Conversations With Cardiologists: Lisa Rosenbaum, MD
'Conversations With Cardiologists' highlights prominent cardiologists throughout the country and shares their invaluable insights on cardiology and sage advice for Fellows in Training (FITs). In this interview, Lisa Rosenbaum, MD, national correspondent for the New England Journal of Medicine (NEJM) and cardiologist at Brigham & Women's Hospital in Boston, MA, shares her advice with ACC FITs.
How did you arrive at such a unique career path as a "cardiologist-author"?
I started out in fiction writing as an undergraduate at Stanford, then moved to New York to pursue a Master of Fine Arts degree. But it was the year of 9/11, and I was feeling untethered from the world, unable to fathom the magnitude of the tragedy. I felt like I needed to be doing something that was more active in terms of helping people, so I left the MFA program and went to medical school. Eleven years later, after medicine residency and two years of cardiology training, I did an editorial fellowship at NEJM and had time again to just write. That was very formative for me, because at that point I was older, had more life experience, and was a doctor, and so I was able to reflect upon what I had learned up until that juncture. I discovered that I didn't have to do one or the other – I could be both a writer and cardiologist. That was a very important year for me, and it also gave me a relationship with NEJM which continued after completing fellowship.
What advice do you have for FITs that are interested in writing but find it intimidating, or never thought of themselves as a writer?
Well, this is going to sound discouraging, but an important thing to realize – writing is really hard. In medicine, we're used to being good at everything – getting excellent grades, performing well on exams -- and then we sit down to write, and it's like nothing else that we've done for our whole lives. The creative element requires a different part of your brain and also a unique kind of patience and forgiveness of yourself. If you can't tolerate abandoning projects or letdowns, then it's utterly unfun. But this is not dissimilar from science at large, insofar as there are failures, missteps, experiments that don't work, but then there are thrilling "A-ha!" moments too. To tolerate that, I think there has to be meaning in the work that is completely separated from whether or not it gets published. To FITs: know that you'll fail, be patient, and try to do it in a way that's meaningful outside of whether or not it's a publication you can put on your CV.
A few other things – read broadly. Nobody just knows how to write. Find people you enjoy reading and dissect their work. I read the work of many other physician-writers I admire, and I read their writing first just to enjoy it, but then I read it a second time to pick it apart, to think about what they did, how they did it, and why it worked. I also tend to read a lot of fiction that has nothing to do with medicine. Part of what I love about fiction is what I love about medicine, which is that you really get to know people and be part of their stories.
And lastly, find a buddy. Writing is this paradox because you do it in isolation and you feel like you're in a void. However, by definition, you have an audience, and so you'll never know the quality of anything until it's read by someone else. I teach a writing class with the Perspectives Editor of NEJM, and there are many doctors who are exceptionally talented writers who just haven't had the time or the space to create. That experience has been really wonderful because you build a community of physician-writers, providing a structure for their writing and a space to workshop pieces. That's something I'd recommend – at your institution, see if you can put a group together where you find like-minded people to create and share ideas.
As a clinical cardiologist, how do you incorporate writing into your busy schedule?
At this stage in my career, my time for writing is very protected, so I am probably not a fair example. During training, I did a lot of writing on weekends and vacation, but there were also several elective blocks where I could do what they called 'self-design', where I had freedom to pursue my interests. While some people did clinical electives, I wrote during those blocks. It took a bit of flexibility on the part of program leadership to recognize the importance of it, and I was exquisitely lucky for that. I try to encourage trainees, if this is something that's important to them, to find someone at their institution to champion their goals, see their potential, and are willing to 'sign off' on a writing elective.
What role – if any - do you think writing plays in helping to avoid burnout?
In the burnout conversation, it's much easier to focus on quantifiable aspects of doctoring, such as hours worked, and much harder to figure out how to sustain that desire to help people that drove so many of us into medicine in the first place. I think we need to rethink burnout, and instead of framing it as achieving better work-life balance, maybe we should be thinking about how to make our work lives more meaningful. For me, writing gives me a personal space to reflect and work through how I can be better as a physician. I find that after I've written about something – whether it's a patient encounter or tackling a systemic issue – I am reminded of how amazing medicine is, despite our many challenges and failures. So, I do think that the act of writing can help us rediscover the meaning in our clinical work in a powerful way.
Do you have any closing thoughts for aspiring writers or FITs in general?
Cardiology is amazing, and it's such a privilege to be a part of this specialty, so just know that even though the training is hard, it's so worthwhile. And as for writing, just remember it takes practice like every other skill – echo, cath, etc. But if you can think of writing as a process of understanding or discovery – rather than as an activity that is only valuable if it results in publication – then that practice is inherently worthwhile.
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This article was co-authored by Amar Parikh, MD, cardio-oncology Fellow in Training at Vanderbilt University Medical Center in Nashville, TN. Twitter: @amar_parikh