Dear Doctor: Danielle Ofri, MD, PhD
The physician writer on finding a voice, a passion, and creating a community.
Accomplished, compassionate, and creative, Dr. Danielle Ofri tackles a range of topics in her writing, from doctor-patient relationships to ethics and medical error. She is the author of six books, a contributing writer for The New York Times and Slate Magazine, the Editor-in-Chief of the Bellevue Literary Review, and a physician at Bellevue Hospital in New York City. She is also a leader and a teacher within the medical community, lecturing across the country and gaining writing inspiration from her day-to-day experiences. Danielle Ofri sends out a monthly-ish newsletter with her articles about doctor-patient relationship. Read on to learn about the mentor who seeded her passion and which of her most recent articles received over 1,000 comments and started a conversation that’s just continuing to grow.
“No one in my family was a doctor. I come from a family of teachers. I didn’t know anything about what doctors do, but I thought maybe I’d be a vet, as I had a dog whom I loved very much. Throughout school, I enjoyed science and once I got to high school, it was the dogma that if you liked science, you’d become a doctor. I ended up following that path and going to McGill University in Montreal. I had no idea I was walking into a pure science and British style education, but I loved it! In that environment, anyone who liked science was going to become a researcher, not a doctor. I became conflicted: should I pursue science or medicine? Toward the end of college, I learned about the combined MD/PhD programs and figured it would be a perfect way for me to figure out what I wanted to do. And it didn’t hurt that these programs came with a full scholarship!”
Finding a Passion for Patient Care
I attended NYU’s MD/PhD program, which is an eight-year program consisting of four years of medical school and a PhD curriculum in basic science. You did two years of medical school (the pre-clinical course), then you took 3–4 years in the lab to complete the PhD portion, then you returned to medical school to complete the final two years of clinical rotations in the hospital. In many ways, the program was grooming you to become clinician scientist who would run a lab and teach. However, in my first year of medical internship at Bellevue Hospital, I completely fell in love with patients, their stories, and clinical medicine. I finally had clarity. Although I loved my PhD training in the lab, I ultimately had to part ways with my science career because I knew that being a doctor was what I was meant to do.
Seeing the World
After I finished all my medical training (10 years in total), I took off 18 months to travel. A majority of my training had taken place during the AIDs and crack epidemic in NYC, which was a pretty brutal time. We were immersed in death and destruction, and were emotionally exhausted.
During those 18 months, I took a job with a temp medical agency that assigns physicians to parts of the country that are short on doctors. The assignments last four to six weeks. I worked all over the country: rural New Mexico, a small town in New Hampshire, a rural community in the west side of Florida, and out in Eastern Long Island. Up until then, I’d only worked in large urban academic hospitals, so getting exposure to community centers, small hospitals, private practices, and managed care organizations was an unparalleled learning experience. In between my assignments, I traveled throughout South America to Guatemala, Peru, and Mexico until the money ran out, and then I’d call for my next assignment. It was very therapeutic to step away from the intensity of medical training.
Finding Writing
As I traveled across the country and the world, I started to write the stories of my medical training. I knew that I would never again be as close to such intense experiences in my life, and that these were singular encounters. While away from New York, I finally felt I had the time and the space to reflect on all that I’d experienced during my training.
Upon returning to New York, I knew that I wanted to return to Bellevue, but unfortunately, it was the height of an economic crisis, there was a hiring freeze at the hospital. Eventually, a part-time position opened, which I took right away, though I’d never planned to work part-time. On one of my days off, I picked up a writing brochure off the street, and then started a writing class at Gotham Writers Workshop. Eventually, one of my teachers suggested collecting my stories into a book. That became my first book, Singular Intimacies: Becoming a Doctor at Bellevue. My friends joked that it sounded like I was writing about French lingerie, but it’s really about the intimate relationships that doctors and patients have.
Writing had never been a big part of my life until then. However, I did discover a love for literature when I was at McGill. A friend who was a few years ahead of me had strongly suggested that I take a class with professor Ruth Wisse, assuring me that I would not regret it. I was surprised to find she taught Yiddish literature, something I’d never heard of before. I was introduced to the incredible world world of Eastern European literature — Isaac Bashevis Singer, Sholem Aleichem, I.L. Peretz.
