1. Jerald Winakur, MD, MACP, CMD
ADVOCATING FOR GERIATRIC CARE, RESEARCH AND EDUCATION A Public Medical Communications Workshop For Health Professionals AMERICAN GERIATRICS SOCIETY ANNUAL SESSION “DAD’S” LEGACY: ADVOCATING FOR POLICY CHANGE THROUGH NARRATIVE--Part I
Jerald Winakur, MD, MACP, CMD
Clinical Professor of Medicine
Associate Faculty,
Center for Medical Humanities and Ethics, UTHSCSA

2. with Dorothy

3. Dad and me, 1949

4. Father and Son, 2005

5. Fishing Eastern Bay 1970

6. Health Affairs What Are We Going To Do With Dad?

8. In the eighteen years that Project HOPE has published Health Affairs, America’s medical care system and the making of health policy have become big business. But the voices of patients, their families, and their caregivers have often, and their caregivers have often gotten lost in the relentless shuffle… (We) have come to believe that we could enrich the journal by nurturing a form of health policy writing that affords greater opportunity for new voices to contribute to future debates. (Iglehart, John, HA, July, 1999.)

9. What Are We Going to Do With Dad – Wash Post

10. With Lydia, 2010

11. “…the subjective characteristics of the personal essay are not prominent values in the science of today, nor are they part of the growing efforts in the field of health policy to make decisions based on quantitative measures…yet…the report of life events from an unabashedly subjective vantage point—remains a powerful tool for focusing the human mind.”
--F. Mullan

12. ‘The plural of anecdote is policy.’
--F. Mullan quoting Dan Fox, historian and health policy commentator

13. “Stories can enable lawmakers to understand a legitimate need for policy change but can, just as readily, lead them to make bad policy decisions…One compelling anecdote (true or false) at a crucial moment in a floor debate can vaporize a mountain of data and careful policy analysis.”
--J. McDonough quoting former Minnesota state legislator Lee Greenfield]

14. “Perhaps the real power of stories lies in their reflection of ideas and values…Much of the policy process involves debates about values masquerading as debates about facts and data.”
--J. McDonough

15. “Red herrings are unacceptable.”
“How do you know that?”
A story needs to be true and presented in a context that does not distort its relevance to the policy choice at hand.
“Red herrings are unacceptable.”
--J.McDonough

16. Dad and Me Baltimore, 1961

17. Jerald Winakur, MD, MACP, CMD
ADVOCATING FOR GERIATRIC CARE, RESEARCH AND EDUCATION A Public Medical Communications Workshop For Health Professionals AMERICAN GERIATRICS SOCIETY ANNUAL SESSION “DAD’S” LEGACY: ADVOCATING FOR POLICY CHANGE THROUGH NARRATIVE--Part II
Jerald Winakur, MD, MACP, CMD
Clinical Professor of Medicine
Associate Faculty,
Center for Medical Humanities and Ethics, UTHSCSA

18. A FEW HEALTH POLICY JOURNALS
--Health Affairs
--Milbank Quarterly
--Alzheimer’s and Dementia
--Health Policy and Planning
--Medical Care Research and Review
--Health Services Research
--Implementation Science
--Health Policy
--Health Education & Behavior
--Academic Medicine

19. FROM THE HEALTH AFFAIRS/NARRATIVE MATTERS WEBSITE (www. healthaffairs
FROM THE HEALTH AFFAIRS/NARRATIVE MATTERS WEBSITE (
What We're Looking For
Narrative Matters features personal stories about experiences with the health care system and the people in it using the power of literary nonfiction to highlight an important public policy issue. We’re interested in well-written policy narratives, told as first-person stories, that explore problems and concerns with health care delivery, roles of providers or patients, need for research, system redesign, and changes in public policy.  Successful submissions will provide a unique perspective and reveal how the author’s thinking evolved over time.  The best way to see the types of manuscripts we'd like to receive is to read published Narrative Matters essays, found on the essay archive.

20. Manuscripts should:
Exhibit the best qualities of literary nonfiction with attention to detail, dialogue, scene, and story arc with a distinct beginning, middle, and resolution told in compelling way.
Be a unique story or perspective written in the first person with an insider’s view.
Reveal the author’s evolution in thinking about a health policy issue on the basis of a personal health care experience.
Be 2,500 words or less.
Use a minimum of medical, technical, or academic language (and no jargon).
Be previously unpublished.
Not be a case study, illness narrative, editorial, op-ed, or commentary.
Have no academic citations or endnotes (a separate list of references is required); no tables or figures

21. The Art of the Personal Essay

22. “The formal essay is characterized by ‘seriousness of purpose, dignity, logical organization, length…the technique of the formal essay is now practically identical with that of all factual or theoretical prose writing in which literary effect is secondary to serious purpose.”
--P. Lopate

