I think
• 19:01one thing I would say
• 19:02is that you can have
• 19:03that independent of having an
• 19:05actual editor. You know, you
• 19:06can develop an editorial team.
• 19:09Some people have a writing
• 19:10club, but, you know, people
• 19:11who you trust their judgment,
• 19:13who you can bounce ideas
• 19:14off of, who you can
• 19:15communicate with about whether this
• 19:17is the right story, whether
• 19:18this is the right length
• 19:19of of a piece. And
• 19:20so, if you don't have
• 19:21an editor that you're already
• 19:22working with, I think that
• 19:23is something that that I
• 19:24would recommend.
• 19:26You know, my style changed
• 19:28a lot in part because,
• 19:30you know, the length at
• 19:31which I was writing changed
• 19:33a lot. I mean, there's
• 19:34something that you can say
• 19:34in eight hundred words. There's
• 19:35another set of things you
• 19:36can say in six thousand
• 19:37words. And so,
• 19:39and a lot of what
• 19:40I was doing earlier on
• 19:41was I think more kind
• 19:42of columns, op eds, arguments.
• 19:45A lot of what I'm
• 19:46trying to do now at
• 19:47least is
• 19:48more reported pieces going out
• 19:49into the world, talking to
• 19:50people,
• 19:51telling a story about, an
• 19:53area or an issue. And
• 19:54so,
• 19:55that is that that's changed
• 19:56a lot too. But,
• 19:58you know, I think the
• 19:58main thing I would say
• 19:59is that,
• 20:00you know, develop that that
• 20:02kind of writing team around
• 20:03you if that's something that
• 20:04you wanna do because,
• 20:07often you can't see the
• 20:08holes in your own writing.
• 20:10Often you've just been with
• 20:12it for too long, and
• 20:12you can't understand how to
• 20:13take it to the next
• 20:14level. Often you think it's
• 20:15really good and it's really
• 20:16not good, that happens to
• 20:17me a lot too. So,
• 20:19so I think having that
• 20:21person or people to bounce
• 20:22ideas off is really helpful.
• 20:24What about you, Lisa, from
• 20:26if you well, is there
• 20:28a difference between the editing
• 20:29that you got
• 20:31from television
• 20:32and then now at The
• 20:34New York Times? Is there
• 20:35sort of a partnership, or
• 20:36now you've been doing it
• 20:37for so long that
• 20:39Oh, no. Everybody needs an
• 20:41editor. And can I just
• 20:42say, Groove, that you really
• 20:43rock a spacesuit?
• 20:47Please look at his piece
• 20:48on,
• 20:49on how what space does
• 20:51to the human body. And
• 20:52you'll never wanna go to
• 20:53space.
• 20:57So, no, editors are always
• 20:59important. And in television,
• 21:01they don't really
• 21:02and this is appropriate. They
• 21:04don't really care what the
• 21:05words are. They only care
• 21:06about the pictures.
• 21:08That's one of the problems
• 21:09with, you know, writing about
• 21:10or covering medicine is that,
• 21:13most of the pictures are
• 21:14either too awful to be
• 21:15allowed on television
• 21:17or, you know, sketches of
• 21:19cells.
• 21:21So,
• 21:22so medicine was kind of,
• 21:23I thought, a little bit
• 21:25dull on television, but I
• 21:26think it's not dull in
• 21:27life.
• 21:29But, you know, it's it's
• 21:31great working.
• 21:33What I love most about
• 21:35my editor, and I love
• 21:36it and need it more
• 21:37as I get further in
• 21:38sucked into doctorhood,
• 21:40I I'm still in process,
• 21:42I think, is that they
• 21:43will ask questions
• 21:45that I thought, oh, doesn't
• 21:46everybody know that?
• 21:48And they'll say, no. No.
• 21:50Not everybody knows that. And
• 21:52so it keeps it so
• 21:53that I am talking at
• 21:54the right level
• 21:56to people who are smart,
• 21:58but not necessarily knowledgeable about
• 22:00medicine.
• 22:01And that's that's really that's
• 22:03also really fun and really
• 22:05important. And do either of
• 22:06you have any tricks in
• 22:08terms of because you both
• 22:09do a ton of research.
• 22:10You're reading medical records. You're
• 22:12reading about the illness. You've
• 22:14obviously done your PubMed searches.
• 22:16You're
• 22:17immersed you have to be
• 22:18immersed in health policy jargon
• 22:20for all the stuff you're
• 22:21writing.
• 22:22But while your styles are
• 22:24very different, they are both
• 22:25so
• 22:26clean of any jargon.
• 22:29Do you,
• 22:30like, after you get all
• 22:32your information,
• 22:33say, okay. Now I have
• 22:34to, like, I don't know,
• 22:35read a Nora Ephron essay
• 22:36or something else just to,
• 22:38like, remember how normal people
• 22:41converse? Or how do you
• 22:42sort of get away from
• 22:43all the jargon?
• 22:45Yeah. I mean, I think,
• 22:50the first thing,
• 22:52what was the first part
• 22:53of your question? Sorry. How
• 22:54do you get like, you
• 22:55must be immersed in all
• 22:56this jargony stuff. And it's
• 22:58easy if you're reading all
• 22:59the jargon.
• 23:00You can't help but get
• 23:01that rhythm in you. Like
• 23:02Yeah. You know? So there
• 23:03has to be a separation
• 23:04of the deep dive into
• 23:06all this academic y stuff.
• 23:08I mean, maybe you do.
