Storytelling
is a two-way street. Illnesses unfold as stories, and physicians need to learn
how to listen to those stories. The same is true of giving advice, for if good
advice is given in the wrong way, the patient will not follow it.
04/09/2012 02:35pm
EDT | Updated June 9, 2012
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"To be a person is to have a story to tell. -- Isak Dinesen
I love telling
stories when I give a lecture, visit with my patients, or lunch with my
colleagues. However, over the years, many of the best stories have come from my
patients -- sometimes in a moment of crisis, and other times during a routine
office visit.
I have a clear memory
of the elderly Scandinavian ship captain who sported a huge white beard and
filled me with tales of his life at sea. I always asked my office to block out
twice the usual amount of time so I could get a double dose of his spellbinding
stories. Equally foreign, but just as enlightening, were the stories of the
immigrant woman who, despite blinding migraine headaches, worked two jobs so
that she could assure that all four of her children received an education.
Their stories provided the fabric and context that taught me more about these
people as individuals, as opposed to just the person in exam room number three.
Last week, I took my
95-year-old mother to the doctor. The young medical assistant, dressed in jeans
and a T-shirt, sat with his back to us as he asked his rapid-fire questions and
typed the answers into the required electronic medical record. We might as well
have been answering a robot, for when he was done, he knew no more about my
mother than when we first sat down. The printer spit out a lengthy description
of all the things that she did not have, but it no more described who she is
than the five previous patients he entered into his "clinical
station."
If we cannot stop the
implementation of the electronic medical record (EMR), there
must still be a way to acquire the rich stories that our patients have to tell
and assemble a complete picture of our patients as people.
Equally challenging
is educating our patients about their illnesses and being certain that they
understand our instructions. As we careen into the digital age, the fistful of
pamphlets that we stuff into our patients' hands will be as ineffective in the
future as they have been in the past. Storytelling, in its various forms, may
be one way to connect more meaningfully with our patients, to both help us get
to know them individually and help them understand their physical condition.
The Storytelling
Tradition
The use of
storytelling goes back to pre-literate societies and ancient cultures, who used
it as a means to convey their history and traditions. Many cultures would
identify specific individuals to adopt the role of tale-teller. The information
was passed along via performance before a live audience, and the performer
would adapt, change, and embellish the information to meet the needs of the
specific audience.
Stories based in
truth have a greater impact, and people are more likely to remember the
information when it is related in the form of a story. The practice of medicine
is filled with stories, but they are widely under-appreciated. Health care
professionals usually relay stories to their patients in a flat, staccato, and
detached manner. Health care providers complicate the problem by using complex
language that the patient and their family may not comprehend. Patients are
more likely to remember a story than a listing of individual facts.
An article that looks
at storytelling in health care gives us examples of why storytelling is an effective tool.
It tells us that stories:
•
Are
mentally richer than simple instructions
•
Engage
and involve the patient
•
Trigger
empathy
•
Are
more likely to be remembered and retold
•
Promote
a two-way conversation
•
Transfer
knowledge
Healing Stories
Storytelling is a
two-way street. Illnesses unfold as stories, and physicians need to learn how
to listen to those stories. The same is true of giving advice, for if good
advice is given in the wrong way, the patient will not follow it. Stories are a
powerful part of support groups and peer visits. I can tell a patient why they
feel so ill and what the future holds for them, but having someone who has
walked in their shoes come visit them in the hospital is much more powerful.
They will believe the story of someone who has shared their same experience.
In 2011, a study published in the Annals of Internal
Medicine evaluated whether storytelling could improve the
blood pressure of people with hypertension. The study divided 299
African-Americans who suffered from high blood pressure into two groups. The first
group watched peers who also suffered from hypertension tell stories that
described their experiences with hypertension, lessons learned on how to
interact with physicians, and strategies to increase medication adherence. The
second group watched health-related topics not related to hypertension. The
group that watched stories related by peers who shared their problem were more
successful in lowering their blood pressure than the other half. A story told
by a friend or peer is most effective in creating a lasting memory.
Storytelling has been
one of the keys to the highly-successful book series Chicken
Soup for the Soul. It encourages people to submit their own
stories and compiles them into a single book to help people cope with specific
issues like grief, stress, or spiritual matters. This well-known brand has
recognized the power of narrative in health and has formed a partnership
with Harvard Health Publications to take
storytelling and health to the next level. They are introducing a new series of
books that will combine the latest medical advice with real stories from real
people to help their readers live healthier lives.
Over the years, I
have eaten chicken soup with kneidlach (dumplings) made by my grandma, mother
and wife -- first only at holidays, then at times when I had a bad cold. Now I
can order up a serving of Chicken Soup for my patients that
they can digest slowly in book form and not just for a cold. It may be time for
storytelling to take a more prominent role in how we treat our patients. Take a
moment to tell us how stories have helped you.
For more by Richard
C. Senelick, M.D., click here.
For more on health
care, click here.
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