EP162: Bridging Passions: From Medicine to Humanities with Dr. Amanda Swain

The Intersection of Medical Humanities and Physician Wellness with Dr. Amanda Finegold Swain

In this episode of The Girl Doc Survival Guide, Dr. Amanda Finegold Swain, MD, Faculty Director for UME Medical Humanities and Assistant Professor at the University of Pennsylvania, discusses her advocacy for incorporating medical humanities into medical education to teach empathy, perspective taking, and improve communication skills. Dr. Swain shares personal anecdotes about her love for reading and the importance of setting personal boundaries. She speaks about her diagnosis with multiple sclerosis, discusses balancing work with personal passions, and elaborates on the significance of writing and narrative medicine in understanding oneself and supporting others. The conversation touches on the cultural expectations within academic medicine and the need to be brutally honest with oneself to achieve fulfillment and maintain mental wellness.

00:00 Introduction to Dr. Amanda Finegold Swain

01:03 The Importance of Reading in Medicine

03:13 Setting Boundaries as a Mother and Physician

07:31 Balancing Part-Time Work and Patient Care

10:14 Living with Multiple Sclerosis

13:52 The Role of Writing and Narrative Medicine

19:33 Finding Fulfillment in Medicine

25:30 Final Thoughts on Fulfillment and Self-Care

Transcript

Christine Ko: [00:00:00] Welcome back to the Girl Doc Survival Guide. Today I am very pleased to be with Dr. Amanda Finegold Swain. Dr. Swain, MD is Faculty Director for UME Medical Humanities and Assistant Professor of Clinical Family Medicine and Community Health at the University of Pennsylvania. She champions using the medical humanities in medical education as a way to teach empathy, perspective taking, improved communication skills and many other goals. She teaches Narrative Medicine in the Master's of Bioethics program at UPenn and has also taught medical students about creative writing and narrative medicine. Her writing has been published in Intima, a journal of narrative medicine, The Philadelphia Inquirer, and JAMA. One of her passions is writing and talking about things that we don't measure in doctor's offices. To Dr. Swain, the medical humanities are a bridge between passion and profession; personally, I just find that beautiful.

[00:01:00] Welcome to Amanda. 

Amanda Swain: Thank you so much. I'm thrilled to be here. 

Christine Ko: I am so excited to talk to you, and I was just wondering if, first off, you could just share a personal anecdote. 

Amanda Swain: Sure. I've always loved reading, and I actually think that reading has absolutely contributed to making me a better doctor and a better person. Something that people are often surprised to hear about me is that I read anything and everything, and I always have. It just is something that gives me so much pleasure and entertainment.

Christine Ko: Yeah. How do you find the time to do that? I love reading, too. I read more now, but I would say, when my kids were younger, babies, and I was pretty busy job wise, I couldn't read anything not related to my job or related to parenting.  

Amanda Swain: When I was working full time, I commuted by train every single day. I needed something to pass the time. So I read there, [00:02:00] and I've always read before I go to sleep at night. To be honest, and this sounds funny, but the truth is, I think I trained my children from a very early age to understand that mommy has to read, and mommy is reading, is a reason not to ask for her attention. I remember being on maternity leave with my second child, not my first. That was way too anxious an experience. But with my second child at that point, I realized, okay, she doesn't actually need my attention every single moment. She was probably a month old, six weeks, eight weeks, and I put her on the play mat, and I would sit next to her, and I would read, and I would let her look at whatever she was looking at over her head and practice rolling over eventually. It's just always been something that I do. I don't think of it as something that I have to make time for, per se. I think of it as something that everyone around me understands they need to give [00:03:00] me space to do. Woe betide them if I do not get the time to do it, because I think it really helps my sanity to be totally honest, even though that sounds funny. 

Christine Ko: I love the way you put that because one thing that I've been thinking about more recently is boundaries and also the concept of the book, Let Them. What you're saying goes along with that, like a boundary being something you set for yourself that determines your actions. If I put it in first person. I set a boundary for myself. I need to be okay with how other people react. And they may be angry or they may be upset, but I should hold my boundary. It sounds like you did that even with your second child. You're like, my boundary is I need to read for this amount of time, and I'm not being a bad mother. The baby's right next to me, has some toys. The baby needs to respect my boundary. If the [00:04:00] baby really is in danger, obviously you're gonna take care of it, but the baby's not in danger. The baby's safe, the baby's right next to you. My boundary is to read, and let the baby fuss a little if the baby fusses. It's okay. That's awesome. I was not able to do that. My first experience with my first child was anxiety provoking, it probably is for everyone, and that's probably normal, but even by the second, I didn't have good boundaries. 

