Dr. Rita Charon

I wanted to find a way to help the students focus on what they themselves were going through, and a way to focus on what their patients had to endure in the course of being ill. It’s a tremendous cauldron of experience, and I wanted to have a way to let them reflect, consider, think about what they themselves were going through. And so I made them write. And I invented the Parallel Chart. I told them every day you write in the hospital chart of your patients. You may have 3, or 4, or 5 patients, and every day you write in each chart, and you know exactly what to write. It’s very proscribed. I told them, there are things that are critical to the care of your patient that don’t belong in the hospital chart, but they have to be written somewhere. And I would say, if you’re taking care of an elderly gentleman who has prostate cancer, and he reminds you of your grandfather who died of that disease, every time you go in his room, you weep. You weep for your loss, you weep for your grandfather. I said, you can’t write that in the hospital chart. I won’t let you. And yet, it has to be written. Because this is the deep part of what you yourself are undergoing in becoming a doctor. Only when you write do you know what you think. And there is no way to know what you think, or even what you experience, without letting your thoughts achieve the status of language. And writing is better than talking. We thought when we designed this chart, that by writing about their own feelings and by writing about patients, that the students would somehow mirror the patient. That if only they were imagining what must it be like for the patient to have an operation, to lose a leg—whatever the case was—that the simple act of imagining it would somehow make it easier for the student to get what the patient was going through and to be of help. This is what we call empathy—that you understand from the other person’s perspective their experience. If you’re not prepared for such profound emotional experiences, the natural, and probably only recourse you have, is to detach, and is to experience your work like this—from arm’s length— and to hide behind the various barriers that we all hide behind, of objectivity, and “I only have six minutes for each patient,” and all of that. Unless we can attend to the interior life, the courage, if you will, of our developing doctors, we will end up with doctors who flinch when things don’t go well, who abandon patients when they’re dying.