Poetry in Practice

In our July issue, ASH Clinical News Editor-in-Chief Mikkael Sekeres, MD, MS, outlined his goal to bring humanity back to patient notes in an electronic world in “Illegitimi EPIC Non Carborundum (Don’t Let the EPIC Bastards Grind You Down).” Several readers wrote in about their own disillusionment with electronic medical records and their efforts to tell patients’ stories.

At 5:30 on a Saturday morning, as I was heading for my patio with my morning cup of coffee, I grabbed the top two journals to peruse from an unread stack of 100. The first one’s cover screamed, “This could be your last issue of ASH Clinical News! Subscribe for FREE today!” Not at all excited about adding to my mountainous collection, I almost passed it over until I read your name on the second page: “Mikkael Sekeres Brings Patient Stories Back to EHR.”

I was a fellow at Cleveland Clinic (2001 to 2004) and remember the inpatient leukemia rotations where you would often bring poetry to our morning rounds. While it left me puzzled, amused, and entertained then, following your editorials for the past five years has been a pure delight. I have often thought of writing to you to let you know how wonderful, amazing, inspirational, and funny your writing is. I just never got around to it.

Now, at 6:52 a.m. in sunny California, under a blue sky with refreshing Santa Ana winds, I have perused the journal, had my coffee, written the long overdue email, and subscribed to ASH Clinical News!

Thank you for what you do.

Sareena Malhi, MD
David Grant USAF Medical Center

Travis Air Force Base
Fairfield, CA

Well done, sir. I laughed out loud at least three to five times reading this article.

The humor and the humanity came through loud and clear. I am always trying to keep the human stories present through the coding and documentation as well.

Keep up the good writing!

Tom Fong, MD
Kaiser Permanente
Fontana, CA

Three students from the Cornell University Medical College class of 1961 reflected on the evolution of patient records:

Reading your editorial, I was reminded of Lawrence Hanlon, MD, who was our dean of students at Cornell University Medical College. On our first day in the main amphitheater, he concluded his welcome speech with the well-appreciated advice, “Illegitimi non carborundum,” which has stuck with me and my classmates for more than 50 years!

I also will add my own brief comment about medical history and progress notes: Personalizing the note about the patient indeed guides the reader – often ourselves trying to reconstruct how the patient was doing and what was going through our heads – and carries great importance. Unfortunately, medical records nowadays are unnecessarily voluminous, and the punchline of what was happening during a hospital admission is lost in a morass of information. We need to advocate for short but equally billable notes – especially those sent outside the system – and technology to delete automatically. Bring back the original narrative and stop with expanding fidgety-didgety (my designation for technology creep across generations).

Franco Muggia, MD
NYU Langone Health

New York, NY

Storytelling is important to any culture. The tedium of typing is frustrating the element of artistry in many physicians’ minds. One medical group here in Tucson now hires “scribes” to follow clinicians.

Part of our dilemma relates to the explosion of new knowledge as we seek to hold onto the humanity of clinical practice. Part relates to the ongoing need for precision as we move into advanced genetics and nanotechnology.

John Hughes, MD
University of Arizona

Tucson, AZ

I dictated and didn’t type, so I was a little better off at writable opportunities.

I left one of these in the chart of a happy con man I met during my Bellevue rotation at Cornell. I don’t recall his name, but he left me a message I have repeated hundreds of times during the last 48 years, sometimes jocular and sometimes serious, to both kids and adults. I have even tried to apply these lines to my own life:

“Good better best
Never let it rest
’Til the good is better
And the better best.”

Clay Alexander, MD
San Diego, CA