An extract of Narrative Medicine: Harnessing the Power of Storytelling Through Essays.
I work for an organization that manages the medical and mental health needs of seriously ill and persistently ill children and adults. Typical diagnoses in the population I serve include intellectual/developmental disorders, autism spectrum disorders, disruptive mood dysregulation disorders, bipolar disorders, schizophrenia, substance use disorders, and many other conditions that impact mood, cognition, reality testing, driving, and impulse control.
Much of my time as a consulting physician involves listening to patient stories and determining whether their services are medically necessary and beneficial. Are their medications the right ones? Is their mental health care coordinated with their physical health care? Should they be hospitalized, or would a less intensive level of care be just as effective – for example, a residential treatment center, assisted living facility, or possibly a group home? Do they have a support system to prevent relapse and hospital readmission?
The teams I work with understand that I want to hear clinical information in story form. I want to hear about the patient as if they are the story: their problems, their current and past treatment, their personal and family history, their successes and failures. What treatment was helpful or not? Who are they angry with? Why are they desperate and discouraged? Who abused them and what was the nature of this abuse? What do their “voices” tell them? How did they become homeless?
Sometimes, instead of being told a story, I listen to a team member read verbatim from the patient's medical record. The person telling the story is one of the company's usage managers. The story is an accumulation of facts, an austere account of the patient's progress notes. There are many time shifts in the story and the timeline of events is confusing. It's up to me to try to piece together the puzzle, to understand the patient's story. Usually the best I can do is speculate about missing vital information, and I'm left with an incomplete story.
It is difficult to make the best recommendations when the presentation – the patient's story – rests on a foundation of inadequate information. It's like trying to decipher a telephone conversation with intermittent dropouts, or playing the piano with faded or partially stained sheet music. I can't read music. Notes (or phone contents) must be interpolated. The problem is that in medicine, crucial decisions should not be based on guesswork.
When I hear a patient's story that is incomplete or missing certain details, I often tell a story in response. The story brings up all kinds of hypothetical scenarios based on my practice days, for example, if the patient did not improve with “X”, I would recommend “Y”, or, if he did not have any trial with drug A, I would consider running them on that, and so on. I really enjoy telling stories, and our team rounds have become a source of pleasure for me and other team members, enriched by the stories of patients and sometimes those we tell about ourselves.
There are differences between telling a story and hearing one, although both are beneficial in different ways. The act of telling a story can be a form of catharsis, allowing patients to express their feelings, experiences, fears or hopes. This can be especially therapeutic for people who have had traumatic experiences or those who are suffering from emotional distress. Storytelling can help patients make sense of their experiences, gain perspective, and find meaning in their story. It can also boost their self-esteem and confidence when articulating their own stories.
On the other hand, listening to a story can provide comfort, inspiration, or insight. This can help patients feel understood and less alone in their experiences. Hearing a story can foster empathy because listeners put themselves in the storyteller's shoes. It can also provide learning opportunities, as individuals benefit from the experiences and perspectives of others.
In the context of narrative medicine, telling and hearing stories is crucial. Healthcare providers listen to patients' stories to better understand their experiences and perspectives, which can inform their approach to care. At the same time, patients who tell their stories can feel empowered and heard, contributing to their healing process.
The phrase “stories heard and stories told” emphasizes the reciprocal nature of storytelling. We both consume and contribute to the rich tapestry of narratives that shape our lives and connect us to each other, regardless of the context in which they unfold. Whether we're listening to someone else's story or sharing our own, storytelling is a fundamental part of human communication, culture, and connection.
Arthur Lazarus is an old Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership and assistant professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania. He is the author of several works on narrative medicine, including Medicine on Fire: a travelogue And Narrative Medicine: Harnessing the Power of Storytelling Through Essays.