• 23:08I I think it's hard
• 23:09to read all the academic
• 23:10stuff and then just start
• 23:11start writing. The fir I
• 23:12mean, the first thing I'll
• 23:13say is,
• 23:14whenever I start writing a
• 23:15piece, I don't know if
• 23:16it's it's probably different for
• 23:17you because of the type
• 23:17of writing, but I, you
• 23:18know, I it takes me
• 23:20a long time before I
• 23:21can sit down and start
• 23:22writing because I have to
• 23:23do so much reading about
• 23:24the topic. And so, like,
• 23:25ninety percent of the writing
• 23:27is just, like, reading and
• 23:28making sure I understand this
• 23:29topic. I'm often writing about
• 23:31things that I don't know
• 23:32that much about, when I
• 23:33first go into it. And
• 23:35so to get into the
• 23:36headspace to even start writing
• 23:38takes me a very, very
• 23:39long time.
• 23:40And I like to understand,
• 23:42you know, basically the landscape
• 23:43of the thing. And then
• 23:45I like to read, if
• 23:46I'm writing an article, different
• 23:48types of not just different
• 23:50perspectives on the topic, but
• 23:51totally different types of
• 23:53books on it. So, like,
• 23:55for instance, the Space Madison
• 23:56piece. Like, I read, you
• 23:58know, Scott Kelly's memoir,
• 24:00which was helpful. And then
• 24:01I read,
• 24:02a science fiction book about,
• 24:05what, what it would take
• 24:06to, you know, land on
• 24:07Mars and settle that planet.
• 24:08Just it's just like to
• 24:09put myself in kind of
• 24:10an imaginative state. And then
• 24:11I read a book about
• 24:13from this geneticist about how
• 24:14we're gonna, like, genetically engineer
• 24:16people so they can live
• 24:17in space so they don't
• 24:18get blasted by space radiation
• 24:19and develop cancer. And so,
• 24:21it's not just, like, you
• 24:23read different types of,
• 24:25books from different angles, but
• 24:26but really try to put
• 24:27yourself in in in a
• 24:28different type of mental state
• 24:30so you can kind of
• 24:31think about things from from
• 24:33different angles.
• 24:34And then, yeah, I'm always
• 24:35kinda going back over the
• 24:37piece after I've written it,
• 24:39both for jargon and for
• 24:40tone. And so,
• 24:42a lot of pieces, particularly
• 24:43if you're talking about a
• 24:44current event,
• 24:46or a controversial issue, a
• 24:47lot of it is about
• 24:48getting the right tone of
• 24:49the piece,
• 24:51and, and stripping away things
• 24:53that we say, like,
• 24:54you know, health care utilization.
• 24:56Like, you know, like, why
• 24:57do people say utilization instead
• 24:59of, like, usage or, like,
• 25:00use? You know? Like, there
• 25:01are just things that we
• 25:03we talk about,
• 25:05that are,
• 25:06words that people don't use
• 25:07in everyday language. And so
• 25:09so that's kind of the
• 25:10last step that I try
• 25:10to, comb through and make
• 25:12sure that everything is as
• 25:13clean as as possible.
• 25:17To me, writing is like,
• 25:20in some ways, like talking,
• 25:21and I would never
• 25:23I don't use jargon in
• 25:25my speech.
• 25:26You know, I I feel
• 25:27like I talk and write
• 25:29like a real person and
• 25:30not like a scientist or
• 25:32a doctor because mostly, I'm
• 25:33a real person, and I
• 25:34always felt like I was
• 25:35just visiting
• 25:37this super
• 25:38science y
• 25:40evidence based planet of medicine.
• 25:43That I really didn't I
• 25:44wasn't a resident there. I
• 25:45was just
• 25:46just visiting
• 25:48and taking notes.
• 25:50And so to me, it
• 25:52would be
• 25:54difficult
• 25:55to write and make it
• 25:56sound like
• 25:57these journal articles that I
• 25:59read.
• 26:00I have
• 26:01written a couple of journal
• 26:03articles,
• 26:04but,
• 26:05but nerdier people than me
• 26:08made it sound right.
• 26:11You can also read your
• 26:13husband's stuff, which I've done
• 26:14when you just wanna get
• 26:15out and read something well
• 26:17done and not jargony and
• 26:18fun and funny.
• 26:20So I'll tell him you
• 26:21said that.
• 26:22Exactly. He'll be so so
• 26:24thrilled. I've done that. I've
• 26:25read jackets. Yeah. To be
• 26:26like, okay. This is this
• 26:28is, like, the normal way
• 26:29of writing. This is kind
• 26:30of fun.
• 26:31So
• 26:32there's probably questions in the
• 26:34audience, and I don't know
• 26:35if anyone's monitoring. I don't
• 26:36know. Are we monitoring questions
• 26:38from Zoom? But I think
• 26:40I think people that made
• 26:41it here in real life
• 26:42get
• 26:45first dibs. Am I in
• 26:46charge of doing this? Sure.
• 26:49I can I can just
• 26:50mine?
• 26:55Hi.
• 26:58I was made aware of
• 26:59the ethical difficulties that you
• 27:01guys have avoided
• 27:03when I I'm a psychiatrist.
• 27:05I had a patient come
• 27:05in and say
• 27:07that someone came up to
• 27:08her husband,
• 27:10in the bookstore and said,
• 27:11I saw you made it
• 27:13in the journals.
• 27:15And,
• 27:17he had no idea. And
• 27:19when we looked at the
• 27:20article, of course, all the
• 27:22names have been changed. The
• 27:23profession had been changed. But
• 27:25the person
• 27:27who recognized him knew enough
• 27:29of the idiosyncratic
• 27:30part of it that he
• 27:32was able to identify.
