World of Nephrology “In a Few Words”

A cognitively impaired man gets a kidney transplant. A patient with anemia rails against the new erythropoietin guidelines. An artist with kidney failure meets a medical student named Raphael. An opera singer loses her voice to granulomatosis with polyangiitis, and discovers a new calling. A Southern nephrologist reflects on the central role of salt in society. A hospital chapel becomes a wedding chapel and a dying patient is granted her final wish.

These are the stories of our profession, the stories of the daily lives of those who have kidney disease and those who treat it. Dr. Dena Rifkin (DR) leads the feature in AJKD called “In A Few Words” (IAFW) that highlights the narrative of medicine. Dr. Rifkin discusses the IAFW feature with Dr. Kenar Jhaveri (eAJKD), eAJKD Blog Editor.

eAJKD: Can you tell us about the IAFW feature and its focus?

DR: Reflective writing has been part of medical literature in many general internal medicine journals. For example, there is a similar column in JAMA called “A Piece of My Mind,” which has essays about the humanities and general medical issues. There are plenty of stories about kidney disease, and plenty of people who can tell those stores well. IAFW was started to have a similar mission.

eAJKD: What exactly inspired you to be part of this venture in AJKD?

DR: Since medical school, I have enjoyed writing. Prior to initiation of IAFW and when I was doing my residency at Yale New Haven Medical Center, I was fortunate to be part of the Writer’s Workshop that is conducted for internal medicine residents. The workshop allows for reflective and creative writing about medicine. After that workshop, I was inspired to really think that these stories shouldn’t just be in our personal journals.  We shouldn’t only be telling them to each other, we should be sharing them with our colleagues and ideally with the community. So, that’s my motivation for doing this.

eAJKD: How does reflective writing help one be a better physician?

DR: Given the routine nature of our work, we forget how important and unusual and really life-changing some of the stories we see everyday are. When I stopped to write these things down, or something stops me in the middle of my day that is a little out of the ordinary, it helps me remember that although what we do is normal in our daily lives, it is certainly not normal in the lives of the people for whom we care . So, reflective writing helps us realize the importance and gravity of what we do.

eAJKD: As nephrologists, we take care of medically and socially complex patients. From your recent ventures at IAFW, do you think nephrologists are good reflective writers?

DR: The quality of the writing submitted for this feature is excellent. I think the challenge is to take the time to sit down and do it. It is not the same as telling your most interesting case from last week to somebody else, and saying, “Hey, have you ever seen a case of this?” It is a different experience. It takes time to make it into a “story” instead of making a “case report.” I am happy to see that we do have a lot of hidden talent among nephrologists.

eAJKD: Some of the essays have been written by patients themselves; any thoughts on these pieces?

DR: I recruited some patients because they are people who have blogs and write on a daily basis about their experiences. We’ve had patients who have written for IAFW advocate for home hemodialysis (see Laird and Shah), and another patient with strong feelings about the regulations on the use of erythropoietin (see Prisant). It has been enjoyable as well to work with them.

eAJKD: As physicians, should we be reflecting on an ongoing basis?

DR: I personally think that reflection is a very important thing. It not only improves what we do, but also prevents us from getting burnt out with doing something that can sometimes be repetitive. I think it really is important to sit down and reflect on this. Every few months, take a moment to step back and say “Where are we coming from and where are we going?” I hope that some of the writing in this feature helps people think about those very important issues.

Share your story with your colleagues. AJKD is seeking submissions for the IAFW feature. We will accept for review nonfiction, narrative submissions up to 1,600 words (footnotes or references are discouraged) that pertain to the personal, ethical, or policy implications of any aspect of kidney disease in adults and children. Interested individuals may submit IAFW manuscripts via e-mail at AJKD@tuftsmedicalcenter.org; Dr Rifkin may also be contacted at this address for essay proposals or any other questions.

Read or listen to “In a Few Words” essays (freely available) at AJKD.org.

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