Keeping Faith: Ethics and the Physician-Writer

Writing about patients is a growth industry. While doctors have always shared detailed case histories with their colleagues, many physicians now publish stories about patients designed for a broader professional and lay public. Stories and poems written by physicians appear in medical journals, commercial magazines, and books and anthologies intended for a general audience. These stories about medical care are usually presented, either implicitly or explicitly, as the writer's “real” experience (hence, nonfiction), although the writers sometimes indicate that they have altered or fictionalized the work. In other cases, physician-writers produce first-person fiction (so indicated) that reads like “real-life” professional experience.

Despite the popularity of writing about patients, the ethics of this enterprise has received little scholarly attention. One exception to this scholarly silence is an important essay by Rita Charon, in which she adopts the strong position that, because patients “own” their stories, physician-writers must have patients read and approve any narrative about them for publication (1).

Although this high standard seems to protect patient privacy, its application may be complex because of the diversity of writings (both prose works and poems) about patients. These include descriptions of real-life medical practice (2-6); problem-oriented clinical histories (7-10); instructive accounts illustrating medical error, hospice care, euthanasia, and other events (11-16); writing that blends autobiography and patient stories (17-22); poems or stories aiming at imaginative truth rather than factual representation (23-45); and integrative anthologies (46-50). Given this richness and variety, it is often difficult to ascertain a patient's degree of ownership of a story, since characteristics and events may be substantially changed. Even in cases where the writer obtains consent, other ethical issues, such as effect of publication on the patient or on the patient–physician relationship, must be considered.

This …