Rhetoric Needs to Regain Its Place in Medicine

Rhetoric. It is a word unlikely to be found in the curriculum of medical school or residency programs. Coupled with logic and grammar, rhetoric completes the trivium—the three ancient arts of discourse. While logic is the instrument that drives intellectual inquisition, grammar has been thought of as the process of “inventing symbols and combining them to express thought.” Rhetoric, though, is a true art, one focused on improving the ability to motivate, inspire, and instruct.

Logic is used daily as physicians observe clinical data to formulate treatment plans. And while physicians have certainly invented symbols as part of our craft, the basic rules of grammar have been battered through medical documentation.

Rhetoric, by comparison, has been left by the wayside. While its siblings have been praised or abused, rhetoric has rusted away in the physician’s tool-box, a forgotten art with the potential to inspire.

But the role of physicians has expanded, and rhetoric is needed again. While physicians formerly operated independently, we now collaborate with colleagues on teams crossing all borders and work alongside our patients to improve their lives. Psychiatrists especially have a greater responsibility than simply healing, as our medical practice impacts not only the mental health of our patients, but also their relationships with their loved ones and their ability to contribute to their communities. As we begin our careers as psychiatrists, how do we learn to advocate for our patients and our colleagues?

Through the efforts of dedicated individuals such as Dr. Steve Koh, the San Diego Psychiatric Society president-elect and chair of the APA Assembly’s Committee of Early Career Psychiatrists (ECPs), and Randall Hagar, the California Psychiatric Association’s government affairs director, there are exciting new opportunities for ECPs and members-in-training to learn the skills necessary to serve as leaders in mental health, and indeed as the new face of medicine.

Interactive sessions that leave the didactic-based classroom and are rooted in applicable, experiential learning have been created to help us understand our new role in our communities. At the 2012 California Psychiatric Association annual meeting, an innovative leadership workshop allowed us to practice delivering information to those outside the medical field, such as media members and legislators.

In this session, we were asked to take a stance on a topic of current affairs such as Laura’s Law—a controversial passage in California allowing court-ordered treatment for gravely disabled adults—and the RxP movement aimed at extending prescription privileges to psychologists. These subjects represented relevant legislative affairs pivotal to the current discourse in organized psychiatry.

By engaging in recorded mock interviews with trained media advisors and critiquing our segments as a group, we received relevant, real-time feedback. Similarly, we argued supporting and opposing views on current legislation by imagining that we had just walked into a meeting with a politician or his or her staff. We found ourselves learning the art of how to speak, write, and communicate in these situations and practiced how to take on leadership roles in psychiatry.

Workshops such as these give residents the unique opportunity to immerse themselves in medicine as perceived by patients. Rather than managing care as we are traditionally trained to do, we are faced with the responsibility of speaking on behalf of our profession and the responsibilities and privileges associated with being a provider of mental health care. Real-life debate, with instructors who are active participants in advocating for medical legislation, helped us better understand our duty to patients and provided us insight into the developmental process of the mental health care system. In this way, we were given what was for many an invaluable first glimpse into the field of organized psychiatry and the patient-advocacy movement.

It would be exceptionally difficult to overstate the value of such an experience to any psychiatrist, especially those early in their careers. For many of us this was the first time we were required to defend our beliefs in the face of a clear and coherent defense of the opposing view. But to be placed in such a position is an incredible learning opportunity. Debate such as this is what drives the wheels of progress, with constructive discourse serving as the foundation for the movement from which innovative ideas have emerged and will do so in the future. Involvement in workshops such as this teaches the rare skills that allow trainees to succeed not only as providers of mental health care, but as champions for the well-being of all patients. Rhetoric, the ancient art of discourse, has once again been called into service.

Laura Marrone, M.D., and Pabbiti Chaitanya, M.D., are, respectively, PGY-3 and PGY-1 psychiatry residents at the University of California, San Diego.