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March 3, 1998;  Page One
Copyright 1998 Dow Jones & Company, Inc. All rights reserved.
Used with permission.

Doctor's Poetry Holds a Rare Message:
Take Time, Listen to the Patient's Story

By ANITA SHARPE
Staff Reporter of THE WALL STREET JOURNAL  

For you may need to strain to hear the voice of the patient in the thin reed of his crying

For you will learn to see most acutely out of the corner of your eye to hear best with your inner ear

For there are late signs and early signs

For the patient's story will come to you like hunger, like thirst

From "Gaudeamus Igitur"

-- John Stone, 1982

ATLANTA -- On a gray winter afternoon, John Stone is meeting in his office with a handful of first-year medical students for an elective course in the literature of medicine. For nearly half an hour, Dr. Stone passes around photos of his pilgrimage to the New Jersey home of the late doctor-poet William Carlos Williams. Remarking on one of Mr. Williams's prose pieces, Dr. Stone says, "This one emphasizes that it's the physician's duty to listen."

He directs the students' attention to an essay Mr. Williams wrote about his practice: "I have never had a money practice. But the actual calling on people, at all times and under all conditions, the coming to grips with the intimate conditions of their lives, when they were being born, when they were dying, watching them die, watching them get well when they were ill, has always absorbed me."

"He's saying, 'Look at the world,' " the bearded, blue-jean-clad Dr. Stone tells the students. "Patients can be a source of renewal if you revel in them and listen to their stories."

Dr. Stone, a 62-year-old cardiologist and associate dean of admissions at the Emory University School of Medicine here, is one of the more visible manifestations of a movement to snatch the practice of medicine back from deal-makers and cost-cutters. "What medicine is all about is being human," he says.

Besides teaching the course on the literature of medicine, he has written three books of poetry, with a fourth to be published this year. "On Doctoring," an anthology he co-edited, and to which he contributed, is sent by the Robert Wood Johnson Foundation to every freshman medical student in the country. Listening to patients is a theme of that book, too.

Dr. Stone is in great demand as a speaker. Last August, after he finished reading passages from his 135-line poem "Gaudeamus Igitur" (Latin for "Therefore, let us rejoice"), more than 200 members of the freshman class of the Medical College of Wisconsin gave him a standing ovation. "It was breathtaking," says Richard L. Holloway, associate dean for student affairs at the college. The medical school had invited Dr. Stone to kick off a session on "Compassion and the Art of Medicine."

 To many people it seems obvious that doctors aren't going to spend significantly more time with patients so long as their practices remain dollar-driven. "It's a dream," says Uwe Reinhardt, a health-care economist at Princeton University. Doctors could spend a lot more time with patients, he says, "if they were willing to live on $80,000 a year."

And if they did, would they listen? In 1995, Consumer Reports magazine polled 70,000 readers on their relationships with their doctors. Nearly a third said their doctors didn't seek their opinions about their medical conditions, while more than 15,000 said their  doctors didn't take thorough medical histories, and 14,000 said their physicians didn't encourage questions. One of Dr. Stone's Emory students, Brett Brinker, says a doctor told him he spends too much time during hospital rounds taking down patients' stories.

Still, even some managed-care companies are looking to improve doctor-patient relationships. In February, Aetna U.S. Healthcare teamed up with New York Medical College to offer the first in a series of continuing-education classes on enhancing doctors' ability to communicate with patients.

"We're seeing the pendulum swing back; we all want personal attention," says Richard D'Amaro, head of KPMG Peat Marwick's health-care consulting practice. Mr. D'Amaro says he recently switched from a doctor who would spend only 10 minutes with him to an internist who sees patients on Saturdays and spends two hours a night calling patients on the phone to discuss treatments.

In class, Dr. Stone acknowledges that doctors are pressed for time, but that shouldn't keep them from listening.

He tells the story of a 60-year-old patient who, he found, had a diseased heart valve. One of his first clues to her condition came when she complained of dizzy spells as she carried sacks of groceries up a hill to her house. Says Dr. Stone: "There are all kinds of epiphanies from relatively small bits of historical data."

After surgery that repaired the valve, the woman invited Dr. Stone to her home to pick figs. When she died years later, her daughter gave Dr. Stone a music box that he had noticed at the woman's house: a whiskey decanter in the shape of a 19th-century British soldier, which, as it turned, played "How Dry I Am." He has it at home. "It's a great treasure," he says.

"I'm always on the lookout for stories and epiphanies every day," says Dr. Stone, who carries a 3-inch stack of index cards in his shirt pocket to jot things down. "It's very important that we be in touch with our spirits so that we can heal."

He has many ardent fans. Last month, medical students at the University of Miami invited him to be the keynote speaker at a student-sponsored conference on what it means to be a physician in the 1990s. After his talk, many students "were like little groupies -- they had him sign their books and their programs," says Ann Flipse, who teaches a course in clinical skills at the university and attended the conference.

"People are still talking about him; he inspired everybody," says Stacy Zimmerman, a medical student who helped bring Dr. Stone to the conference. Ms. Zimmerman says she read Dr. Stone's collection of essays, "In the Country of Hearts," as an undergraduate and decided to pursue medicine partly because of that book.

Clyde Partin, a doctor of internal medicine in Atlanta and former student of Dr. Stone's, says the lessons from the classroom have stayed with him in his practice. Despite today's increased pressures, he says, "I try to spend a little more time trying to understand people's lives -- what kind of work they do, problems they may be having at home." Dr. Partin says the extra dialogue makes it hard to stay on a rigid schedule: "I tend to just run behind, and I apologize."