Some of our best educators were storytellers. Mark Twain told us a great story in the pages of The Adventures of Huckleberry Finn, and he also instructed us on slavery in those pages. C.S. Lewis taught via allegory in his Chronicles of Narnia. Politicians connect with disparate audiences with relatable stories. Our nation’s best trial lawyers persuade juries by crafting stories. My guest today has similarly harnessed the power of the didactic. His books inform while they entertain. Prepare to meet a master storyteller and physician leader.
This transcript of the discussion has been edited for clarity and length.
Mike Sacopulos: My guest today is Arthur Lazarus. Dr. Lazarus is a physician leader with a broad background. He has leadership experience at academic medical centers, health insurance companies, and pharmaceutical firms. Dr. Lazarus has written more than 400 articles and is the author of eight books. Arthur Lazarus, welcome to Sound Practice.
Art Lazarus, MD: Thank you, Michael. I appreciate you having me.
Sacopulos: Art, before we delve into your most recent book, could you describe your career path as a physician leader?
Lazarus: Michael, thank you for the question. The best analogy for my career path is like trying to press a wet noodle into a straight line with your finger. It’s very circuitous and winding, and it’s taken me through all those domains that you mentioned at the outset.
I think the common denominator is behavior. I’ve always been interested in human and animal behavior. At one time, I thought I would become an ethologist and obtain a PhD in animal behavior. That led me to major in psychology in college and got me interested at the time in Skinnerian behaviorism and Skinner boxes, et cetera, et cetera. I then graduated into learning theory and eventually just became fascinated by the human condition. So I pressed onward. In medical school, I wanted a complete training of the mind and the body, so naturally I specialized in psychiatry. I tried to give other branches of medicine a chance, and there were some close competitors to psychiatry, but psychiatry won out.
I did my residency where I went to medical school, Temple University in Philadelphia, Pennsylvania, which is where I’m from. I eventually extended my interest from one-to-one interactions to what is today called “population health,” and as a result of my interest in improving the health and the lives of populations of people, I gravitated toward the health insurance industry, where I was able to be more free and innovative and design disease management programs for patients with depression, for example, and initiate screening programs for postpartum depression.
Finally, I had one more itch to scratch, which was pharmaceuticals. I’ve always been interested in pharmacology, and I think nowhere is the result of pharmaceutical actions more impressive than in psychiatry, where within a matter of days, floridly psychotic individuals can become very sane and normal with the aid of the proper medication. So I worked in the pharmaceutical industry for about a dozen years. In one word you could say my career has been eclectic.
But I gravitated away from patient care — I haven’t seen patients in about 20 to 25 years. My clinical career was very academically oriented. Most of it was spent at Temple or affiliates of Temple University. But once I left clinical practice for the health insurance industry and the pharmaceutical industry, I no longer continued to see patients.
Sacopulos: Very interesting. Now, I mentioned that you have several books out and that we’re going to be talking about your most recent book, but it’s really more a series of books that you’ve authored. Can you give me a high-level overview of this work?
Lazarus: Yes, I’d be glad to. It is, as you said, a series of books. It’s really one long book now divided into four books that are chronologically oriented, but thematically very similar. And the theme throughout really is storytelling. I became very interested in storytelling through accidentally stumbling upon the field that we call narrative medicine, which is the application of storytelling principles to honor our patients. That field really came into focus around 2006, 2007, with a couple of prominent physicians who wrote textbooks, both published within a year of each other, in the field of narrative medicine, the principles and practice, and so forth.
And in conjunction with my interest in storytelling, about five years ago I started to write some essays. That seems to be my wheelhouse. My stories are really contained in essays and op-eds, and that’s what I feel very comfortable with in terms of my writing. It’s not like one long autobiography, but there are many autobiographical elements in my essays.
I’ll end by saying that the impetus for my writing, which has surprisingly continued since my first book in narrative medicine — which was only published a couple of years ago, not even a couple of years ago — my impetus for continuing to write really is my son. I have four children, one son and three daughters. And it’s interesting — my three daughters are all in the health professions, and my son is a writer. Poetry is his love, but he also writes fiction. He teaches in the English department at the University of Hawaii in Honolulu, where he lives with his wife and his son.
The point is this: the last several years, and especially since COVID hit and we were locked down, he would say, “Dad, why don’t you write your autobiography?” And there’s no way I wanted to undertake my autobiography, and I really felt no one would ever be compelled to read it. But I do think there are snippets from my own life that many people can resonate with. So that’s what pushed me forward into incorporating autobiographical elements into my essay writing, all pretty much focused on some aspect of healthcare.
Sacopulos: For purposes of our audience, tell us the full title of your most recent book.
Lazarus: The most recent book, which was published several months ago, is called Narrative Medicine: Harnessing the Power of Storytelling through Essays. Of the four books that I’ve written in the category of narrative medicine or what pundits would call creative nonfiction (which I think is somewhat of an oxymoron), but within that realm, I think the last book really hits the nail on the head: narrative medicine and then harnessing the power of storytelling through essays. Because that’s what I write, that’s what I feel comfortable with, about 1000 to 1200 words.