Many, many years later, one of my books was written up in Publisher’s Weekly. Although I’d read the review online, an acquaintance of mine tore the page out of the magazine and mailed it to me. When I saw the actual article, I realized right next to my book’s summary, was a book by Professor Ruth Wisse (fodder for yet another article)! When she came to give a lecture in New York, I had the chance to thank her in person for inspiring me to fall in love with literature (and to give her a copy of my book!).
Starting the Bellevue Literary Review
When I returned to Bellevue as an attending physician (after my 18 months of travel), I wanted to incorporate writing into my teaching. Each month, my students would hand in patient “write-ups,” which are written in a very standardized format, employing a lot of medical jargon. I challenged them to try something different — instead of writing a typical report, just tell the patient’s story. Ask them what it’s like to deal with their illness. I wanted the students to get to know their patients and understand their perspectives. It turned out to be an amazing experiment — I was so impressed with papers I was receiving.
At the same time, NYU had just gotten a new chair of medicine, Martin Blaser, who was asking students on the inpatient side (I was in on the clinic side), to write a thousand-word essay on any topic, as long as it was inspired by a patient. A thoughtful colleague introduced us, and we compared notes with our respective stacks of student essays. Initially, we thought about starting an in-house journal for student writing.
However, we realized that there was a much larger societal discourse about medicine that taps into a powerful existential angst. Everyone interacts with the medical system in some way and at some point in their lives.
As we step into the medical world, we’re often at a loss. Our skills and sense of agency seem to crumble away. We have no idea what will happen next (or how much everything will cost) and this creates an intense feeling of vulnerability.
But most medical writing focuses on “top ten tips” for this or that, and does not address these fears. Creative outlets like poetry and fiction, however, have the potential to mine this sense of vulnerability. Thus, the Bellevue Literary Review was born. We put out a call for submissions. We got 1,000 nearly overnight and realized that we had touched a nerve. Writers submit from all walks of life and from all over the world. Now, almost 20 years later, we receive 4,000 submissions a year and publish twice a year. As the Editor-in-Chief, I oversee the creation of each issue and help grow the journal. We organize readings for the public (always free!) and hold a writing contest every year.
Writing About Issues Doctor Face Daily
One of the recent op-eds I wrote for The New York Times is called The Business of Healthcare Depends on the Exploitation of Doctors and Nurses. I was shocked — although maybe I shouldn’t have been — by how many responses I received; it was more than I had ever gotten on a single piece in my entire life. I think we as a society haven’t fully realized that the EMR and corporate medicine is completely overwhelming the ability of doctors and nurses to take care of patients (a topic I dive into here). The EMR has turned into a vehicle to pile on more and more work onto staff. If doctors and nurses actually checked out when their hours are up, the whole system would come crashing down. I don’t think that there is a deliberate or calculated effort to exploit medical staff, but it’s increased to the point that it’s affecting patient care.
The term “burnout” is being used to describe this danger, but it implies that if we simply provide staff with more “resilience” or “wellness,” then the problem will be solved. But that misses the point because for many of us, it’s not really burnout. As I wrote the article, it dawned on me that I’m not actually burned out — I love my job, as do most healthcare workers. Having the chance to help patients feel better and move the needle a tiny bit makes everything worth it. There’s nothing that will ever rival that. But in our current system, it’s growing ever more difficult to deliver the quality of patient-care that everyone deserves.
Lightning Round
Everybody needs some TLC sometimes.
Best advice you’ve ever received? Better to apologize later than ask permission first.
Words you live by…just get it done.
Favorites
Writer / poet: Gabriel Garcia Marquez, Wislawa Szymborska
Fun Fact: For the last ten years, I’ve been working on the Bach Suites for Cello. Wrestling with Bach is exhausting but exhilarating — you feel like you are peeking into his brain and soul. There are six suites and each one has about six movements. It takes me a year or so per movement, so it’s going to be a long haul!! (I’m at the halfway point now….)
You can learn more about Dr. Danielle Ofri here.
Know a great female doctor in NYC? We’d love to meet her, introduce us here!