• 27:34And that sort of taught
• 27:35me a quick lesson that
• 27:37if you're gonna write about
• 27:38anybody, you really better get
• 27:39permission
• 27:41because it's very hard to
• 27:42cover up the parts that
• 27:45are of interest that bring
• 27:47you to the story.
• 27:49And,
• 27:50when I went to the
• 27:51I asked the my my
• 27:53patient if I could talk
• 27:54to the editor of the
• 27:55journal, and she said, yes,
• 27:56but don't identify.
• 27:58The problem, of course, was
• 28:00when I told him,
• 28:02he knew exactly who it
• 28:03was.
• 28:05But you can see how
• 28:06that kind of stuff can
• 28:07get very difficult.
• 28:15Thank you all for being
• 28:16here.
• 28:17My name is Carson, and
• 28:18I'm a master's student in
• 28:19the school of public health,
• 28:21preparing to apply to medical
• 28:23school in about a year.
• 28:25And,
• 28:25something I've been thinking about
• 28:27recently, and, Dhruv, you actually
• 28:29mentioned this when you came
• 28:30to speak to Howie Forman's
• 28:31class last year, was,
• 28:34the
• 28:35pressure,
• 28:36for academic
• 28:37medicine
• 28:39to publish, you know, in
• 28:40peer reviewed journals
• 28:42can sometimes
• 28:44supersede
• 28:45the
• 28:46desire or personal,
• 28:49interest in writing and storytelling,
• 28:51and that's something I have
• 28:53been thinking about a lot
• 28:54recently. And so I was
• 28:55wondering if you have any
• 28:56advice for someone who's preparing
• 28:58to enter the profession sort
• 28:59of on the outside looking
• 29:00in at some older med
• 29:02students who,
• 29:04you know, have said there's,
• 29:05like, this pressure to publish
• 29:07and if you have any,
• 29:09thoughts.
• 29:12Yeah. No. Thanks for that
• 29:13question. I think,
• 29:18you know, the most important
• 29:19thing,
• 29:20the advice that I got
• 29:21and the one thing that
• 29:22I'm, you know, proud about
• 29:23following is that I I
• 29:25I I very rarely feel
• 29:27like I did things to
• 29:29to bolster my resume that
• 29:30I wasn't genuinely interested in.
• 29:32And so the extent to
• 29:33which you can feel comfortable
• 29:35that, you have a clear
• 29:37sense of what you wanna
• 29:38do,
• 29:39you know, avoiding the temptation
• 29:41to just take a job
• 29:42or take a project because
• 29:44you think it's gonna get
• 29:45you to the next level.
• 29:46There are enough ways to
• 29:47be creative and impactful
• 29:50that, you know, serve the
• 29:51dual purpose of looking good
• 29:52on your resume.
• 29:53So,
• 29:54I I think,
• 29:55if if your ultimate goal
• 29:57is to to write and
• 29:58not to do kind of
• 29:59research that,
• 30:01there will be,
• 30:02opportunities to do that. And
• 30:03you have to find people
• 30:04that will support that. And,
• 30:06you know, fortunately, there's programs
• 30:08here and and elsewhere
• 30:09that do that. You know,
• 30:10when I was looking for
• 30:11my first job,
• 30:12after residency,
• 30:15I,
• 30:16I knew I wanted to
• 30:17do research, but I I
• 30:18didn't have a PhD. I
• 30:19didn't even have a master's
• 30:20in, you know, health sciences
• 30:21really. And so,
• 30:24you know, some people, I
• 30:26went to various department chairs
• 30:28who I wanted to work
• 30:28in. Many of them, you
• 30:30know, didn't, didn't pick up
• 30:31what I was putting down.
• 30:32You know? They,
• 30:33they weren't interested in someone
• 30:35who didn't have that PhD
• 30:36level training of, you know,
• 30:37health con
• 30:39economics and and so on.
• 30:40But some of them, and
• 30:41it's part of this is
• 30:42part of finding the right
• 30:43department chair and the right
• 30:44institution that's gonna, support a
• 30:46more nontraditional career if that's
• 30:47what you're interested in.
• 30:49We're interested in it. And
• 30:51so I feel like a
• 30:52lot of,
• 30:53my ability to do kind
• 30:55of what I
• 30:56do now and what I,
• 30:57you know, love doing is
• 30:59because I've waited for the
• 31:00right kind of or found
• 31:02the right people who would
• 31:03who would support that type
• 31:04of thing.
• 31:06But I would just say,
• 31:06you know, don't don't do
• 31:08research just because, you know,
• 31:09you feel like you should.
• 31:10I mean, there's there's such
• 31:11a an important role for
• 31:12health communication, and,
• 31:15and and I think that's
• 31:16becoming more and more clear.
• 31:17And so if that's your
• 31:17real passion, then then then
• 31:19do that instead.
• 31:27Thank you, guys. I guess
• 31:28my question is kind of
• 31:29the compliment of the confidentiality
• 31:31question. You know, for all
• 31:32the stories that you're not
• 31:34there for and not present
• 31:35and see yourself,
• 31:36you know, how are you
• 31:37making sure you're getting the
• 31:39right details in terms of,
• 31:41like, the quotes or, like,
• 31:42the mood or the emotion
• 31:44of the character? Like, even
• 31:45the example you read, like,
• 31:47oh, the neurologist reluctantly
• 31:49went, like, how do you
• 31:49know that? Or you asked
• 31:51him or yeah. So
• 31:58I can take it. But,
• 31:59you know, that was,
• 32:00straight from the horse's mouth
• 32:01over here. So
• 32:03no. I I so so,
• 32:04you know, I I try
• 32:05to be as clear as
• 32:06possible, about, you know, when
• 32:08I am there and what
• 32:09I know and,
• 32:10and what I don't.
