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From Medscape <http://www.medscape.com/medicalstudents> Med Students
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Pre-Rounds
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Dr. Hébert: Katrina Survivor, Patient Whisperer, Satiric Storyteller
Posted 10/26/2006
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Nicholas Genes, MD, PhD
Last year, a doctor started a Web site to boost publicity for his Louisiana
practice. Over time, though, his storytelling, thoughtful opinions, and
impassioned writing following Hurricane Katrina have made Dr. Michael
Hébert's site a beloved destination for readers all over the country.
I've been fortunate to correspond with Dr. Hébert about his interactions
with patients, how that translates to literature, and how the hurricane
affected his life.
Dr. Genes: The first entry on your site is surprisingly terse -- especially
given the expansive posts that soon followed. Did you know, when you
started, how your writing would develop?
Dr. Hébert: I started my blog mostly to grow my medical practice. The site
was intended as a promotional one; I would discuss various medical topics
for patients to read and then hopefully they would come into my office. At
some point, I abandoned my plan to use the site as a practice promotion.
This was because I noticed that the people who were reading it were almost
entirely out-of-towners. So I adjusted my posts to address the interests of
a broader audience.
As I wrote, I discovered that I got no pleasure out of writing about
medicine. I have no desire to be -- and in fact have a little disdain for --
those TV docs on the "Health Minute" segments. I think all that facile
spoon-feeding of medical information oversimplifies medical problems, and
may even be harmful. Sometimes it scares people into seeing their doctors,
which can be good. But we live in a society of fear. Nowadays, people are
terrified of spinach and the West Nile virus, for heaven's sake; we don't
need any more of that. About the same number of people will die from West
Nile virus this year as from lightning strikes, but the media don't care
about that. The media are only interested in making money.
Given this, I decided to refocus on what really interests me about medicine:
patient interactions. Patients are complex and mysterious, and many doctors
do not appreciate how little they understand about their patients. I talk to
patients all the time and realize that there are thoughts and feelings
running through their brains that I will never fully understand. Sometimes I
have to guess. Why won't this patient take his blood pressure medication?
Why is this person afraid of surgery? I knew an ER doctor once who had
vaginal bleeding for something like 10 years. She would get a CBC (complete
blood count) every once in a while, and the lab would call her back in a
panic because her count was so low. She would say, "Oh, that's normal for
me." Yet she never went to a gynecologist to find out where the blood was
coming from!
It is amazing how people think one way as a doctor and another way as a
patient. That is my primary interest when I write about patients -- the
difference between the thinking of the doctor and the patient. The more I
wrote about this, the more it became a major theme in my site. So I guess
you could say that I grew into my blogging. I wrote about what interested
me, and ended up with what I have now.
Dr. Michael Hebert hosts Grand Rounds
<http://drhebert.squarespace.com/journal/2006/10/30/halloween-grand-rounds.h
tml>
October 31, 2006
Dr. Genes: You've done a lot of analysis since the upheaval of Katrina, with
respect to both the people it touched and your own life and practice. Given
that your blog started shortly after the hurricane, how has Katrina affected
your writing?
Dr: Hébert: Katrina, yes. I went through it in my fortieth year, which
means, God willing I live so long, it will have divided my life exactly in
half. Everyone in New Orleans will tell you that there is only Before and
After. I didn't intend for my blog to be about Katrina. After all, my site
was initially supposed to promote my practice, and posting about Katrina
wouldn't help that. However, as I got hits from out of town, I began to see
an opportunity to say more to a broader audience.
I still have great difficulty getting my mind around what happened.
Everything failed with Katrina -- the levees; the federal, state, and local
governments; the police; FEMA -- you name it, it failed. And then, the week
after the storm, people started saying, "Maybe we shouldn't rebuild New
Orleans." This really got under my skin. Perhaps if the failure had not been
so global, they would have had a point. But the truth is that no one in
authority cared enough to help in our darkest hour. Suppose a patient came
into an ER with chest pain and the doctors there did absolutely nothing for
hours and hours. Then the man has a massive heart attack, his blood pressure
drops, and he suffers brain damage. Finally, the doctors come around and
say, "There's nothing we can do now; let's just euthanize him." That is how
I feel about the government's response to Katrina.
Southeastern Louisiana is certainly a society on the edge, and it was even
before the storm. There were a lot of problems before Katrina: crime, poor
schools, corruption. But those are human problems; they can be solved. The
area's vulnerability to hurricanes can be greatly reduced, too, with the
proper land management. New Orleans is and was culturally different from any
other city in the United States, even from other cities in Louisiana. If
there is one thing we lack in this country of 170 cable channels that are
all the same, it is variety. What can help our country to survive is not
that we become all look-alike and think-alike, but that we stay different.