Amanda Swain: That is very normal. Honestly, I don't think I ever would've framed it as a boundary at that time. It makes so much sense the way you are describing it now, but at the time it just felt, can I just do this one thing for myself? I just saw it as this is what I give myself. I still see it that way. It's just always been something that is tremendously relaxing and engrossing.

Christine Ko: It's telling, too, that you said you never really thought [00:05:00] of it as a boundary. Boundaries are necessary for me. I don't think I ever really had good boundaries. I don't think I've had good models for that. Not to be pointing the finger at anyone else, this is my thing to deal with. But what I mean is that I grew up in a culture where being a mom is about sacrificing. A mom should want to serve. So without really thinking about it, I just thought when I became a mom, oh, I need to just serve. Sometimes it was just so hard, and when I went back to work after maternity leave, I remember I was like, okay, this is for me 'cause I love my job, and I've always loved my job. I was like, okay, this is my time. That really helped keep me sane.

Amanda Swain: Yeah, I remember going back to work after maternity leave and just marveling at the fact that I could pee whenever I wanted to. It didn't have to be on anyone else's schedule. I could just go, and I could eat, and I could just have a moment where I just breathed.

Your point about models is an excellent one, and kudos to my mom [00:06:00] who modeled taking the time to do the things that she loved. I think occasionally I was slightly resentful about it as a child, and at the same time realized that it was really nice to have a mom that was not solely fulfilled by focusing on me and my sister. She was, and still is, a writer. Her professional career was as a writer in advertising and a copy editor, and she loved writing for herself, which she would do on her computer for hours. And she was very active in community theater and that took her out of the house sometimes almost every night of the week for hours. That was just how I grew up, that mom had her things that she did, and we didn't question that. Obviously it made her happy and fulfilled. Overall I was very proud of her for those kinds of activities. That absolutely [00:07:00] informed how I approached when my children were very young and now approach the things that I feel I need to do for myself. 

Christine Ko: Yes. 

Amanda Swain: And luckily I have a husband who's completely supportive of that and never questions, whatever I want to do, if it takes me out of the house or away from the family. Probably my mom's modeling that really informed a lot of the decisions that I've made. 

Christine Ko: May I ask, do you work part-time now? 

Amanda Swain: I work part-time now, yeah. When I first went from full-time to part-time, I definitely struggled a lot with, what does it look like to be a part-time physician? cause there's no way to truly be a part-time physician, right? I can't not care at all for my patients on certain days of the week, right? That's not how it translates. But again, to come back to the term boundaries, where I've [00:08:00] settled is some tentative seesaw like balance between knowing that the care that I give my patients when they are in front of me is laser focused 100%, and I do the best I can as an individual within a system that is not adequately designed on the days that I am not in front of them. Of course that means that sometimes things are delayed. And that sometimes I really do feel moral distress. But the alternative is a complete lack of boundaries and lack of balance. And I can't tolerate that either. 

I think my patients know that I care for them, deeply, and also that both they and [00:09:00] I are in a very large, complex system that is not able to deliver rapid assessment and rapid care, even in person. So we are both victims in a way of that, and I can do my best. That's all I can do, and I don't think that's good enough at times. I know that. And also, my motto, if you could call it that for myself, is I am not an individual solution to systemic problems. I could try to be, but I think that's ultimately a proposition that will fail. My patients know that I really do care for them and that when they don't get the care they want or need in a timely manner, it's not because I don't wish I could give it to them. It's for countless other reasons that ultimately aren't truly my fault. I don't think they blame me for it [00:10:00] directly, but I would not sit here and say that it's completely understandable or reasonable that we can't really give care in a timely manner.

Christine Ko: Yes, I'm with you. Can you talk about when you got your diagnosis?

Amanda Swain: In the winter of 2022, I started to have symptoms clearly related to multiple sclerosis. Fatigue can be a tough symptom to manage. And so really I would say up until the past month it's been something that I've still been really trying to actively manage and understand. As of a month ago, changed a dose of medication and it's been much easier since then, but that's a month. It's hard to know what the future holds. But it's been fatigue, primarily, that has been limiting.

Christine Ko: [00:11:00] Yeah. How did you initially, or now, balance being a patient and also being a doctor, like being both at the same time?

Amanda Swain: I think I'm really good at compartmentalization, to be honest. I don't think very much about being a patient except when I really need to. Overall it feels manageable. Stimulant medication is doing a great job for me right now, and I'm feeling more like myself than I have in years. I am also very mindful of the privilege that I have as a physician to be able to have a direct impact on my care. In terms of advocating for myself as a patient it's a huge one. 

Christine Ko: When you said you're really good at compartmentalizing, something that I've been thinking about more recently is called splitting, where physicians split from the patient experience. There are positives and negatives of that, but the positive is so that we don't get overwhelmed. But I think the negative of splitting is that, at least for me, I can just [00:12:00] get used to things that maybe I really shouldn't get used to.

