Book Review: Letter to a Young Female Physician

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Letter to a Young Female Physician: Notes from a Medical Life

By Suzanne Koven

W. W. Norton & Company, 320 pages

Sometimes you pick up a book that seems to be written not just for you—a young female physician—but for you in this very moment in time: halfway through residency, balancing motherhood and career, feeling like the rest of my career hinges on what I decide now, and struck with frequent imposter syndrome. 

At this training crossroads, I devoured Dr. Suzanne Koven’s memoir, Letter to a Young Female Physician, in a matter of days. Dr Koven is a primary care physician at Massachusetts General Hospital (MGH) and the writer-in-residence at MGH’s Department of Internal Medicine. This is an inaugural position that was created for her, and the existence of such a job piqued my curiosity such that I had already interviewed her for a Doctors Who Create Profile in Creativity back in 2015. So when I picked up her memoir, I thought I had a good guess at the contents, but quickly realized there was depth and introspection that went far deeper than her essays and interviews.

Dr. Koven was inspired to write her memoir as a continuation of the titular essay, which she published in NEJM in 2017. In that essay, which has since been widely shared, she writes openly about combating imposter syndrome. “I’ve been haunted at every step of my career by the fear that I am a fraud,” she writes. In this book, which starts with that essay, she then delves deeper into her experiences as a female physician, and her evolution as one. From the beginning, she starts with the personal— her experience watching her father work in orthopedics, her relationship with her mom, and her feelings of inadequacy. She gives herself the nickname “Curvy Curly.” It is a joking name she calls herself, but it also places her squarely as the unique, assertive, unabashed protagonist in her own life: someone who cannot be anything other than herself, as much as she may try. It alludes to the overarching theme of her book, which is that there is no specific answer to many of the quandaries of a medical career, but there is much that storytelling and presence can do. For example, Dr. Koven describes starting a job as a new attending physician and inheriting a panel of patients. One patient, who she has yet to meet, is admitted to the hospital, and Dr. Koven gets a notification. It is nighttime, and Dr. Koven is at home. She’s not sure it’s going to make a big difference, medically, if she goes to visit this patient. She doesn’t have to visit the patient. The patient has an inpatient medical team. But finally, after deliberating, Dr. Koven decides to go to the hospital from home, in the middle of the night, and see her patient. She sits at the bedside and they have a conversation. She isn’t sure whether the patient will even remember her visit during the chaos of an inpatient stay. But that established a trusting relationship—years later, she found out that the patient did indeed remember and appreciate her showing up that night. The story made me think of many of the most important decisions we make in medicine—not the decisions that we are obligated to make or taught to make, but the ones we choose to.

Dr. Koven jokes that she went into medicine because she couldn’t hack it as a writer, but what is remarkable is how her writing career blossomed when she took an MFA course in her 50s. She describes how writing opens her to a new side of her career, one that is increasingly recognized in the field of medicine. Through writing, she is able to make sense of medicine and its unique culture and interpersonal relationships.

As a physician-writer, Dr. Koven does not shy away from personal content. In one chapter, she describes seeking out therapy; in another, she details the stress and emotional rollercoaster of having a child with an illness. She spends many chapters unraveling her complicated and close relationship with her mother, including her feelings of guilt as a physician-caregiver at the end of her mother’s life. Dr. Koven reveals many unique dichotomies of a medical career. For example, wanting to control the care of your loved one while also trying to fulfill the role of daughter or mother. Or, wanting to please your patients while realizing that they might not like you and that’s okay. And, as a female physician, recognizing in retrospect the gender bias she faced, and reframing her presence as not an aberrance, but as an important asset.

I imagine that this is a book I could return to at many points in my career, and it would reveal to me different truths. Dr. Koven centers storytelling in her practice and her work, and I certainly felt that in reading her book. I am reminded of the power of narrative, which is like a buoy in the ocean of medical training, bringing me up to see the horizon.