What Does ‘Paying Attention’ Mean in a Healthcare Setting? A Reflection by Ewan Bowlby

Ewan Bowlby  is a doctoral student at the Institute for Theology, Imagination and the Arts (ITIA) in St Andrews. He is researching ways of using mass-media artworks to design new arts-based interventions providing emotional, psychological and spiritual care for cancer patients. Bowlby’s paper “Talk to me like I was a person you loved”: Including Patients’ Perspectives in Cinemeducation” appears in the Spring 2021 Intima: A Journal of Narrative Medicine.

Narrative Medicine is about creating connections: finding words, ideas or stories that bridge the gap between patients and health professionals. This search for common ground is beautifully rendered in Carol Scott-Conner’s short story “Christmas Rose” (Spring 2017 Intima). Her fictional narrative reveals how mutual understanding can emerge in unexpected places. An encounter between the resolute, inscrutable Mrs. Helversen and her oncologist shows that the relationship between a physician and patient can flourish when the physician pays attention to the intimate, personal details of a patient’s story.

Initially, the clinical encounter in “Christmas Rose” seems unpromising, hampered by reticence and disagreement. Mrs. Helversen, who has a neglected tumor on her breast, has been “strong-armed” into a cancer clinic by her concerned daughter, and she is not receptive to the prospect of treatment. Scott-Conner, a Professor Emeritus of Surgery at the University of Iowa Carver College of Medicine, switches the first-person narrative from Mrs. Helversen to her oncologist, allowing the reader to inhabit two alternative perspectives on the same meeting and reminding us that the same interaction can be interpreted very differently.

When I wrote an academic article that appears in the Spring 2021 Intima proposing that patients’ perspectives should be included in “cinemeducation,” these differences in interpretation were central to my argument. Showing clips from films to encourage medical students to relate to a fictional patient is an excellent idea. Yet listening to how patients respond to these clips can enrich this pedagogical method. As I demonstrate through the qualitative research presented in my article, patients “see things differently.” The same fictional scene featuring a patient-doctor interaction can draw responses from patients that surprise and challenge healthcare professionals. So, why not use such scenes as a space in which different perspectives can be expressed and discussed, bringing patients and providers together through the audio-visual medium?

In “Christmas Rose,” it is a rock that facilitates this meeting of minds. While the oncologist is surprised when Mrs. Helversen describes her tumor as a “rose,” betraying a complex emotional attachment to the growth, she finds a way to react empathetically and imaginatively to Mrs. Helversen’s unusual behavior. Offering the elderly patient a desert rose rock in exchange for her tumorous “rose,” the oncologist persuades Mrs. Helversen to accept treatment. This fictional oncologist shows an adaptability and ingenuity that the health professionals involved in my research also exhibited. In my article, I describe how health professionals engaged constructively with patient’s unique or unexpected responses to imagined patient-doctor interactions in films. Listening to both sides and hearing alternative perspectives on the same encounter can yield important, enlightening insights, whether one is participating in a focus group, watching film clips or doing a close reading of a short story such as “Christmas Rose.”

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Ewan Bowlby  is a doctoral student at the Institute for Theology, Imagination and the Arts (ITIA) in St Andrews. He is researching ways of using mass-media artworks to design new arts-based interventions providing emotional, psychological and spiritual care for cancer patients. This involves using fictional narratives, characters, and imagery to reflect and reframe patients' experiences of living with cancer, helping them to understand and articulate the effect of cancer on their lives. He is developing the impact of his research through an ongoing collaboration with Maggie Jencks Cancer Care Trust (Maggie's) and Northumberland Cancer Support Group (NCSG). Other interests include theological engagement with popular culture, the relationship between theology and humor and the use of narrative form for theological expression. Bowlby’s paper “Talk to me like I was a person you loved”: Including Patients’ Perspectives in Cinemeducation” appears in the Spring 2021 Intima: A Journal of Narrative Medicine.

"Who is Black excellence for exactly?" A poem reflects on that question by medical student Michael Arnold

Chronic Black Excellence by Michael Arnold

A hundred years ago, Abraham Flexner
Eulogized Black medicine.
The ink in his pen tattooed
A sleeve on the arm of systemic racism.
The idea that screamed off his report
And echoed the loudest throughout history
Was the notion that Black medicine
Was fundamentally inadequate.

For the last century, Black medicine
Has been self-medicating with Black excellence.
A treatment plan that may be just as bad
As the prevailing social illness.
Black excellence is a poisoned apple,
Being eaten by a Trojan Horse.
Side effects may include:
Elitist attitudes, reactionary logic
Burnout, brunch addiction
And respectability politics
The siren song of Black excellence
Has veered us completely off course.
It’s a self-appointed pedestal that
Makes us look down on the
People that we dreamed of healing.
It makes us want to walk away
From the neighborhoods that
Raised us and never look back.

Black excellence is a blade on
The tongue of Horatio Alger’s descendants;
White people who will cut and paste
Your story into anecdotal evidence
That absolves them of their privilege.
Black excellence is a weight that actively
Compresses our humanity,
Erasing the mere possibility
Of us being normal, regular or average.
It erases the relief of mediocrity
That many of our white colleagues
Comfortably enjoy during their careers.

Who is Black excellence for exactly?
What’s the message we are trying to send?
Who are we sending it to?
Are we trying to claim that we are better
Than the Black people who lifted us up
High enough to access the white-dominated
Space called Western medicine?
Are we trying to signal that we
Are one of the “good ones”?
Is it an attempt to exorcise the demons
Of ever-haunting stereotypes?
Or is it just our insecurities
Crying out, wanting desperately
For white people to finally believe
That we are adequate?

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Michael Arnold is a medical student at Ohio State University Heritage College of Osteopathic Medicine. His poem “Chronic Black Excellence” appeared in the Fall 2019 Intima.