Amanda Swain: Absolutely. There are pros and cons of splitting or compartmentalization or however you frame it for yourself. Yes, it's a positive and a negative. I am able to put things away and feel like I don't ever really have to address them. I don't think that is actually the case. I think I end up addressing them indirectly, probably in ways that maybe aren't so healthy. But I do think that it is much harder to do that now than it was before my diagnosis because as I write about in that essay in A Piece of My Mind, it's easy in a way to imagine that you can just go and go. That there is truly nothing stopping you from just doing what needs to get done as a physician, but that's [00:13:00] not the reality. And sometimes it's a diagnosis that stops you or it's a family situation or it's something else. But I can appreciate that while I am not actively thinking about being a patient and a physician every day, and certainly not when I'm in the office seeing patients, it is there. We have to find ways to manage stressors, and it's either compartmentalizing on the side of patient care or you're doing it on the family and personal side, right? How many times have we left with a sick child at home? It is really interesting how we focus. We have to focus. You don't make it through medical school without being able to focus.

Christine Ko: Going back to the work you do in the humanities. Can you talk about that a little bit [00:14:00] and how that might apply? 

Amanda Swain: For me, writing is a way to understand myself. There is no other way that really equals writing for me in terms of trying to understand myself, which is ultimately why I decided to pursue an MFA in creative writing. At the time, I really viewed it as, okay, I really need this education because I wanna be a better teacher, and I wanna have a really firm foundation to be able to teach writing. But I think now, several years down the line, because I'm doing my MFA at a snail's pace, I can appreciate that it's really very much focused on the pursuit of understanding myself. For me, writing is a way to try and make sense of things because there's so much that comes at me on a daily basis that I just can't process in the moment. And I've found that a lot of medical students are very interested in writing, either as a tool for self-reflection, [00:15:00] as a tool for capturing patient encounters, as a tool for advocacy. So it's been really fun to teach that and to encourage students in their writing. If you ask, when do you really enjoy teaching and medical student interactions? It's hands down talking about writing or creative expression or narrative medicine. That's where I would really love to spend time teaching. I love writing and I find that, going back to that idea of compartmentalization, it's a way for me to open up some of those drawers and look in and say, oh there's this thing that I put away that I didn't really know what to do with. Maybe I wanna take that out and start to think about it. That's how I do that. That doesn't have to be how everyone does that, [00:16:00] but that's a very important tool for me to do that. 

Christine Ko: How did you first start teaching narrative medicine and writing?

Amanda Swain: In my role at the Perelman School of Medicine, I mainly oversee our medical humanities electives. And then as I've been working with medical students and they learn that I write and that I'm pursuing my MFA, it's come up, oh, why don't we create a time for you to talk to us about that? Or, let's have students do some kind of an elective in writing, but then, will you be someone who volunteers to read some of what they've written and provide edits for them? And I've been happy to do that. And then, out of the blue, I was asked by the Director of the Bioethics Program to teach Narrative Medicine to that [00:17:00] group. And I'll do that again in the summer of 26. And so it's a little bit of a lean in moment. If you're asked to do something that sounds really interesting, you say yes, and then you figure out how to do that after the fact, which I did. I have found it so fun and so fulfilling, to think deeply about things with students, because I certainly don't wanna position myself as this authority that has all the answers. To think about these things and really learn alongside them has been so fun and it gives me energy. Talking about writing and reading and narrative medicine and teaching, it gives me a tremendous amount of energy. 

Christine Ko: In listening to you speak and the passion with which you talk about your profession right now, I think it seems really obvious that merging passion and profession takes really doing something that gives you energy. 

Amanda Swain: Yes, [00:18:00] absolutely. And I think it probably takes time to figure out what that is. Let's see. From the time I started practicing medicine to when I even started to have an inkling of, oh, I am really interested in medical humanities and maybe this is something I wanna be doing. That was more than 10 years. And then even trying to get my foot in the door at the medical school, and who do I talk to and what does that even look like? Took another few years. And to get to the point where I can say, I really love what I'm doing and I know what I'd like to do more of, and I even have some vague sense of where I'd like to be in another five to 10 years. I'm 20 years into my career at this point. That's just, that's not something that happened overnight. It takes time for me at least. I say that just as a way to maybe assuage people who don't feel like they have that kind of interest or passion, whatever you [00:19:00] wanna call it. You don't have to. Maybe it will just happen organically, and maybe it won't be related to medicine also, right? Mine overlaps with medicine, which is a wonderful thing. However, whatever another person feels is really fulfilling for them or helps them really come back to themselves could be completely detached from medicine, and that's fine. Being a physician does not have to be your entire identity. It probably shouldn't be. 

Christine Ko: Yes, I agree with you. Being a physician hopefully is not our full identity. Do you think there are other tools that you found useful to stay passionate about what you do and the way you live your life? 

