Medicine needs fiction, especially now

The American medical system needs fiction because, as Albert Camus supposedly said, “Fiction is the lie through which we tell the truth.” And those in health care, from hospital administrators to clinicians and technicians, need to hear the real truth about health care.

For decades, a small group of physician and nurse writers has provided behind-the-scenes looks at the experiences of being a doctor, the lives saved, the ones lost, and how the profession has changed the way many people look at the world. Nonfiction works by Jerome Groopman, Atul Gawande, Danielle Ofri, Theresa Brown, and others are rightfully recognized as providing important insights to the public about life as a clinician and what can be learned from patients during their most vulnerable periods.

This publishing trend accelerated during and after the Covid-19 pandemic when so many in the field endured unprecedented challenges, and some physicians and nurses turned to the page to tell their stories and make sense of their experiences. Walk into almost any bookstore now and it’s hard to miss seeing titles prominently displayed that describe not only what occurred in hospitals during the pandemic, but also an ever-increasing subset of books about what went wrong (spoiler alert: a great deal).

To be sure, there have been talented physician novelists, Michael Crichton, Abraham Verghese, Kimmery Martin, and Samuel Shem, to name just a few. But as masterful as their stories have been, medical novels have typically avoided directly confronting the systemic issues in American medicine, instead leaving dissections of this sort to their nonfiction brethren.

I believe that fiction plays an important role in the medical world. With the latitude it provides, fiction allows an author to address issues in health care without drawing the reflexive ire of those in the medical-industrial complex, many of whom are heavily invested in trying to ensure that nothing changes in the profit-over-purpose system.

I wrote a memoir that chronicled my career as an organ transplant specialist, the good and the bad and the forces that eventually led me to leave clinical medicine altogether. But for fear of offending the people and institutions that I worked in (and yes, the ever-present concern about being sued), I tiptoed around some of the touchier issues, getting as close as possible to telling the entire story but, perhaps, never quite fully doing so. Instead I scratched the surface, I circled my prey, but never really moved in for the kill.

So I decided to write a novel, to take off the shackles and get the whole mess down on the page. Although not entirely surprising, my protagonist is an arrogant surgeon who works in a flawed hospital environment. I expose his shortcomings and those of his partners and hospital administrators (the phrase “write what you know” is cliché for a reason). Through my main character and those he worked with, I wander around the hospital, making commentary along the way about our health care “system,” which is not a system at all but a fragmented collection of profit centers. I was able to reveal in inglorious detail situations that actually occurred in hospitals with only the names and places changed to protect the not so innocent. It was fun!

But fiction is more than just a source of pleasure. It can reveal the truth, and in no area of society do Americans need more of the truth than in how American medicine works. There’s no doubt that some of that truth can be told through nonfiction. But nonfiction books about the health care crisis, especially the more academic ones, have not solved the problem, or even come close to doing so.

I share the same degree of optimism for the impact of works of that type as I do for position papers and 15-point plans that purport to have a plan to fix the health care system. I would go as far as to say the impact of these well-intentioned treatises will be minimal, given how amorphous the U.S. health care system is and how dysfunctional its political environment is. The money involved in health care delivery is too significant to move people and institutions out of their trenches.

Here’s a fact to consider: the American health care system is a $4.5 trillion industry (and counting), around the size of Italy’s entire gross national product. Health spending accounts for 17% of the gross domestic product (the entire defense industry accounts for 3.4%), and much more of our national conscience. Research data and detailed analyses can tell us what’s wrong with our health care, but only stories can tell us the impact these deficiencies have on real people.

It would be foolish to argue that medical-based fiction will rescue us from the soullessness of American health care, but stories can help expose its failings.

“Uncle Tom’s Cabin” by Harriet Beecher Stowe unmasked the dehumanizing injustices of slavery. “The Grapes of Wrath” by John Steinbeck vividly depicted the extreme hardships of the Dust Bowl. Tim O’Brien’s stories in “The Things They Carried” brought to life the horrors of the Vietnam War. “The House of God” by Samuel Shem was, in many ways, a parody of the medical education system, but it also brought to light many ethical dilemmas that face young physicians during their training.

No great social movement ever happens in a top-down manner; change nearly always occurs from the bottom up, fueling movements that can be inspired by great storytelling. Addressing the inadequacies of American medicine must move past saying health care is broken — that’s obvious to anyone who has interacted with the system and no additional arguments, even if well researched and presented, will likely result in meaningful changes. The best hope might be to do what humans have always done, going back to the prehistoric days: tell stories that will influence hearts and minds, stir emotion, and motivate action that will lead to real progress.

Medicine desperately needs this kind of change, and we should approach the problem as if our lives depend on it. Because they do.

David Weill, M.D., is the former director of the Center for Advanced Lung Disease and Lung Transplant Program at Stanford University Medical Center and author of a 2021 memoir “Exhale: Hope, Healing, and A Life in Transplant” and a novel “All That Really Matters” (Rare Bird Books, June 2024).