"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
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.
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