For Clinicians Who Write Essays About Patients: Conceptual Review of Consent and Ethical Considerations

Clinician-writers are publishing a growing corpus of personal accounts about their healthcare practices in clinical and general readership journals. For many clinician-writers, personal and creative writing offers a means for expressing both the rewards and the costs of clinical work, while providing a means to honor their patients and bear witness to their suffering. Many accounts include private, intimate moments with patients and families. Emerging at a time of consequential economic changes in healthcare systems, the inclusion of humanities, ethics, and the arts-including creative writing in medical journals-has been recognized to increase professional satisfaction and reduce burnout among physicians but also to deepen comprehension of patients' concerns and to increase patients' trust in their doctors. Alongside digital platforms, clinician-written essays occupy growing space in contemporary medical publishing, influencing larger public discussions about health and society. Publishing such writing creates a complex ethical dilemma regarding patient privacy and confidentiality. In this essay, we reflect on the ethical dimensions that arise when a clinician-writer considers publishing a nonfiction account that describes a patient or exposes private aspects of the writer's self. We review the salient published literature and discuss the divergent ethical stances among clinician-writers regarding the choice to publish their writing and issues surrounding consent from patients to publish descriptions of them. An examination of journal policy guidelines reveals a paucity of attention to the particular contributions of reflective, personal, and creative writing. Instead, most journals seem to rely on informed-consent guidelines for clinical trials to guide writers of personal and creative essays in their ethical decisions. Addressing issues of privacy for patients and trustworthiness of clinicians with insights from humanities and creative disciplines can illuminate patients' perspectives and clinicians' creative contributions to effective care. We suggest initial concrete steps toward that aim.