23. “The struggle for honesty is central to the ethos of the personal essay…So often, the ‘plot’ of a personal essay , its drama, its suspense, consists in watching how far the essayist can drop past his or her psychic defenses toward deeper levels of honesty…If the essayist stays at the same flat level of self-disclosure and understanding throughout, the piece may be pleasantly smooth, but it will not awaken that shiver of self- recognition…which all lovers of the personal essay await as a reward.”
--P. Lopate

24. “Some vulnerability is essential to the personal essay
“Some vulnerability is essential to the personal essay. Unproblematically self-assured, self-contained, self-satisfied types will not make good essayists.”
--P. Lopate

25. “Personal essayists are adept at interrogating their ignorance
“Personal essayists are adept at interrogating their ignorance. Just as often as they tell us what they know, they ask at the beginning of an exploration of a problem what it is they don’t know—and why. They follow the clue of their ignorance through the maze.”
--P. Lopate

26. “The enemy of the personal essay is self-righteousness, not just because it is tiresome and ugly in itself, but because it slows down the dialectic of self-questioning…”
--P. Lopate

27. “An (important) formal technique…is the movement from individual to universal.”
--P. Lopate

28. ON WHICH TO JUDGE AN ESSAY
DOMAINS
ON WHICH TO JUDGE AN ESSAY
--Readability/Story Arc/Engaging
--Honesty
--Factuality
--Policy Relevance apparent or not?

29. YOUR PRESENTATION: DOMAINS: --Readability/Story Arc/Engaging --Honesty
State your name a quick bio
Give the name of the essay you read
Name the author of the piece and the author’s bio
Briefly summarize what the thrust of the essay is about
Using these Domains and/or quotes you have taken from the essay judge the success or failure of this policy narrative. How might it be improved?
DOMAINS:
 --Readability/Story Arc/Engaging
--Honesty
--Factuality
--Policy Relevance apparent or not?

30. “A Room With A Grim View: The ‘Ambient Despair’ That Marks Life in Assisted Living”by
Martin Bayne
Health Affairs, July 2012

31. How I Fought To Stop Medical Errors From Killing My Mom”
“As She Lay Dying:
How I Fought To Stop Medical Errors From Killing My Mom” by
Jonathan Welch
Health Affairs, December 2012

32. “Surrendering the Keys:
A Doctor Tries To Get An Impaired Elderly Patient To Stop Driving” by
Anna Reisman
Health Affairs, Feb. 2011

33. Jerald Winakur, MD, MACP, CMD
ADVOCATING FOR GERIATRIC CARE, RESEARCH AND EDUCATION A Public Medical Communications Workshop For Health Professionals AMERICAN GERIATRICS SOCIETY ANNUAL SESSION “DAD’S” LEGACY: ADVOCATING FOR POLICY CHANGE THROUGH NARRATIVE--Part III
Jerald Winakur, MD, MACP, CMD
Clinical Professor of Medicine
Associate Faculty,
Center for Medical Humanities and Ethics, UTHSCSA

34. “I Want To Put Rich People To Sleep”
TITLE:
“I Want To Put Rich People To Sleep”

35. AUDIENCE
BACKGROUND
PURPOSE
METHODS—See Examples
SOURCES
EXAMPLES
VOICE
PITFALLS
POLICY IMPLICATIONS

36. A primary care doctor who just gave up his practice:
“Primary care physicians, in general have been constantly reliving trauma after trauma for many years that appears to be beyond our control…primary care has become (a) victim in its search for acceptance in our health care system.”
(Chen, M. NOSHChartingSystems Blog, Primary Care Has Lost its Self-Esteem, 4/23/13)

37. An early-career general internist struggling with her professional life:
“…Sometimes I awaken in the middle of the night thinking about my patients: Have I done all I can do? Am I doing the right thing?...When can I stop being at work and start just being?...To find the “me” in medicine, we must embark upon a paradigm shift. We must become the generation of physicians that says it is okay to be an outpatient physician who leaves the hospital admissions to the hospitalists. There will always be patients. There will always be illness…”
(Wiesenthal, A., “Work-Life Balance: Where Does Being A Doctor End And Me Begin?” American College of Physicians Texas Chapter Newsletter, Summer, )

38. A geriatrician who just traded a stressed life in an outpatient clinic and
“relaunched (her)self as a direct-pay solo micropractice offering house calls and geriatric consultative care.” She charges an hourly rate and does not take Medicare and only sees patients who have a primary care doctor .
(Kernisan, L., “Reimagining Geriatrics,” Over65 blog, 4/25/13)

39. Caring For the Ages