Poetry, metaphor and the medical imagination
Metaphor is at its most potent in poetry and the poetic imagination – literature that is distilled down into essences. There is a strong tradition of physicians as creative writers and poets, and many doctors describe the use of poetic imagination as an antidote to the reductive tradition of scientific medicine. Whereas patients’ narratives and ‘histories’ may be long and complex, the poetic imagination can help to reformulate such narratives in compact form without losing complexity and quality. Writing poetry and creative prose demands close attention to the things that are written about, and this offers a good education for close noticing in clinical work. Poetry is especially effective in educating for tolerance of ambiguity or uncertainty, essential to clinical work.
A case study is presented of the author working with a fourth-year medical student on poems written out of her experience of clinical contact with patients. As the poems are worked up through cycles of tuition (the poetic imagination must be educated and not taken for granted), not only do they reveal new facets of the medical student–patient relationship, but they also advertise the value of learning through crafting – respecting poetry as an art form resembling the formulation of clinical judgements. Poetry’s lifeblood is metaphor, while metaphoric thinking is the heart of teaching and learning clinical reasoning. Guidelines are presented that align poetic thinking and writing with ‘thinking clinically’, bringing clinical practice and poetry into a complex conversation.