I’ve taken a couple of graduate courses in creative writing. We had an assignment each week, from class to class, and it always was a very open-ended assignment. My instructor would simply say, “Write 800 words.” That’s it. So again, that felt very comfortable for me, so 800 to 1000 to 1200 words. But yet at the same time, the last book is really not all that different from the first book in this area, which was titled Every Story Counts, and subtitled “Exploring Contemporary Practice through Narrative Medicine.” So it’s really all about storytelling.
I think that I am a storyteller. I may not be a natural storyteller in terms of having the capabilities and the skills of standing in front of an audience as a professional storyteller. But I think when I’m in the comfort of my writing room and I have the time and space to think and write about certain events in my life and put a spin on it, that it makes a good story that people can relate to and that somehow makes a point about medical practice or physicians or healthcare policy or any number of areas.
Sacopulos: For whom did you write the book? Who’s the intended audience?
Lazarus: Ostensibly, physicians and physicians in training, which would include medical students as well as residents. But I realized that there is a broader audience that could enjoy my books. For example, physician assistants and nurse practitioners, those who are in the nursing professions, really any of the healthcare professions. And then beyond that, I think healthcare administrators would enjoy this book and could relate to it. And finally a general audience of readers who enjoy reading anything on the topic of medicine or enjoy hearing stories. So I think it has a broad appeal, and I’ve had people from all walks of life write to me and thank me and tell me that they enjoy my short essays.
Sacopulos: Well, they’re certainly well done. It strikes me that there’s a teaching element to this, that these are effective ways to learn about areas of medicine. Do you think that that’s accurate?
Lazarus: Oh, it is dead on, Michael, and I thank you for bringing that insight out, because as you know, doctor comes from the Latin root word meaning to teach. Many people don’t know that, and I only discovered it within the last half dozen years or so. But I do view myself as a teacher, even more so than a doctor, since I don’t see patients anymore. And I love to teach and I love to teach not only medical students and residents and early career physicians, but really anyone that I work with. I do a fair amount of consulting work in healthcare, and I work with a lot of nonmedical individuals, and I like to teach them as well about the basics of medicine. I think that one of the best ways to teach is using stories.
I didn’t realize until recently that when I was in active clinical practice, my specialty, my subspecialty in psychiatry was called consultation liaison psychiatry, or what we call C&L psychiatry. I worked in an academic center, and I was the one in the psychiatry department who would put on the white coat. It really wasn’t fashionable for psychiatrists to wear white coats. Some did, but most didn’t. But I’d put on the white coat and I’d take my flock of medical students and residents, and we’d go to the medical-surgical floors and round on patients whose physicians had requested psychiatric consultations. I’ve always been interested in the dualistic mind–body interface, and when I was with trainees, I always used stories to get some points across. I can’t even begin to tell you that a training as a psychiatrist, and going through medical school even before that, just conjures up a wealth of clinical material that you can spin into really good stories.
Sacopulos: It occurs to me that medicine’s both an art and a science, and that your ability through narrative medicine or storytelling really touches on the art aspect of medicine. And perhaps that’s an area that doesn’t get enough attention. Do you agree?
Lazarus: I do agree. In fact, we’ve put it way too low in our practice. Especially as the term evidence-based medicine has become rooted and practice guidelines have become available and we weigh the validity of our findings against those, the artistic aspect of practice has been given short shrift. A lot of my writing does focus on bringing that out more, and I think you need a healthy balance between the two.
One of the stories in one of my books specifically addresses that. When I was asked to be an expert witness in a case that involved a patient who had Lyme disease — now, I’m not an infectious disease specialist, but I was called to be an expert witness because a health insurance company had repeatedly denied benefits to this individual who had Lyme disease. And I was called to be an expert on health insurance and how health insurance systems work, especially with respect to approving and denying treatment.
I can remember that when I took the witness stand, the first thing that the opposing attorney, who represented the health insurance company — I actually represented the plaintiff, who was a patient — but the defendant for the health insurance company, they had a very strong lawyer. And the first thing he did was he approached me with a huge textbook which I recognized immediately as Harrison’s Principles of Internal Medicine, which is the Bible for medical students. And he heaved it on the table and made it thud. And he said, “Dr. Lazarus, are you familiar with evidence-based medicine?”
So to make a long story short, he was attempting to say that the health insurance company followed all the principles of evidence-based medicine in their decision-making. And I was to argue that there’s more to evidence-based medicine than simply following the latest research reports and findings, that there is an art to medicine as well, and that the insurance company failed to take into account some of the nuanced issues involving this one particular patient with Lyme disease. As a matter of fact, when you read the early formulations and definitions of evidence-based medicine, clinical experience is taken into account. It does count. And so that’s where the art of medicine really is intertwined with evidence-based medicine.
Sacopulos: You have a series of essays in your books, and I’m curious, do you have a personal favorite?
