Growing up, I was your typical bookworm. I loved going to the library and couldn’t get my nose out of fictional tomes even while walking. I was often lost in the exciting world of mysteries, magic, history, romance, and fantasy. My love of all things literary was initially encouraged and often applauded. After all, we are always encouraging children to read. However, as I got older, I was often questioned about my love of fiction and frequently told to use my time more efficiently by reading “useful” and “informative” pieces of writing. Thankfully, psychologists have been curious about the role of reading for decades and many studies have shown the positive impact that reading fiction has on one’s social-cognitive abilities. Today, I still gravitate toward fiction and continue to read in my free time. I have found that reading fiction has been integral to my medical training, providing me with the communication tools that I both subconsciously and consciously apply in my interactions with patients.
The ability to communicate and connect with patients is integral to the practice of medicine and although these are often considered “soft skills,” they can very much be practiced. In most medical schools, students work with standardized patients in their pre-clinical years to not only learn important history and physical taking skills, but to also learn the nuances of physician-patient communication.
Ultimately, good communication with patients seems to come down to one’s social-cognitive abilities. The two major elements of effective social interaction include the theory of mind and empathy. The theory of mind is a cognitive perspective-taking in which we make inferences about what another person is thinking. Empathy is an emotional perspective-taking in which we infer the emotional experiences of others. Interestingly, as students progress from the preclinical to clinical years, their capacity for empathy appears to decline. The cause of this phenomenon is likely multifactorial, due in part to desensitization, burnout, prioritization of other aspects of medical education, and the need for emotional control. While there is no one solution to this problem, reading fiction may be an outlet for developing and practicing the important listening skills, theory of mind, and empathy required to be an effective and caring physician.
Keith Oatley, a cognitive psychologist, refers to fiction as the “mind’s flight stimulator;” just as pilots improve their flying skills in flight simulators, people who read fiction can improve their social skills. Psychologists have used the Mind in the Eyes Test — in which individuals look at photographs of people’s eyes and choose from four terms to indicate what the person was thinking and feeling — as an index for empathy and theory of mind. Using this test, they found a significant association between reading fiction with greater empathy and theory of mind. In addition, other studies have found that individuals who read fiction score better on the Mind in the Eyes Test than those who read non-fiction. But why is this the case?
While reading a novel, we are often transported into a different world. We begin to identify with the main characters, imagine what it is like to be them, and experience the events of the novel through their eyes. We quite literally put ourselves into the main character’s shoes. In many ways this process by which we relate to fictional characters is quite similar to our interactions with patients. In order to understand my patients’ motivations and feelings, I often have to take a step back and re-consider the situation through their perspective. Oatley theorizes that this process of making inferences about what the characters are feeling and immersing ourselves into the imaginary story may be what allows us to develop empathy through fiction. In effect, the process of reading fiction appears to require the ability to construct an immersive simulation. Neuroimaging studies have investigated this simulation process and found that fiction reading and social cognition involve overlapping neural networks. By recruiting these neural networks while reading, we are effectively practicing the types of skills required during social-cognitive tasks, which for physicians is most often communicating with patients.
Ultimately, reading fiction appears to be a unique way to practice one’s ability to empathize with and understand the perspective of others. Through fiction we can experience a wide variety of circumstances we might not ordinarily encounter. Immersing ourselves in these foreign worlds through the lens of a novel gives us the space to suspend disbelief, broaden our outlook, and experience a wide range of emotions in the safety of our own space. While I can’t say that reading novels will be the solution for sustaining medical student empathy, I do believe we should encourage creative outlets that require imagination and creativity and push the boundaries of what has traditionally been considered “useful” for medical education.
What is your favorite fiction read? Share your reading recommendations below.
Ruchi Desai is a current fourth-year medical student at UC Irvine School of Medicine. She is planning to pursue a residency in internal medicine. During her free time she loves to read, listen to podcasts, and learn as much as she can about the world. She is a 2021–2022 Doximity Op-Med Fellow.
Illustration by April Brust