Storytelling in medicine

Every day, I listen. Listen to strangers tell their stories. Usually one of woe, with medical problems and uncomfortable symptoms, fears and dis-ease. Of course, before the COVID era, I would see and touch and interact with this person. Now, it is more like reading a book, an audiobook, an interactive audiovisual textbook—one where you contribute to a chapter, then sign off as they continue their onward journey. Many times, you can influence the course of that journey. Maritime analogies seem to come to mind: As a tugboat captain you can pull stranded ships off rocks in high seas; or maybe you are the pilot, helping navigate unfamiliar waters; or the boat-builder, fitting a new mast and keel. Many have written about the important role of storytelling in medicine, much better than I can. We are all listeners, information gatherers, processors, and do-ers. We establish a connection, extract meaningful data, and formulate a problem set. With the tools we have, we propose a solution and fix the issue at hand. And we move on. To be efficient, we have to be more digital than analogue, more discrete than continuous. We cannot bathe in the torrent of patient experience, relive their life events, and understand the foundation of their anxieties. We have our work to do. Usually, 45 minutes is barely long enough to get the basics. And then there are those of us who DO something, physically, that brings a different type of intimacy. Many years ago, I was an intensivist and enjoyed inserting central lines and chest tubes, intubation and ventilation, floating pacemakers and shocking rhythms. Hands-on stuff. Big interventions for big stakes: many times, I won big too. This was “search & rescue” stuff. But I was sidelined in that career by administrative bureaucracy, and I moved on to in-patient, and then out-patient, care. I still enjoy every patient interaction, although these days I need every bit of “spider-sense” to dodge the pitfalls of telemedicine. This week, I spoke with a patient with a history of heart surgery—who had ADHD. His thought processes were fragmented, and he clearly struggled to represent his view of reality. His family member was his “interpreter” and his rock. I was honoured and privileged to be part of his storyboard and was reminded that this is an opportunity we don’t take on lightly. “There but for the grace of God, go I.” I was reminded how fortunate I have been to enjoy good health and a stable living environment most of my life. Then the senior with severe aortic stenosis (oh, dear, there I go again, labelling people by their diagnosis) came on the line. In plain speech, I painted a future of cardiovascular decline, which was eminently fixable with transcatheter aortic valve replacement. I found it difficult to understand his procrastination. He said, “Let me move to a different room,” and there was a pause. He came back to say, “My wife has rapidly progressive dementia, and I am her only caregiver. My kids live far away, and I see my future just with her.” I realized the complexity of his situation was huge. I was trying to sell an operation to this asymptomatic man, pointing out that his future well-being was key to looking after his wife. He said he would “think about it.” I believe recognizing what you are NOT hearing or seeing is just as important, and often key to success. Yes, the attending can summarize a patient’s problem in 15 words, when the medical student wrote three pages. But the next step is to recognize, understand, and value the human experience that brought you two together. I have lots of “small world” stories, where two ships meet on the high seas, then move on. These stories are sometimes unbelievable (I met a stranger who had been born in the same bed as me!). Well, this crew member may have had a remarkable past, a textbook of experience, and a library of achievement, and now YOU come along to help tow him off the sandbank. Unless you are invited on board, and meet his family, and see life through his eyes, you are but a momentary blip in his journey through life. Maybe the best perspective is: “How would you want to be treated if you were in their shoes?” Fix the rudder and sail on? Or help me understand the charts, predict the weather ahead, and trim the sails. Does the physician become part of the narrative or just a footnote? Stories are what people tell us. Or what we make of that conversation. Medicine, as a profession, is awash with stories. I write 10 consult letters a day: After 30 years, I have an extensive compendium. I wish I had kept a journal, but for now, memories will have to suffice. If I am older and wiser, it is because (a) time passes (b) patients taught me most of what I know. Don’t lose that spark of humanity to an EMR or a spreadsheet or a mediocre process. You are always able to do better. Sharing stories is part of that. Reading: 1. Storytelling in Medicine: The Passion and the Peril. Danielle Ofri. https://danielleofri.com/storytelling-in-medicine-the-passion-and-the-peril/ 2. The importance of storytelling for physicians. EM Collins. Indiana University School of Medicine. 9Aug2019 https://medicine.iu.edu/blogs/spirit-of-medicine/importance-of-storytelling-for-physicians. 3. Doctor as story-listener and storyteller. R Schwartz. Can Fam Physician. Aug2007. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949244/

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Storytelling in medicine

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Hector Baillie

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