• 32:12And often when,
• 32:14when I'm not there,
• 32:15it is,
• 32:17based on the accounts of
• 32:18at least one person, if
• 32:19not more people. And and
• 32:22to the extent possible, you
• 32:23try to cross reference the
• 32:24same thing to if someone
• 32:26says it was a sunny
• 32:28day, then you ask the
• 32:29other person, you know, what
• 32:30was it sunny or was
• 32:31it cloudy? You know? And
• 32:32so, you try to triangulate
• 32:34in a way to try
• 32:35to get as close to
• 32:37the truth as possible. And,
• 32:39and if you if you
• 32:40don't know, then then you
• 32:41have to kind of use
• 32:42language that either makes it
• 32:44very clear that you don't
• 32:45know or,
• 32:46you know, say things like
• 32:47reportedly or allegedly or, you
• 32:50know, possibly or likely, things
• 32:51that at least give the
• 32:53reader a sense of your
• 32:54your hedging because you're not
• 32:55a hundred percent sure about
• 32:56something.
• 32:58Yeah. I mean, you can
• 32:59ask this.
• 33:00Reading both of your cases,
• 33:02I've been immersed in the
• 33:03last couple days.
• 33:04If you study them, they
• 33:06rarely try to mind read
• 33:08their characters.
• 33:10They might say she was
• 33:11tapping her foot. You know?
• 33:13Like, you describe them in
• 33:14ways that the reader knows
• 33:16they're nervous or they're annoyed.
• 33:18But both of you rarely
• 33:21you're not judging it. Maybe
• 33:23you are in real life,
• 33:24but on the paper,
• 33:25you're not judging with your
• 33:26characters. You're just seeing what
• 33:28you saw, like picking your
• 33:29cuticles or rubbing your, like,
• 33:31grimaced or lips were tight
• 33:33or something. So I think
• 33:35which I think is wonderful
• 33:36about both of your writing
• 33:37that we can feel by
• 33:39what you're carefully observing, which
• 33:40is probably part of your
• 33:41medical training.
• 33:44I am rarely
• 33:45with the person who
• 33:47I'm rarely present
• 33:49in the encounters that I
• 33:51write about. It's usually an
• 33:52encounter between a doctor and
• 33:54a patient. That's that's all
• 33:55there is. So I asked
• 33:58the patient, tell me your
• 33:59story. What happened?
• 34:02And then I and what
• 34:03did the doctor say? And
• 34:04what did you say? And
• 34:06then I go back to
• 34:06the doctor and and say,
• 34:08what happened? And then I
• 34:09try
• 34:10to find the places where
• 34:12they come together. And when
• 34:13they don't come together, I
• 34:14go back and say, you
• 34:15know, the patient said you
• 34:17said this.
• 34:18And the doctor will either
• 34:20say, oh, I would have
• 34:20never said that.
• 34:23Happens occasionally. Or says, oh,
• 34:25yeah. That's so like me.
• 34:26I say that all the
• 34:27time. You know? So I
• 34:28try to confirm it. And,
• 34:29you know,
• 34:31the story I'm writing now
• 34:32happened on
• 34:34a a sunny June morning.
• 34:36The patient told me it
• 34:37was sunny.
• 34:38I looked it up on
• 34:39the Google.
• 34:40It was, in fact, sunny.
• 34:44So, you know, you try
• 34:45to be I mean and
• 34:46there are enough details in
• 34:47life in any
• 34:49experience so that you can
• 34:50pick the ones that you
• 34:52know to be as true
• 34:53as possible,
• 34:55which is all you can
• 34:55hope for.
• 34:59Thank you.
• 35:01So as one who is
• 35:02towards the end of a
• 35:03long career
• 35:05and,
• 35:06having been in primary care,
• 35:08think of myself as a
• 35:09diastician
• 35:11diagnostician.
• 35:15Do you think
• 35:16doctor AI
• 35:18would be as good
• 35:20a diagnostician
• 35:21as doctor Duffy? Well, I
• 35:23already know the answer to
• 35:24that one. But,
• 35:26the question is, so then
• 35:28what would the role be
• 35:30of
• 35:31the doctor after AI takes
• 35:33over with the diagnosis
• 35:35part and so on?
• 35:37I read that and write
• 35:39it too. You know, when
• 35:42when we have what they
• 35:44had on Star Trek, where
• 35:46we have a little AI
• 35:47that we pass over the
• 35:48patient and the machine can
• 35:50actually look into the patient
• 35:52and see what is actually
• 35:54wrong,
• 35:55then that's gonna maybe help
• 35:57diagnosis, although there's a lot
• 35:58of components to diagnosis that
• 36:00are that are not visible.
• 36:02So I don't actually see
• 36:04AI
• 36:05collecting the information.
• 36:07So
• 36:08what AI gets
• 36:10is the patient story,
• 36:12the doctor's version of the
• 36:13patient story, what the what
• 36:15the doctor knows about the
• 36:16patient in addition to that,
• 36:18and then it feeds it
• 36:20into
• 36:21the AI. And the AI
• 36:24just has a bigger
• 36:25database
• 36:26of things to draw from.
