Building Compassion Through Narrative Medicine
This is the first in a special series of Einstein Untold profiles in celebration of Women’s History Month. The featured women are innovators. They pursue unlikely dreams. They’re stand-outs with spirit and strength and stand-ins for all the women of Einstein Healthcare Network.
As a neonatologist, Rachel Fleishman, MD, treats newborns who are ill – babies who are born prematurely or with unexpected medical problems – while supporting their anguished parents.
Dr. Fleishman is a mother of two children who can be powerfully affected by what her patients and their families endure. She’s learned to work through those emotions so she doesn’t become detached or burned out – and now she’s helping other practitioners at Einstein Healthcare Network do the same.
Dr. Fleishman has launched a Narrative Medicine program designed to help doctors, nurses and staff become more empathetic and compassionate through exposure to individual stories that evoke strong emotions. The program also provides a nonjudgmental place to share their reactions.
Processing Emotions to Prevent Burnout
“A lot of provider burnout comes from being unable to process our emotional response every day from what we see at work,” Dr. Fleishman says.
“Almost every patient we deal with is in a state of stress, so we need to be able to hold space for them and allow ourselves to be human as well. Otherwise we burn out and shut down and that can lead to fragmented, non-holistic and non-compassionate medical care.”
Once a month, Dr. Fleishman selects a short story, essay or an excerpt from a longer work. She chooses topics that evoke a strong reaction in her: individual tales of grief, misplaced hopes, racial injustice, suffering, COVID. During a Zoom meeting, she leads a discussion with participants, who usually number 25 to 30 doctors, nurses and administrators.
Narrative Medicine has become a mainstay in medical care and education in the United States. “The goal is to give people a comfortable and safe outlet to see the world through someone else’s eyes,” she says.
Rohit Gulati, MD, Chief Medical Officer at Einstein facilities in Philadelphia and Elkins Park, is a strong proponent of Narrative Medicine and has collaborated with Dr. Fleishman to establish the program.
Seeing Patients as Individuals
“You read about a person’s experience and empathize with it,” he says. The experience enhances practitioners’ capacity to perceive a patient as an individual rather than a disease to be cured.
Dr. Gulati vividly remembers an instruction he was given as a house officer at John Radcliffe Hospital of Oxford University. He was told, if you’re called to attend a hospital patient in the middle of the night, dress the part, even if you’re aroused from sleep. Put on a shirt and tie under your white coat and look perfectly groomed, he was told.
In retrospect, says Gulati, “it might have been better if I looked a little disheveled. It gives that human touch that people are looking for.”
Narrative Medicine disrupts the hierarchical relationship with doctor and patient, he says, enabling physicians to drop the pretense.
Dr. Fleishman minored in creative writing as an undergraduate, but the demands of building a medical career and raising a family prevented her from pursuing that interest. Then she and her colleagues lived through the calamitous closure of Hahnemann Hospital and the bankruptcy of St. Christopher’s Hospital for Children, where she had been working.
“As we all banded together to care for our patients, I began to understand the importance of professional forums for the journey we lived through as staff and how that journey impacted patient care,” she says.
More Empathy, Better Care
“I deeply believe that self-reflection and using close reading of literature to foster empathy in healthcare would lead to safer, more holistic care delivery from providers.”
Dr. Fleishman came across the formal construct of Narrative Medicine and began creating the program for Einstein, which has been underway since September. She resumed writing and her essays have been published in medical journals and the Philadelphia Inquirer.
“I’ve learned to heal myself through writing. I have plenty of essays I’ve written about children I’ve lost,” she says.
Dr. Fleishman came to neonatology after being profoundly influenced by a mentor who was “an incredible pillar of compassion” while he navigated a gut-wrenching and “ethically challenging” case involving an infant in a protracted stay in intensive care.
“I was attracted to complex medicine and fascinated that he was able to support this family through their journey. I remember thinking, ‘Wow, I want to be like him.’”
Now she’s helping her Einstein colleagues do the same.