Amanda Swain: I think that what's been really helpful and also hard to do is being brutally honest with myself about what I truly enjoy doing, and what I do because I have to do it, and what I [00:20:00] don't have to do, because those are three categories. In order to figure out who you wanna be at any point in your career, you need to really think about those categories and not judge yourself while you're doing so, because there are people out there that might actually not love patient care. And that's okay. It might feel bad to admit that to yourself, but that's okay. That can be your truth. But in order to feel truly fulfilled, that's something you're probably going to have to admit to yourself, if that's your truth, right? Thinking about when I was sitting in this place of, oh gosh, I'm not happy right now at work. Why am I not happy? I could identify at that time, when I'm in a room with a patient, I actually am happy. That is a place where I want to be. Okay. So I can identify that, right? What am I [00:21:00] not happy with? I'm not happy with the administrative piece. I'm not happy with X or Y but if I can identify, okay, what is something that I know I wanna hang on to? Okay. There's that piece. And so that was helpful. Or, I may not love some of the nitty gritty stuff that comes with having an administrative role at the medical school. I'm not a details person, which I know sounds ridiculous because I'm a physician. We have to be detail people but I don't love a lot of tiny details. And truthfully, what that's translated into is that I don't love research, and luckily, I don't actually have to publish in my current role. I do make an effort to do, but if my name is on one publication a year, that's great. Good for me. Medical journal publication. Not my own written publications. Those I'm endlessly interested in. But I can be honest about that, and it took a long time to be honest about that because if you're in an academic medical center, to admit that you don't really like [00:22:00] research is like saying you don't like puppies. But that is how I feel. And that's okay. That's how I feel. And that works with my current role. And then there are the things that I really just don't enjoy at all, and I've structured my current role so that I don't do some of those things. I think that's key in really coming to a place where you can identify okay, what's really gonna make me happy here? You just have to really not judge yourself. And that can be hard depending on where you were brought up medically speaking. Going from a place like Mount Sinai, training at Jefferson, being a career physician at Penn, admitting I just don't like research. It took me a long time. Not just that I don't like it, but that's just not my skillset so much. That's okay. 

Christine Ko: I think it goes back to when I first mentioned models. When you're at "hardcore" academic places, there is a culture and a model of what you should be [00:23:00] doing and what's really praised is the triple threat. Someone who's a really great teacher, someone who's a really great NIH funded researcher someone who really is a great clinician. Great with patients, great teacher, great researcher. I definitely grew up in that kind of medical culture where that's really what's praised.

Amanda Swain: Yeah and again, just speaking to what's fulfilling, right? There are probably people that are in academic medical centers that actually would rather be in a small practice somewhere not having anything to do with students or research, and that's okay too. So I think there's always this kind of conversation you have with yourself of, what am I expected to be? Or, what do I think I should be? What do I want to be? Who do I wanna be? And that can be hard to do when it feels like there's external pressures to be a certain thing. And I'm saying this also, talking about privilege, from the [00:24:00] perspective of someone that can work part-time. My husband works full-time, and we were able to sit down and say, I think I wanna work part-time, and let's give this a couple years and see how that goes. Can we still save for college? Can we still pay our mortgage? And we've been able to do that. And so that gives me a tremendous amount of flexibility that lots of people don't have. So it's all well and good to say, what do you need to feel fulfilled? But truthfully, most of us also need to make an adequate salary to afford the basics and raise children. So obviously that's a big part of this conversation. But again, it doesn't necessarily need to be, you change your entire career and throw everything up and see where the chips fall. It can also be making smaller decisions that honor what you [00:25:00] feel makes you a better physician and a better person, and finding ways to incorporate that in whatever piece you can into your life. 

Christine Ko: I love it. I think that's really important actually to be brutally honest with yourself. What do I really want? What do I have to do in the current job I have, if I don't want to quit or if I'm not able to quit because I need that income? What would really actually make me happy? I think that's very wise. Do you have any final thoughts?

Amanda Swain: I would say that it's always time well spent to think about what you find fulfilling and what gives you energy, and to try not to judge yourself for the answers to those questions because they may not have anything to do with your career, and that's okay. To be a [00:26:00] healthy physician, someone that can give to others, you need to figure out how to give yourself what you need. Whatever that looks like for you. And that can be hard to figure out. And I'm not sitting here saying, oh I've completed this process, and I'm this person to look up to that I've had all of this now figured out. No, of course not. However, I've at least been going through the steps of doing that and continue to do, and I do think it's time well spent. 

Christine Ko: I love it. Thank you so much for your honesty and the willingness to share with me and anyone listening in. Thank you so much. 

Amanda Swain: Oh, my pleasure. Thank you so much for having me, Christine.