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With people in white lab coats and nametags around a conference table, it wasn't your typical wine-and-cheese book club.

The topic at Mercy Medical Center this particular evening was battlefield medicine. Dan Collins, director of media relations at the Baltimore hospital, was talking about the dismaying number of injured and killed in Iraq. Karen Arnold, the book club's facilitator, offered that survival rates were improving. And Sister Carole Rybicki noted the level of dedication to care on display. But there was a lot more to do than offer thoughts and opinions on the war in Iraq between bites of finger sandwiches.

The session was one in a months-long program called Literature & Medicine that aims to broaden the perspectives of medical providers as they vet the latest chapter.

It's a book club, but it's also a movement, say those working to improve health care, in particular the doctor-patient relationship. Hospitals have searched for a way to improve that for decades, with book clubs being started in more than 100 hospitals in recent years, partly mirroring the Oprah Winfrey book club phenomenon.

The supporters have lofty hopes of care becoming less rushed and institutional and more comprehensive and personal.

The volunteer participants from all corners of Mercy have read about such things as being trapped in a stroke-debilitated body in The Diving Bell and the Butterfly, incorporating Native American healing methods in The Scalpel and the Silver Bear and patching Iraq war soldiers in Better: A Surgeon's Notes on Performance.

Surgeon Atul Gawande's Better particularly struck Dr. Tara Coles. She hasn't been to war and doesn't know anyone in the 274th Forward Surgical Team, but she does some patching of her own as an emergency doctor.

"In the emergency room, we are always talking about overcrowding ... and how can we give quality care within the time confines," Coles said. "The article on war gave some perspective from people in a high acuity situation."

The club doesn't restrict itself to doctors. But a few months in, Coles said her approach already was different. She said she developed a "thoughtful scaffolding." And the fact that "it's there at all allows me to provide more thoughtful care and communicate more effectively with my colleagues."

Mercy launched its program four years ago, said Ann Fisher, a secretary in pastoral care who helps coordinate it. The idea came from the Maine Humanities Council, which recruited its first hospital there in 1997. Federal aid has since helped attract 117 hospitals in 20 states. Programs last six months and involve about 20 people each.

Maine officials wanted to bring humanities more into everyday life and thought health care providers could benefit most from a little perspective, said Lizz Sinclair, a program coordinator.

A 2005 survey shows participants believe it's meeting its goals: Large majorities said they had greater empathy for patients, increased cultural awareness and job satisfaction, and improved communications skills.

But explaining the point to outsiders sometimes still takes more than a few words. Like most book clubs, the members read and discuss, veering onto subjects in their professional lives - but the goal lies more in those tangents than dissecting the books.

"It's not quite a book club, a class or group therapy," Sinclair said. "It's people gathering around books and humanities for specific reasons. It's for pleasure, for stimulation, to make connections and form a community and reflect on serious issues."

Book clubs are a result of long-term consumer advocacy and are more than a touchy-feely way of doing business, said James Conway, senior vice president of the Institute for Healthcare Improvement, a Boston-based nonprofit research group that has followed the growth of book clubs.

He said most hospitals and workers are not bad or uncaring, though many are hurried and set in their ways. As a result, patients have felt - or were - mistreated and lost faith in the system. He noted a 2005 survey of sick adults by researchers at the Commonwealth Fund, a charitable foundation aiming to improve the health care system, that showed almost 75 percent thought the system needed fundamental change or total rebuilding.

Book clubs can spark better communications and empathy, he said. That could lead to more consultations, fewer mistakes and more humane treatment.

"Even in the best hospitals, the patients can have a bumpy ride," he said. "The system is very broken. ... But there is a willingness to change we didn't see four or five years ago."

That doesn't mean the system will change quickly, said Glenn McGee, who has also followed book clubs as the head of the Alden March Bioethics Institute at the Albany Medical College in New York and as editor of The American Journal of Bioethics.

He said, for example, when doctors are sued for malpractice, patients almost always say the doctors didn't acknowledge the mistake or apologize. Book clubs and other strategies to humanize doctors might offer protection because patients wouldn't unrealistically expect them to be infallible, McGee said. But doctors often resist efforts to strip their armor.

McGee said the problem starts in medical school, where doctors are trained as technicians first. That is hugely important, he said, but makes them ill-prepared to actually deal with patients who have different religious or cultural backgrounds or are just scared.

"We have to make sure the next generation is trained in a better way," he said. "When one doctor thinks about what it means to be a doctor in a book club, then the trickle-down theory applies. One person in a unit can set the tone."

To that end, the Maryland Humanities Council continues to pitch book clubs, said program officer Jean Wortman. The Kennedy Krieger Institute and Howard County General and Union hospitals in Elkton have or plan groups.

The council suggests fiction and nonfiction centering on medical issues, including well-known works, like Jean-Dominique Bauby's The Diving Bell and the Butterfly, recently made into a movie, as well as lesser-known works such as a poem about rehab and a story of eradicating polio in India.

At Mercy, the council hired Arnold, a retired professor, to facilitate. And on a recent evening, she kept the discussion flowing among nurses, doctors and administrators, who gathered around a table to eat sandwiches and talk about Better.

Gawande wrote that it wasn't just new technology such as plasma delivery, antibiotics or burn care that helped reduce war deaths by two-thirds since World War II despite an increase in firepower. It has been a change in methods:

Troops had resisted wearing Kevlar vests and goggles because they were uncomfortable or unfashionable, but when they were retooled, they wore them. And surgeons joined military convoys so they were there for the "golden hour" when trauma care is most essential. They also meticulously documented their data so they could be mined for other changes.

Sister Carole, a pastoral care chaplain at Mercy, said she was impressed by the medical providers' selflessness and effectiveness in using their time and skills.

"They relinquish their success to someone else, and that must be hard," she said of the doctors in Iraq. It made her think about how Mercy workers could think more holistically about the needs of the sick and wounded there.

Paul Vitale, the hospital's chief pharmacy officer, said reading about others' struggles and triumphs has helped him encourage his staff to better treat Mercy's large population of indigent patients by making resources go further and care more humane.

All this from words on paper?

"It's what came from the discussions. It was surprising," he said.

meredith.cohn@baltsun.com

Real page-turners

Some suggested readings for the Literature & Medicine program:

Drama

Wit by Margaret Edson

Medical Reader's Theater: A Guide and Scripts, edited by T.L. Savitt

Fiction

"A Nurse's Story" from A Nurse's Story and Others by Peter Baida

Cathedral by Raymond Carver

He's at the Office by Allan Gurganus

You Are Not A Stranger Here by Adam Haslett

The Interpreter of Maladies by Jhumpa Lahiri

The Metamorphosis by Franz Kafka

The Things They Carried by Tim O'Brien

Tell Me a Riddle by Tillie Olsen

The Death of Ivan Ilyich by Leo Tolstoy

Nonfiction

The Diving Bell and the Butterfly by Jean-Dominique Bauby

The Spirit Catches You and You Fall Down by Anne Fadiman

Better: A Surgeon's Notes on Performance by Atul Gawande

Nurses at the Front: Writing the Wounds of the Great War by Margaret R. Higonnet

Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study (Studies in Social Medicine) edited by Susan Reverby

Refuge by Terry Tempest Williams

Poetry

Without by Donald Hall

Rehab at the Florida Avenue Grill, poems by Veneta Masson

[Source: The Maine Humanities Council]

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