It is our strength, and I am really disappointed at how often Americans are
ready to throw that diversity away.
Dr. Genes: Many of your stories begin grounded in reality, before veering
off into the satirical or absurd (like the woman with the novel weight-loss
plan <http://drHebert.squarespace.com/journal/2006/9/16/maria-maria.html>
or the doc who tries to dry his stethoscope
<http://www.drHebert.squarespace.com/journal/2006/4/13/the-slings-of-fortune
.html> ). The opinions are always well reasoned (like the effect of
Wal-Mart's formulary
<http://drHebert.squarespace.com/journal/2006/9/23/the-4-generic.html> ),
though sometimes they are given the cover of a story (as when you took the
prayer studies
<http://www.drHebert.squarespace.com/journal/2006/4/2/a-scalpel-and-a-prayer
.html> to their logical conclusion). How do you weigh the pleasant mix of
fiction and opinion on your site? Does the balance come naturally or do you
force the occasional creativity?
Dr: Hébert: My patient stories are usually satirical. I like to write
comedy, and I think comedy plays better on the Internet.
I find that I am strongest as a reactionary writer. That is, I read
something, or something happens to me, and I write in response. Writing
about Katrina is easy for that reason. It happened to me, so I can react to
it. Most of my patient vignettes are derived from something I observed in a
patient that I found odd. I often focus on the oddness of other people. That
is not intended as an insult; I like odd people.
When I find an oddness or a contradiction in a patient, I carry it around
for a while, then devise a self-contained story about it. I rarely, if ever,
make up the main idea, but I will flesh out my story as needed, or condense
several separate patient encounters into a single one, if necessary.
I do try to mix opinion and fiction pieces. I don't think I could come up
with enough fiction to post regularly, so I have to add in other topics. I
like doing a little of everything, and I hope my readers do, too. My main
goal, whatever I may be writing about, is aesthetics. I want my posts to
read easily and to be pleasing to read. This is more important than any
single point I make. Writing should always be, first of all, compelling, and
secondly, entertaining. There is plenty of boring stuff on the Web. Plenty
of strident stuff, too. So I try to keep the ranting down and just
entertain. I do say, for example, "My last 3 posts were political. Time to
write something different." Opinion posts come easier, so I have to
concentrate on bringing out the creative side.
Dr. Genes: What have you learned from other doctor-writers?
Dr: Hébert: Like any writer, I believe in learning from other writers.
Obviously, I do not restrict myself to Internet writers. Since I became a
blogger, I have developed a strong interest in print writers whose style
strikes me as being "bloglike." Lately I have been reading Anton Chekov's
short stories, and have been astonished at how they resemble blog entries. I
also like Flannery O'Connor for focused, morally powerful stories.
Montaigne's Essays also have deeply influenced my style. Montaigne in
particular was a master at writing about himself without sounding
egotistical, and I think of him often when I sit down to write a new piece.
What I have learned from online bloggers is that a blog doesn't have to be a
personal diary; it can be a daily art exhibition. Actually, I think of mine
as more like a jazz club. Every post is a different tune, but the overall
style is always the same.
But I have 1 major rule in my blogging: However the story comes out, I run
with it. This usually means that the posts come out long, and frequently
exhaustive. I, as some other medical bloggers have done, opt for quality
over quantity. This reflects my personality anyway.
Dr. Genes: Readers are welcome to judge the quality of Dr. Hébert's writing
when he hosts the upcoming Halloween edition of Grand Rounds on October 31,
2006 (the link to Grand Rounds
<http://drhebert.squarespace.com/journal/2006/10/30/halloween-grand-rounds.h
tml> will go "live" on October 31). Each week, the host of Grand Rounds
compiles and edits the best of recent medical blogging. As is often the
case, the personality of the host shines through. But if new readers need
further introduction to Dr. Hébert's blog, they can check out his collection
of favorites
<http://www.drHebert.squarespace.com/display/ShowJournal?moduleId=355334&cat
egoryId=37331> as well.
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Nicholas Genes, MD, PhD, second-year resident in emergency medicine, Mount
Sinai Hospital, New York, NY
Disclosure: Nicholas Genes, MD, PhD, has disclosed no relevant financial
relationships.
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Medscape Med Students. 2006;8(2) ©2006 Medscape
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