Lazarus: I wouldn’t say that I have a favorite, but I clearly like some better than others. I feel some are better written or that the stories are more interesting or compelling or that they were deeply, deeply meaningful to me and so for that reason, they resonate a little bit more with me. Do I have a couple of minutes to maybe just share one with you?
Sacopulos: I think we need to do that. If we’re talking about storytelling, we need to tell a story. Can you favor me with one?
Lazarus: I’m going to read just a couple of paragraphs verbatim. I thought you might ask this question so I came prepared. This comes from the book Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine, which was the first book of the four that I wrote that was published with the American Association for Physician Leadership, a great organization that I’ve been associated with and very involved with for decades. And I thank them for publishing this book and for giving me the impetus to continue on my writing journey. This appears as Essay 11 in that book, and it’s titled “Like Many Physicians, I’ve Forgotten How to Relax.” Of course it comes back to, well, not of course, but it actually comes back again to my son’s urging that not only should I write my autobiography, but also that I should learn how to relax — because he’s clearly been in Hawaii for long enough to understand the principles and practices related to relaxation.
So my family — it’s hard to get all the four children together in one spot, but we got a couple together, and my wife and I journeyed out to Honolulu in January of 2023. It was supposed to be a vacation. So I’ll just read a paragraph here about that experience, that I was on vacation at a luxury resort in Hawaii with my wife and two of my four children, and there are three small children in the group as well.
“It’s 10:00 p.m. I’m beginning to write this essay while everyone is snug and tucked away for the night. Earlier in the day, sitting around the swimming pool, I was glued to my iPhone and my son, who resides in Honolulu, commented, ‘Dad, you’re so wired in. Why don’t you play with the kids?’ meaning my grandchildren. ‘Play with them in the splash zone, take them on a ride down the lazy river. Why don’t you just relax with us?’ But like many physicians, I’ve forgotten how to relax. Patient care has been front and center since the pandemic started in addition to the usual crises in emergencies and we’re increasingly burned out or we’re using substances to cope as physicians. Our clinical performance is diminished, resulting in increased errors and other quality concerns. But the one thing that I’ve been good at, that we’ve all been good at as physicians it seems, is neglecting our own health. And researchers have found that physicians who were wedded to their jobs experienced lower quality of sleep, greater levels of depression, and lower levels of general well-being, plus they exhibited more stress at work.”
So that’s how I begin the essay. And then at the end, my son says to me, we’re still talking about relaxation, and he wants me to grab a cup of coffee with him one morning at one of his favorite local coffee spots. And I say to him, “Josh, I’ve been thinking about leaving my computer and smart devices at home the next time I take a vacation here.”
I also informed my son of my intentions, and he took me to his favorite coffee cafe. He said,
“Everyone’s connected and engaged here.” And he pointed to a sign behind the cashier that read, “Sorry, no wifi for you.” A smile crossed my face. I began to relax. The irony of it was that I was so connected, obviously, that he took me to a cafe where there was no wifi where I couldn’t use my iPhone. And when he said, “Everyone here is connected,” he obviously meant in the good old-fashioned way face-to-face person-to-person without any electronics or social media. And so I really appreciate his efforts to help me relax and get me unglued from the electronic world. And maybe the next time I go out there, I’ll leave my computer behind.
Sacopulos: Well, not only are you an exceptional physician leader, it sounds like you’ve done a great job as a parent. Tell me, what are your future plans? Do you have more writing to do? What’s on your agenda?
Lazarus: That question really dovetails nicely into the Hawaii episode, because yes, my future plans are to continue to write. The reality is that I’ve told most of the stories, and I don’t like to repeat stories in books. Occasionally there’s a repetition of a story, but I don’t like to repeat stories. Having now written four books containing stories, I’ve almost run out of stories. So my writing has slowed down. But yes, I still write, and not every essay has to be autobiographical or contain a story.
I will continue to write. I’ll continue to do some consulting work, but I do envision working less and eventually spending more time in Hawaii. As we talk now, Michael, we are building an addition onto my son’s home in Honolulu, a so-called ohana suite (ohana meaning family in Hawaiian). So we’re building a two-bedroom addition onto his home. And I plan to spend my winters in Hawaii and continue to write. He’s a writer, so he’s a good influence in that respect. And of course, my three daughters, as I mentioned, they’re all in healthcare. One’s a family physician, one is a physician assistant who specializes in pediatrics, and the other one followed more or less in my footsteps, she’s a mental health counselor. So between the kids and my wife, who was a retired teacher, all those influencers are very healthy and spur my writing.
Sacopulos: Fabulous. Well, Art, thank you so much for your time and great writing that benefits the profession and your colleagues. So thank you so much. My guest has been Dr. Arthur Lazarus.
Lazarus: Thank you for having me, Michael. It’s been a pleasure speaking with you and talking about my journey.
Sacopulos: My thanks to Arthur Lazarus for his time and insights. Dr. Lazarus teaches while humanizing the practice of medicine through the pages of his books.