• 36:28That's great. That's important. That's
• 36:29a tool. We've had this
• 36:30for a long time. It
• 36:31hasn't been as great
• 36:33as it may be now.
• 36:35Although, I have AI to
• 36:36help me write my notes,
• 36:37and let me just tell
• 36:38you,
• 36:39not great.
• 36:41But, you know, it's beginning.
• 36:42It's just beginning. It's new.
• 36:44So I'm sure it will
• 36:45get better, but I think
• 36:46that there are things that
• 36:48come out of a personal
• 36:49relationship
• 36:51with a patient
• 36:52or even with just another
• 36:54human being that I I'm
• 36:56perhaps
• 36:57AI is better. I mean,
• 36:58I hear that
• 36:59in psychiatry
• 37:01or in in in counseling,
• 37:04You know? AI does as
• 37:05well as humans,
• 37:07at eliciting
• 37:08at, you know, being empathetic
• 37:10and eliciting
• 37:12or, you know,
• 37:13deep thoughts or
• 37:15that may be. And and
• 37:16maybe we'll get replaced by
• 37:18doctors, but it ain't gonna
• 37:19be in my lifetime.
• 37:28Yeah. Thank you all for
• 37:29being here and giving this
• 37:31talk. I have kind of
• 37:32a more practical question for
• 37:34both of you. I'm an
• 37:35I'm resident here who really
• 37:37enjoys writing.
• 37:39And, of course, we see
• 37:40crazy incredible things in the
• 37:42hospital every day.
• 37:44But then weeks or months
• 37:45later when I find the
• 37:47time to actually sit down
• 37:48and start writing, I feel
• 37:49like I spend most of
• 37:50my time thinking back,
• 37:52and trying to remember the
• 37:53interesting cases that I saw.
• 37:55And I I spend most
• 37:56of my time kind of
• 37:57brainstorming what to write about.
• 38:00And so for both of
• 38:01you throughout your med school
• 38:02careers, residency, and practices,
• 38:05just practically, how do you
• 38:07sort of keep track of
• 38:08all of the interesting
• 38:09cases that you see, stories
• 38:11that you're you hear, and
• 38:12then what is your process
• 38:13of turning those thoughts and
• 38:16stories into writing down the
• 38:18road?
• 38:23So,
• 38:24you know,
• 38:26I think there for me,
• 38:27at least, there's there's a
• 38:28couple ways in which I,
• 38:29you know, come up with
• 38:29ideas, and I and I
• 38:30think about writing about them.
• 38:33The first is kind of
• 38:33what you're describing, which is
• 38:35you're in the hospital or
• 38:36you're in the clinic and
• 38:37you're experiencing things. And some
• 38:38of that is with patients,
• 38:40and some of that is
• 38:41the frustrations of the system.
• 38:42And as a resident or
• 38:43a medical student, you have
• 38:44a very unique perspective that
• 38:46you lose as you're an
• 38:48attending or senior physician.
• 38:50And so, I think it's
• 38:51really important to have that
• 38:52voice. And so I didn't,
• 38:53you know, encourage you to,
• 38:54to to write. And and
• 38:56a lot of that is
• 38:57to,
• 38:58basically, you know, have a
• 39:00journal or entry, jot down
• 39:02even some bullet points of
• 39:04thoughts or insights that you
• 39:05have over the course of
• 39:06the day so you can
• 39:07return to those. And so
• 39:08I think that's,
• 39:09that that's part one.
• 39:11The other things that I
• 39:12often kept track of is
• 39:14one,
• 39:15is this idea of just
• 39:17being aware of the current,
• 39:19you know, health care landscape
• 39:20and current events, and there's
• 39:22no shortage of, you know,
• 39:23events right now that are
• 39:24happening. And so if there
• 39:25are things that you see
• 39:26that you think are important
• 39:28parts of the conversation that
• 39:29are being missed as things
• 39:30are being upended and changed,
• 39:33you know, it's important to
• 39:34kind of have that as
• 39:35as part of the backdrop.
• 39:37And the third is
• 39:39being aware of the medical
• 39:41literature. And so, you know,
• 39:42often there'll be a new
• 39:43paper in the New England
• 39:44Journal or JAMA or whatever,
• 39:46you follow. And, maybe there's
• 39:48an opportunity to,
• 39:51convey something interesting that's been
• 39:53changed in the medical literature
• 39:55or has a new practice
• 39:57changing insight or brings to
• 39:58bear something new,
• 40:00that you can use,
• 40:01in some of your writing.
• 40:02So those are the three
• 40:03things that I've often used
• 40:05to come up with ideas
• 40:06and then to start writing.
• 40:11So when I get to
• 40:12a place where I don't
• 40:13know what to write next,
• 40:15I always know that it's
• 40:16an information deficit.
• 40:18And I could be in
• 40:19the middle of a story,
• 40:20or I could be writing
• 40:21something else. But when I
• 40:22really don't know what to
• 40:23say,
• 40:25I always think I always
• 40:26suspect it's because I really
• 40:27don't know,
• 40:28and I have to go
• 40:30and
• 40:30do get more inputs.
• 40:34The other thing that I
• 40:35think is important
• 40:37is to monitor your own
• 40:38emotions. When something like,
• 40:42I've been doing it for
• 40:43so long. It it and
• 40:44doctors have been doing it
• 40:45for so long that I
• 40:46think it becomes second nature.
• 40:47But when you
• 40:50get that funny feeling,
• 40:53then
• 40:54you you're like, oh, that's
• 40:55interesting.
