What's the point of reflective writing?

I was recently drawn into a friendly debate on Twitter about the value of reflective writing for doctors. In the United Kingdom, all doctors are now required to record written reflections on their learning, as part of their annual appraisals. For general practitioners (GPs) these reflections have to cover a wide range of their experience during the past year. This includes clinical cases, feedback from peers and patients, quality improvement, and any complaints or significant untoward events that may have occurred. Some doctors find this arduous, and question whether it has ever improved anyone’s performance as a doctor. Others, including myself, enjoy the act of writing and find it a useful way of processing complex events or seeing them in a more objective light. However, I do have some sympathy with the sceptics. Most doctors have never had any training in reflective writing. Colleagues who carry out appraisals are unlikely to have been taught how to read such reflections critically, to judge their quality, or to make the exercise a fruitful one. As a result, the experience can be dismal, and may make it seem as if reflective writing is another pointless demand placed on busy clinicians by bureaucrats and academics with nothing better to do. In spite of this, I think there are several reasons why we should welcome the appearance of reflective writing on the medical scene. In the past, being literate was regarded as an essential part of being a professional. Doctors had to write extended essays to pass any exam, and medical teachers took it for granted that there was an inseparable link between clear writing and logical thinking. This tradition has largely died out, but there has been a general deterioration in medical literacy as a result. Compare, for example, the opening sentences from these two articles, written in 1925 and 2013 respectively, on similar subjects. ‘Vertigo may be quite briefly defined as a subjective sensation of instability. It is a departure from the normal sense of equilibrium, which in health is hardly perceptible, though it plays a part in the general sense of well-being’. ‘Tinnitus is the perceived sensation of sound in the absence of a corresponding external acoustic stimulus. Unlike auditory hallucinations, which are phantom phenomena that occur mainly in people with mental disorders and manifest as the perception of voices and musical hallucinations, in which instrumental music or sound is perceived, tinnitus sensations are usually of an unformed acoustic nature such as a buzzing, hissing, or ringing’. As you will have noticed, the earlier article is a model of clear communication, with short words and short sentences, and has a rather human feel to it. By contrast, the more recent one is an abstract, polysyllabic muddle, and hard to follow without reading it twice—typical of much medical prose nowadays.