Dr. Amanda Swain is still a little surprised that she’s a physician. Born into a family of creatives in small town Long Island, Dr. Swain herself found a lifelong passion for creative pursuits at a young age. Her journey from a childhood steeped in writing and theater to a career as a medical educator at Penn is unconventional, but Dr. Swain’s unique background has also granted her extraordinary vision. A champion for medical humanities, she is working to bring about changes in the culture of medicine towards increased compassion, greater interprofessional synergy, and deeper personal fulfillment.
In the course of our conversation, the importance of creative expression emerged as a consistent theme guiding Dr. Swain from her developmental years to today. As a freshman at Brandeis University, she eagerly took to cultural anthropology, imagining a career in the realm of museums, archaeology, and artifacts. But her father’s history of chronic illness had piqued her curiosity about the medical field, and an experience shadowing a gastroenterologist family friend catalyzed the diversion of Dr. Swain’s route towards medicine. She found a means of retaining her creative interests while pursuing a career in medicine when, her sophomore year, she was admitted to a program at Mt. Sinai designed to attract humanities-oriented applicants. Dr. Swain graduated from medical school, completed a family medicine residency at Jefferson, and made her way to Student Health at Penn, drawn by the challenge and fulfillment of caring for the adolescent population.
Several years ago, a friend of Dr. Swain’s invited her to a theater class for health professions students at Jefferson. “We should do this kind of thing at Penn,” she thought. In search of an avenue to make medical humanities initiatives a reality at PSOM, she connected with Dr. Horace Delisser, who oversees the humanism and professionalism curricula, via Dr. Benoit Dube, then an attending in psychiatry.
Their collaboration has proved more than fruitful. In the years since, Dr. Swain and Dr. Delisser have worked together to develop aspects of the Doctoring course as well as medical humanities electives for Perelman students. Those classes, including Art, Observation, and Empathy and Writing a Life, have given students opportunities to develop faculties for introspection and creative expression both in relation to medicine and beyond it. Here, Dr. Swain has found her niche.
“I enjoy my primary care practice so much, but in terms of where I get my energy from, I don’t enjoy my interactions with medical students as much in that arena as I do in the medical humanities space. It’s so much more fun and so much more satisfying to talk to and teach students about narrative medicine and the visual arts and theater than to be talking about analyzing a urinalysis . . . I want to talk about the things we don’t measure in the office—empathy and communication skills and observation skills . . . I feel very lucky that I’ve found a way to pull that piece of myself into what I’m actually given time and salary to do, and I would love to do more of it,” she says.
Given the role creative arts have played in her own life, Dr. Swain sees medical humanities as a bridge between passion and profession.
“So many of us will spend our careers as salaried physicians within much larger health organizations. There are good things about that, but you can also start to feel like a very small cog in a very big machine, and that can be very draining if you really want to feel motivated and passionate about what you do. And I definitely think the humanities have a role in that discussion,” she told me.
“From college to medical school and beyond, I felt I had to choose,” Dr. Swain reflected.
“I would think, ‘there’s a part of you that is so creative and feels so fulfilled by writing and theater, but that’s not something that you really have time for now; that’s not something that you can really make work with your career.’ When you do that you strangle off a little part of yourself; you tie a little tourniquet. And that pressure builds up and I think it ends up for some people probably leading to some kind of burnout.”
For Dr. Swain, though, it has been a tremendous boon to be able to express herself creatively in her day-to-day work in medicine: “I feel very lucky that I’ve found a way to pull that piece of myself into what I’m actually given time and salary to do.”
“I would hope that finding a way to bridge the creative interests of doctors with some aspect of their clinical experience will ultimately help people feel more fulfilled in their careers over the long haul. It’s a long career—if you go straight through, like I did, you’ve got your MD and you’re 25 years old. You’re going to be practicing medicine for 50 years. You need to maintain energy and focus and enthusiasm.”
Dr. Swain went on to expand on how she imagines medical humanities can promote mutual understanding and strengthen interdisciplinary healthcare teams.
“If you work in a typical medical office, you’re working with people in administrative roles, psychologists, social workers, nurse practitioners, PAs, medical assistants, nurses, students, reception, medical records, referrals, lab techs, and more. How do you manage and unite this group of people? How do you put forward the idea that we’re all in this together in the common goal of providing excellent patient care, but we may be all judged by different metrics, have different responsibilities, and come from very different educational, social, and cultural backgrounds?”
“I think the humanities are a way to do that because you could go in at the monthly staff meeting and go through educational competencies and run through the fire drill, but that doesn’t bring people together. But instead, you could sit down and say, ‘we’re going to give you protected time in your schedule and watch this movie or do a visual arts thinking exercise, share our views, have a really meaningful discussion, take something from each other and learn from each other in a way that we wouldn’t have before.’ I think you’re going to get a lot farther in getting everyone working together, on the same page, and motivated than you would in the monthly staff meeting.”
Finally, Dr. Swain credits the COVID-19 pandemic for highlighting an important role for the humanities in a healthcare system and society under significant stress. She commends Penn Medicine for implementing the COBALT site, a platform for healthcare workers compiling mental health and wellness resources. Besides offering contacts for psychotherapists, resilience coaches, and other support personnel, COBALT also provides for interpersonal connection and creative exchange including art appreciation.
“In a time of crisis, where did we go? We didn’t go back to our textbooks. We wanted to engage in ways that could feel creative. There’s a lot to be said about using the same kinds of resources in non-crisis situations to foster a sense of community and responsibility and relationships in organizations.”
We drew our call to a close so Dr. Swain could make it to a piano lesson. When her son took a break from lessons this past summer, she figured she would resume her own piano journey after a hiatus of several decades, and she’s been loving it.
“You feel like you’re using a different part of your brain, and you are!” She exclaimed. “Now I’m in, and I’m committed, and I don’t see myself stopping again.”
Carolyn Chow is an MS1 at the Perelman School of Medicine.