• 40:56I'm interested in that. And
• 40:57then you try to file
• 40:58it away. But if you
• 40:59don't write it down, it's
• 41:00gone. So you have to
• 41:02keep a journal, write things
• 41:04down,
• 41:04keep aware of it.
• 41:06I have a a five
• 41:08year journal,
• 41:09and what's great about a
• 41:10five year journal is that
• 41:12every day
• 41:14of the year has sections
• 41:15for every for five different
• 41:17years, so you only have,
• 41:18like, seven lines.
• 41:21And so it's easy to
• 41:22come up with seven lines
• 41:24of stuff
• 41:25that you that you that
• 41:27caught your interest, that caught
• 41:28your eye. I try to
• 41:29make it about something
• 41:30interesting or something I learned
• 41:32or something new or
• 41:34some observation
• 41:35so that I have something
• 41:37to write about, but anybody
• 41:38can write seven lines.
• 41:47I don't know if you'll
• 41:47point on that.
• 41:51I think we just have
• 41:51time for, like, two more
• 41:52questions. This gentleman in the
• 41:54back is very eager to
• 41:55ask a question also. So
• 41:58I would like to go
• 41:58first.
• 41:59Thank you so much for
• 42:00speaking with us. This has
• 42:01been great.
• 42:02I'm wondering if you could
• 42:03speak more about your research
• 42:05process.
• 42:06How do you start researching
• 42:08a topic? And then I'm
• 42:09also curious about, you know,
• 42:11when there's such a broad
• 42:12medical topic and you're trying
• 42:14to make it
• 42:15understandable, how do you limit
• 42:16the information you're putting in?
• 42:20Research as in research for
• 42:22an article.
• 42:23Yeah.
• 42:25So as I said, the
• 42:26first thing that I do
• 42:27is just try to read
• 42:28as much as I can.
• 42:30And I know that I've
• 42:31read enough when I start
• 42:33coming up against the same
• 42:35ideas
• 42:36over and over again or
• 42:37the same,
• 42:38key articles and key insights
• 42:40over and over again. And
• 42:41that could take,
• 42:42quite a quite a bit.
• 42:43So the first thing that
• 42:44I do is just read,
• 42:47as much as I can
• 42:48about a given topic,
• 42:50until I feel like I've
• 42:51got theme saturation, basically.
• 42:54The second thing that's really
• 42:56helpful is just to talk
• 42:57to experts,
• 42:59who know something,
• 43:00about how to contextualize the
• 43:02literature that that I I
• 43:03don't know. And I try
• 43:04to stack the experts,
• 43:06from, like, people who are
• 43:08gonna be, like, most
• 43:10generous and nice to me
• 43:11to those that are a
• 43:12little bit more intimidating.
• 43:13Because by the time I'm
• 43:15talking to those latter people,
• 43:17I feel like I can
• 43:18hold my own. And so,
• 43:20you know, talk to someone
• 43:21who you feel a little
• 43:22bit more comfortable with,
• 43:23who you can bounce your
• 43:24ideas off of, and then
• 43:25hone them up, you know,
• 43:26as as you go along.
• 43:27So I think, you know,
• 43:28read as much as you
• 43:29can.
• 43:30Talk to,
• 43:31talk to experts. And then
• 43:32I try to condense
• 43:33those, ideas and insights that
• 43:35I've had,
• 43:36by theme. And so, if
• 43:38it's an article about, you
• 43:40know, whatever whatever it might
• 43:41be,
• 43:42I'll have, I'll have, like
• 43:44or these are the three
• 43:45or four main points that
• 43:46I wanna make in this
• 43:47article. And do I know
• 43:48enough about each of these
• 43:49points?
• 43:50And then from there, I
• 43:51think about,
• 43:53how do I make it
• 43:54feel like not four or
• 43:55five separate sections, like separate
• 43:57essays in a piece, but
• 43:59what is going to be
• 44:00the kind of
• 44:02texture,
• 44:03the, kind of interstitial,
• 44:06fluid that's going to connect
• 44:07everything.
• 44:08And so I'm often thinking
• 44:09about then how do I
• 44:10how do I create an
• 44:11arc that makes someone wanna
• 44:13read to the end of
• 44:13this piece as opposed to
• 44:14just stop in the middle?
• 44:19Well, I only have
• 44:20fourteen hundred words,
• 44:22so that really that really
• 44:24limits, I mean, for my
• 44:25regular column. So that really
• 44:27limits,
• 44:29and what I can stick
• 44:31in there. And I try
• 44:32to
• 44:33make everything I say
• 44:35pertinent
• 44:36to what happened in the
• 44:37story, you know, what the
• 44:38presentation is, what the
• 44:41how it all worked.
• 44:43And once you
• 44:44once you recognize that
• 44:46the story is
• 44:48about there that there's a
• 44:50story here.
• 44:51Everything that's not story
• 44:53just needs to go away.
• 44:55So that's
• 44:56an important
• 44:57part of editing is realizing,
• 44:59oh, this is cool,
• 45:01but it doesn't belong in
• 45:02the story. But it's not
• 45:03part of the story. That's
• 45:04such an important point. I
• 45:05mean, there's a saying, you
• 45:06know, murder your murder your
• 45:07darlings. Like, this idea that,
• 45:09like,
• 45:11it is so painful so
• 45:12much of the time because
• 45:13you've, like, you have all
• 45:13these great,
• 45:15you know, words and ideas
• 45:17and, you know, like, these
• 45:17phrases that you're so proud
• 45:18of. You just have to
• 45:20kill them. You know?
