Doctors in the Making: Memoirs and Medical Education (review)

Suzanne Poirier, author of Doctors in the Making: Memoirs and Medical Education, taught literature to medical students at the University of Illinois College of Medicine for twenty-five years, and in this new book she focuses her considerable critical and educational expertise on autobiographical writing by doctors-in-training. Bridging literary criticism and ethnography, Poirier examines over forty book-length accounts of medical education—medical school, residency, or both—written between 1965 and 2005, and mines these memoirs, diaries, and blogs for what they collectively reveal about the subjective experience of such training. More than future lawyers, teachers, or business people, future doctors undergo a notoriously long and brutal apprenticeship and, perhaps because the experience can be so inhumane, they more often choose to write about it. They turn to writing to make sense of the suffering they witness and to sort through the wrenching tests and transformations of their own identities. Poirier interprets these memoirs through both literary and social scientific lenses: they become data for her qualitative assessment of the subjective effects—especially the emotional effects—of becoming a doctor. Although Poirier respects the competence of the physicians who emerge from medical schools in the United States, she finds in this body of work evidence of how poorly the system of medical education serves the people who move through it.

The primary audiences for Poirier's literary-ethnographic study are medical educators and scholars in the medical humanities. She positions her work amidst studies of medical culture and education from fields such as history, anthropology, sociology, and philosophy. With clear, jargon-free prose, she also situates it in relationship to literary studies, explaining how life stories in medicine draw on traditions of the picaresque, the bildungsroman, and the coming-of-age story, as well as the ideal of the self-reliant individual perpetuated by both the American literary tradition and medical culture. Because she is writing for an audience broader than literary studies, her discussion of theoretical issues related to autobiography is appropriately light. She quotes liberally from the books and blogs in her archive, letting the doctors' voices share space with her interpretations. And yet, she does not settle for simplistic readings of the material, and cautions her readers to be attuned to the many ways stories are mediated.

Although Poirier's readers are likely to be humanists who work in the medical education system, it would be a mistake for literary scholars to assume that Doctors in the Making is not relevant to the more general study of autobiography. Poirier's book invites critics to think in new ways about what personal writing accomplishes for the writer. The narratives she examines are examples of what Richard E. Miller calls "institutional autobiographies" (138). This genre, he explains in Writing at the End of the World (U of Pittsburgh P, 1995), unites "the seemingly opposed worlds of the personal—where one is unique, free, and outside of history—and the institutional—where one is constrained, anonymous, and imprisoned by the accretion of past practice" (138). Miller conceives of the institutional autobiography as intentionally connecting "the conventional questions that reside at the heart of the autobiographical enterprise" with a narrative that is located "within a specific range of institutional contexts" (138). Poirier's study demonstrates, however, that "shifting attention from the self to the nexus where self and institution meet" (Miller 138) can also be an implicit, although perhaps unrecognized, goal of memoirs in which subjective transformation intersects with professionalization.

Frequently, the memoirs and journals of medical students address tensions between the goals and methods of medical education. This system values scientific knowledge and skill above all, and yet it also expects to produce physicians who are responsive and altruistic, even as it provides comparatively little instruction regarding patient care. The cognitive and emotional dissonance created by such training surfaces regularly in the memoirs Poirier examines. She quotes Perri Klass, for instance, expressing her discomfort with the person she...