TThe American health care system needs fiction because, as Albert Camus is said to have said, “Fiction is the lie through which we tell the truth.” And health care professionals—from hospital administrators to doctors and technicians—need to learn the real truth about health care.

For decades, a small group of doctors and nurses have been sharing behind-the-scenes insights into the work of a physician, recounting lives saved and lost, and showing how the profession has changed the way many people see the world. Nonfiction books by Jerome Groopman, Atul Gawande, Danielle Ofri, Theresa Brown, and others are rightly recognized as important insights into life as a clinician and what can be learned from patients at their most vulnerable times.

This publishing trend accelerated during and after the Covid-19 pandemic, when so many people working in the field faced unprecedented challenges and some doctors and nurses turned to reading to tell their stories and process their experiences. Walk into almost any bookstore today and it’s hard not to notice prominently displayed titles not only describing what happened in hospitals during the pandemic, but also an ever-expanding selection of books about what went wrong (spoiler alert: a lot).

Certainly there have been talented medical novelists, such as Michael Crichton, Abraham Verghese, Kimmery Martin, and Samuel Shem, to name a few. But as masterful as their stories were, they have generally avoided directly engaging with the systemic problems of American medicine, leaving sections of this kind instead to their nonfiction colleagues.

I believe that fiction plays an important role in the medical world. With the latitude it offers, fiction allows a writer to explore healthcare issues without incurring the ire of those in the medical-industrial complex, many of whom have a vested interest in ensuring that nothing changes in the system that puts profit over purpose..

I wrote a memoir describing my career as an organ transplant specialist, the good and the bad, and the forces that eventually led me to abandon clinical medicine altogether. But for fear of offending the people and institutions where I worked (and yes, the ever-present fear of being sued), I tiptoed around some of the more sensitive topics, coming as close as I could to telling the whole story, but perhaps never quite doing so. Instead, I scratched the surface, circling my prey but never actually going in for the kill.

So I decided to write a novel, throw off the shackles and put the whole mess on paper. Although it’s not entirely surprising, my protagonist is an arrogant surgeon working in a flawed hospital environment. I expose his shortcomings and those of his partners and hospital administration (the phrase “write what you know” is a cliche for a reason). Through my main character and those she works with, I wander around the hospital, making comments along the way about our healthcare system, which isn’t a system at all, but a fragmented collection of profit centers. I was able to reveal in inglorious detail situations that actually occurred in hospitals, with only the names and locations changed to protect the not-so-innocent. It was fun!

But fiction is more than just a source of amusement. It can reveal the truth, and there is no area of ​​society where Americans need the truth more than about how the American health care system works. No doubt some of that truth can be conveyed through nonfiction. But nonfiction books about the health care crisis, especially the more academic ones, have not solved the problem, not even close.

I am as optimistic about the impact of work like this as I am about position papers and 15-point plans that claim to have a plan to fix the health care system. I would even go so far as to say that the impact of these well-intentioned treatises will be minimal, given how amorphous the US health care system is and how dysfunctional its political environment is. The cost of health care is too high to get people and institutions out of their trenches.

Here’s a fact to consider: America’s health care system is a $4.5 trillion industry (and growing), about the size of the entire gross national product of Italy. Health care spending accounts for 17 percent of the gross national product (the entire defense industry accounts for 3.4 percent) and an even larger part of our national conscience. Research data and detailed analysis can tell us what’s wrong with our health care system, but only stories can tell us what impact those deficiencies have on people.

It would be foolish to claim that medical fiction can rescue us from the soullessness of the American health care system, but stories can help expose its failings.

Harriet Beecher Stowe’s Uncle Tom’s Cabin exposed the dehumanizing injustices of slavery. John Steinbeck’s The Grapes of Wrath vividly portrayed the extreme hardships of the Dust Bowl. Tim O’Brien’s stories in The Things They Carried brought the horrors of the Vietnam War to life. Samuel Shem’s The House of God was in many ways a parody of the medical education system, but it also brought to light many of the ethical dilemmas that young doctors face during their training.

No great social movement ever arises from the top down; change almost always comes from the bottom up, fueling movements that can be inspired by great storytelling. Addressing the inadequacies of American health care requires moving beyond the claim that health care is broken—that much is clear to anyone who has interacted with the system, and no additional arguments, even if well researched and presented, are likely to lead to meaningful change. The best hope may be to do what people have always done, since prehistoric times: tell stories that influence hearts and minds, stir emotions, and motivate actions that lead to real progress.

Medicine desperately needs this kind of change, and we should tackle the problem as if our lives depended on it. Because it does.

David Weill, MD, is the former director of the Center for Advanced Lung Disease and Lung Transplant Program at Stanford University Medical Center and author of the 2021 memoir Exhale: Hope, Healing, and A Life in Transplant and a novel “All that really matters” (Rare Bird Books, June 2024).