• 45:21And,
• 45:22and I've I've gotten
• 45:24this idea in my mind
• 45:25that, like, the reader can
• 45:27sense that there's a lot
• 45:29more underneath the iceberg that
• 45:30has been left out and
• 45:31you're just try but but
• 45:32it's, like, it's actually,
• 45:34informing every word that's on
• 45:36the page. It's just kind
• 45:37of not not quite didn't
• 45:38didn't quite make the cut.
• 45:39So you have to get
• 45:40comfortable with this idea that
• 45:42a lot of what you
• 45:42do, a lot of what
• 45:43you read, a lot of
• 45:44what you write doesn't actually
• 45:46make it on the page,
• 45:46but it's it's there. It's,
• 45:47like, playing a really important
• 45:49supporting role.
• 45:50I'll add it's very different
• 45:52in terms of academic writing.
• 45:53I think that
• 45:56sometimes I was gonna say
• 45:57we. I'll just say me.
• 45:59Sometimes I'm so proud of
• 46:00being able to understand something
• 46:02that I didn't before,
• 46:04and I kind of want
• 46:05even the experts reading my
• 46:07piece to know that now
• 46:08I understand it. That makes
• 46:10for lousy writing. Like, you're
• 46:12not writing
• 46:13you're not writing to prove
• 46:15to the specialist in the
• 46:16field that you did your
• 46:18homework.
• 46:19You're trying to write a
• 46:20good story that people with
• 46:22no medical background can be
• 46:24engaged in.
• 46:25And if you're ever giving
• 46:26a talk and there's someone
• 46:28in the audience that sort
• 46:29of questions and says, but
• 46:30do you really understand x?
• 46:31You can actually say, yes.
• 46:32I actually did my homework.
• 46:34But it's hard because you
• 46:35do all this work, and
• 46:36now it's like, yikes. Now
• 46:37they're gonna think I might
• 46:38not know. But I think
• 46:39the authority comes through. That's
• 46:40what I tell myself. You
• 46:42know? It's true. Yes. I
• 46:44think I have your book.
• 46:45I see your Right. The
• 46:46authority. Right. And also gives
• 46:48you confidence that you're not
• 46:49missing something big. You know,
• 46:50even if you've left things
• 46:51out, you wanna make sure
• 46:53that the opposite of what
• 46:54you're saying isn't actually true.
• 46:55And so you you've done
• 46:56your homework in a very
• 46:57broad way.
• 46:58Owen, we had one.
• 47:02Hello. I have, two quick
• 47:03questions for doctor Sanders, if
• 47:05I may.
• 47:06One,
• 47:07I too was a perceptibly
• 47:09older medical student, and I
• 47:10wonder if you could reflect
• 47:11on that experience
• 47:13in your regard.
• 47:14And two, did anything from
• 47:16Bertrand Richer make it into
• 47:17bones?
• 47:20Which I love that show,
• 47:21by the way.
• 47:22To bones or the? Well,
• 47:24into anything that you've done,
• 47:26actually. Yeah.
• 47:27Well, I love Bertrand Richer,
• 47:29and I think that,
• 47:31I think it must have
• 47:32been informative because when I
• 47:33reread
• 47:34somebody after I started writing
• 47:36my columns, I'd said, Oh,
• 47:38you must know about Bert
• 47:40and Touche? And I was
• 47:40like, I don't think so.
• 47:42So I bought the book,
• 47:43The Book of Bouvet, and
• 47:44when I was reading it,
• 47:45I remembered
• 47:46that I had read
• 47:48Barker,
• 47:49his first book, like ten
• 47:51or twelve.
• 47:52So I'd say, but he
• 47:53probably shaped it, Doctor. Fighter?
• 47:56I am.
• 47:58And but I don't think
• 47:59any of it I mean,
• 48:00might have. I mean, I
• 48:02do think there was a
• 48:03house that was called three
• 48:06somethings,
• 48:08and it was, I think,
• 48:09a reference to a rep
• 48:10event, but I'm not sure
• 48:11if that I wasn't the
• 48:12writer. I was just myself.
• 48:23We are at the end
• 48:23of our slightly longer hour
• 48:25than an hour. So I
• 48:26just wanna give,
• 48:28each of the our speakers
• 48:30two minutes or one one
• 48:31to two minutes
• 48:34to impart some advice or
• 48:35reflection on writing in medicine
• 48:37and being a doctor who
• 48:38writes their work some questions
• 48:40in the chat about
• 48:41how do you do it
• 48:42all. Obviously, you can't answer
• 48:43that in one or two
• 48:44minutes, but just
• 48:46give us give us a
• 48:47pearl of wisdom. No pressure.
• 48:49And thank you everybody for
• 48:51coming. And I have to
• 48:52also say,
• 48:53Susan Duffy, Tom Duffy's wife,
• 48:56is in Spain, and she
• 48:57is listening and watching right
• 48:59now. So hi, Susan.
• 49:01We wish
• 49:03you
• 49:05were
• 49:06here.
• 49:08Well, for my closing statement,
• 49:11I don't know that I
• 49:12have any, pearl of advice
• 49:13to to give other than,
• 49:16I think as doctors,
• 49:18we,
• 49:20we're in a very,
• 49:22unique position in society, and
• 49:24I think we should try
• 49:25to leverage that, in the
• 49:27best way that we can.
