Writing May Become Your New Favorite Coping Strategy

Writing May Become Your New Favorite Coping Strategy

Reflective writing, narrative medicine — whatever you call it, it’s a simple and cost-effective way to manage stress.

The COVID-19 pandemic is an unprecedented global crisis, and healthcare personnel and support staff are taking it particularly hard. If you are feeling the stress of doing your job, staying safe personally, and keeping your family safe as well, you’re not alone.

But how do you cope when so many of the regular options for stress relief aren’t available due to social distancing measures, or even your own practice’s or facility’s rules and regulations?

Reflective writing, or “narrative medicine,” can be a useful tool for processing experiences, and you don’t need any special equipment or access to other professionals to do it.

What Is Narrative Medicine?

Narrative medicine is an educational movement that some medical schools are incorporating into their curriculum in order to build empathy for patients and residents, as well as to check in with clinicians’ own biases and realities.

“Narrative medicine gives doctors, nurses, and social workers the skills, traditions, and texts to provide nuanced, respectful, and singularly fitting clinical care to the sick while also achieving genuine contact with their own and their colleagues’ hopes and ideals as health professionals,” says Rita Charon, MD, PhD, in her book Narrative Medicine. Healthcare professionals and laypeople can use methods inherent to narrative medicine to get in touch with their own feelings about an experience, as well as connect with others.

Writing can be an especially effective tool right now, while so many crave connection during this period of social distancing.

“Narrative medicine offers a unique framework to explore and manage the complexity of healing. Its impact extends beyond the physician-patient relationship and into the relationships between physician and self, physician and colleagues, and physician and society,” say Samir Johna, MD, and Ahmed Dehal, MD, in their article “The Power of Reflective Writing: Narrative Medicine and Medical Education” in The Permanente Journal.

Make Sense of Your Experience

Compartmentalization is a go-to coping skill for many. You may, for example, use your commute to unwind so you don’t bring work home (hard to do now, if you’re working from home). Practitioners may try to pack their feelings about a tough or sad experience with a patient or an uncomfortable interaction into one corner of the heart or mind so they don’t bring the guilt or sorrow home.

“The ‘self’ in question is necessarily both the professional and the personal self because clinical practice is informed by both medical and personal experience. Few medical educators writing about empathetic witnessing or narrative medicine, however, make note of the impact that a physician’s personal identity — including personal and familial illness history, ethnicity, gender, sexuality, class — may have upon their ability to hear, interpret, and translate patients’ stories,” say Sayantani DasGupta, MD, MPH, and Charon in their article “Personal Illness Narratives: Using Reflective Writing to Teach Empathy” in Academic Medicine.

Right now, being a healthcare professional — or working alongside colleagues who provide direct care — is unduly stressful, from both a business standpoint and a personal one. Many people are grieving the loss of pre-pandemic normalcy and feeling complicated guilt surrounding patient care or business margins.

“Health care professionals’ guilt is a powerful engine for their behavior. We are burdened and also supported by a highly developed sense of personal accountability. When we inevitably err in the course of practice, we must deal with the tremendous pain of guilt,” Charon says.

Acknowledging any complicated feelings is part of the process, as well as a result. “Although the specifics of the suffering may
change — paralleling the technological realities of practice — the heart of the suffering remains the same: shame at being powerless, guilt and rage in the face of blame, and fear of all the dying,” Charon says.

Right now, while social distancing is in effect for much of the country, as states pause or even reverse their reopening plans, writing is an effective method for processing all of these feelings and experiences. “Writing, or telling, gives a speaker the authority and the opportunity to reveal the self,” Charon says.

How to Begin Narrative Writing

Set a timer for five minutes and put a pen to paper. Don’t think too hard about what you’re writing, just jot down your feelings about what happened that afternoon, day, or week. Don’t worry about editing — just get the words down. For some people, putting words to paper is cathartic in and of itself.

You may try this exercise together with colleagues. Although most studies have been conducted with medical students, and the results aren’t conclusive, evidence suggests that sharing your writing within a small group can be helpful both personally and as a whole.

“The first phase (writing) is individual and solitary, consisting of personal reflection and creation. Here, introspection and imagination guide learners from loss of certainty to reclaiming a personal voice; identifying the patient’s voice; acknowledging simultaneously valid yet often conflicting perspectives; and recognizing and responding to the range of emotions triggered in patient care,” say Johanna Shapiro, PhD; Deborah Kasman, MD; and Audrey Shafer, MD, in their article “Words and Wards: A Model of Reflective Writing and Its Uses in Medical Education” in Journal of Medical Humanities.

“The next phase (small-group reading and discussion) is public and communal, where sharing one’s writing results in acknowledging vulnerability, risk-taking, and self-disclosure. Listening to others’ writing becomes an exercise in mindfulness and presence, including witnessing suffering and confusion experienced by others,” Shapiro, Kasman, and Shafer say.

Devoting five minutes to writing or 15 minutes to writing and sharing your work could make a difference in how you cope with the pressures of COVID-19. You may also find you’re connecting with your colleagues over an experience you’re sharing together but apart.

Rachel Dorrell
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Rachel Dorrell, MA, MS, writes about the Minimum Data Set, practice management, and ICD-10 coding, focusing on the issues that keep nursing facility and medical office personnel up at night. She has a Master of Science in narrative medicine from Columbia University. She also runs a farmstead in the New York Finger Lakes region, focusing on sustainably raising happy, healthy heritage-breed livestock.

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