• 49:27And some of that is
• 49:28writing, but a lot of
• 49:29it will be,
• 49:31communicating about what we see
• 49:32and feel,
• 49:33in some fashion. I say,
• 49:35you know, there's all sorts
• 49:36of reasons that we're, kind
• 49:37of a unique profession. But
• 49:38one of it is,
• 49:41doctors are
• 49:42highly educated and highly paid
• 49:44and have a certain level
• 49:46of social status in society.
• 49:49But they're one of the
• 49:49few professions
• 49:51that see,
• 49:53and care for people in
• 49:55the dire straits. And so,
• 49:56you know, if you're in
• 49:57private equity or you're a
• 49:59consultant, you're also highly paid
• 50:00and highly educated, but you're
• 50:01not, you know, examining the
• 50:03feet of
• 50:04people who are homeless and
• 50:06diabetic. And you're not,
• 50:08you know, meeting people from
• 50:10all walks of life in
• 50:11the way that,
• 50:12physicians are. And so,
• 50:14for those stories to be
• 50:15told,
• 50:16we need to speak up
• 50:18and speak out.
• 50:19And,
• 50:21otherwise, you know, they won't
• 50:22be told or they'll be
• 50:23told by people who don't
• 50:24have
• 50:25the,
• 50:26the kind of social standing
• 50:28that we do just by
• 50:29the virtue of our of
• 50:30our profession.
• 50:31And so that's my plug
• 50:32for for everyone to to
• 50:34write or to speak or
• 50:35to talk to other people
• 50:36who who write and speak,
• 50:38and to, and to advocate
• 50:40in any way that you
• 50:40can.
• 50:42You can get the last
• 50:43word.
• 50:44The last word. Oh, I'm
• 50:46I'm so honored.
• 50:49Well, I think that the
• 50:50most important thing is to
• 50:51have
• 50:52empathy
• 50:53and sympathy and try to
• 50:55get into the mindset of
• 50:56everybody
• 50:58you talk to,
• 51:00as part of the story.
• 51:01I mean,
• 51:02if
• 51:04you have to I think
• 51:05when you're interviewing somebody,
• 51:07you have to go into
• 51:08it thinking their point of
• 51:10view is probably
• 51:12maybe different from mine, but
• 51:13it's probably very interesting, and
• 51:15I wanna understand where it's
• 51:16coming from.
• 51:18So I think that being
• 51:19open and,
• 51:21open minded and open hearted
• 51:24in your conversations
• 51:25is gonna
• 51:26help you when you're writing.
• 51:30It's also important to recognize
• 51:32that your feelings
• 51:33are going to affect
• 51:36what you see and what
• 51:37you hear. And our job,
• 51:39at least in part, is
• 51:40to
• 51:42try to at least recognize
• 51:43it. But I do wanna
• 51:44since Susan Duffy is is
• 51:46listening from Spain, I do
• 51:48wanna talk about one moment
• 51:50where I learned how much
• 51:51emotion can change your perception.
• 51:54I wrote about Tom Duffy
• 51:56in the story
• 51:57that Randy read. That was
• 51:59the first time I wrote
• 52:00about him very early on
• 52:01in my,
• 52:03column.
• 52:04And he came up to
• 52:05me afterwards, and he goes,
• 52:06well, thank you so much.
• 52:07That was so kind, but
• 52:08you did make one mistake.
• 52:11And, of course, you know,
• 52:12just terror shot through me.
• 52:15And he said,
• 52:16I'm not actually tall.
• 52:18But
• 52:19we
• 52:21all thought. But we all
• 52:22thought. And when I said
• 52:23that to Randy, she's like,
• 52:25he is tall. No. No.
• 52:26He told me. He is
• 52:28a towering figure, but that
• 52:30was my feelings
• 52:32changing
• 52:34what I actually saw. And
• 52:36that happens all the time,
• 52:37and that was the first
• 52:38time I became aware of
• 52:39that.
• 52:41I try to think about
• 52:42it all the time because
• 52:43your feelings, they might be
• 52:44good feelings, they might be
• 52:45bad feelings, but they're affecting
• 52:47what you see, and you
• 52:48have to try to
• 52:49be aware. I'll just get
• 52:51one more plug on the
• 52:52writing because I know we
• 52:53have a lot of future
• 52:54writers here.
• 52:56There's a push not at
• 52:58The New Yorker, The New
• 52:59York Times. There is this
• 53:00push to be very binary.
• 53:02It's good or it's bad.
• 53:04It's great or it's terrible.
• 53:06And I would urge all
• 53:07the writers out here that
• 53:09the only way we're going
• 53:11to bridge the gap
• 53:13is to write with nuance.
• 53:15And nothing is a hundred
• 53:16percent great. Not well, some
• 53:18things are a hundred percent
• 53:19terrible, but nothing's a hundred
• 53:20percent great. But the more
• 53:22it's trickier. It's trickier to
• 53:24say to stay in the
• 53:25gray zone,
• 53:27but I think
• 53:28you know that from being
• 53:29here at Yale. That's the
• 53:30way you're taught,
• 53:31and I think you need
• 53:32your writing to show that,
• 53:34because it is the only
• 53:35way that we're gonna
• 53:36get people to trust us
• 53:38again. Right. And that's what
• 53:40empathy is for. I mean,
• 53:41that's what getting into their
• 53:43trying to put yourself in
• 53:44their place does for you,
• 53:46lets you write in a
• 53:47way that's not, it's no
• 53:49wrong. Right.
• 53:51And we're gonna stop there.
• 53:53Thank you all so much.
• 53:55Thank you everybody for joining
• 53:57us.