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Sharing Medicine
August 21, 2017

Sharing and Healing Through Storytelling in Medicine

Author Affiliations
  • 1Internal Medicine Residency Program, Department of Medicine, University of California, San Francisco
JAMA Intern Med. Published online August 21, 2017. doi:10.1001/jamainternmed.2017.2996

In January 2016, a small audience in San Francisco listened to physicians tell stories about life in medicine. One physician described how her perspective on end-of-life care changed after receiving a few words of advice from her mentor. Another explained how the demands of residency training damaged a treasured friendship. A third physician spoke about a chance encounter on the street with a patient who was homeless. No presentation was rehearsed, and the crowd’s reaction shifted easily between laughter and silence. A year later this program, named “The Nocturnists,” attracted enough interest to fill a theater of 250 listeners, and to draw speakers from many health care disciplines from across the San Francisco Bay Area.1

Widespread enthusiasm for programs similar to The Nocturnists may reflect a latent hunger for health care narratives within the medical community. Physicians are burdened by an increasingly automated health care system: tethered to their computers, saddled with menial digital tasks, and expected to interpret notes organized in a template and often devoid of real meaning. Faced with high turnover and difficult time constraints, physicians rush through their daily encounters and spend less contact time with both patients and colleagues. Many have argued that stories in medicine are getting lost,2 which may be a problem that reduces the quality of patient care and contributes to physician depression and burnout.

Storytelling is medicine’s currency. A patient describes his symptoms using a narrative: “Doctor, my legs are so swollen that I can barely walk to the bus stop.” The physician translates the story into a form of medical language and communicates it to colleagues after stripping away the extraneous information: “This is a 53-year-old woman with heart failure and reduced ejection fraction.” Physicians tend not to insert themselves into their patients’ narratives. Medical notes are typically penned in the passive voice, “The decision was made to start antibiotics” as opposed to the active voice, “I decided to start antibiotics.”

Events like The Nocturnists celebrate a different type of storytelling; one that puts the storyteller at the center, promotes an expansive rather than reductive approach, and rewards texture, openness, doubt, and humor. Physicians witness and alleviate suffering; storytelling can be an activity of self-care. This process is especially important for trainees who work up to a 28-hour period and expend immense physical, emotional, and intellectual energy. In this stressful environment, telling and listening to stories reminds us of the deep meaning present in the healing arts and generates a much-needed catharsis for the individual. As Henry Miller, the 20th-century American writer, observed, “Along the way one discovers that what one has to tell is not nearly so important as the telling itself.”3

Storytelling is not just an act of self-healing; it may actually create better physicians. Storytelling reinvigorates interest in patient experiences and reminds us to take a holistic approach to care. Properly telling a story can help explain complicated medical concepts to patients and families. For example, metaphors such as, “Your cancer behaves like a weed in a garden,” are increasingly recognized as an important tool for effective communication.4,5 Stories can be used when disseminating data to other clinicians. Investigators in a recent study showed that using a narrative hook improves retention and adaptation of new practice guidelines.6 Stories can be used to more effectively transmit health data to our patients.7 One study group reported that a hybrid message to college students containing both data-driven and narrative descriptions of human papillomavirus resulted in a greater perceived risk of getting human papillomavirus than a message containing data or narrative descriptions alone.8

Including nurses, therapists, social workers, hospital administrators, and other health care workers in storytelling events helps to view the health care landscape through different lenses to better understand our colleagues’ points of view. Hundreds of health care organizations in the United States and abroad have launched Schwartz Center Rounds. This team of physicians and others involved in patient care, led by a trained facilitator in a formal session, discuss the human aspects of a difficult medical case in a confidential and safe environment. This event, named after Kenneth Schwartz, a Boston health care attorney who died in 1995, allows the group to enhance communication skills, reduce stress, and improve teamwork.9

Storytelling events may include people who work outside the medical field. Although the experience of illness is deeply personal, people who are not exposed to the health care environment may feel alienated by the complex hospital campus, the medical staff wearing white coats, and the confusing medical jargon. Hearing physician stories may demystify certain aspects of medicine for the general public. Compelling medical narratives may be a potent tool for health care advocacy since health care workers can share unique and important perspectives on issues, such as health insurance, opiate prescribing, and gun violence. For example, the Cradle to Grave program at Temple University Hospital in Philadelphia, Pennsylvania, uses narrative to educate youth about the physical and emotional realities of gun violence.10

One cannot underestimate the value of bringing people together away from the sterile clinical environment. The sensory and social experience of attending a storytelling event can boost morale, build community, and renew a sense of purpose. The crowd contributes toward promoting wellness for patients and ourselves.

Some individuals in the medical community feel uneasy about physician storytelling because it raises concerns about violation of patient confidentiality. Personal medical narratives are powerful and can be harmful if they are used irresponsibly. Physicians should use good judgment and obtain written permission from any identifiable individual, or their details should be changed or omitted when necessary. The degree of narrative fictionalization can be disclosed depending on when and how the story is disseminated. Some people also believe that it is unprofessional for physicians to be emotionally vulnerable in front of colleagues. The greater risk, however, is for the health care professional to appear superhuman by pretending to not feel grief, suffer from moral distress, laugh at work, or need rest. These emotions should be explored, not concealed. The focus has often been to humanize the patient. In this environment of physician burnout, storytelling may actually help to humanize the physician.

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Article Information

Corresponding Author: Emily Silverman, MD, Department of Internal Medicine, University of California, San Francisco, 1903 Golden Gate Ave, San Francisco, CA 94115 (emily.silverman@ucsf.edu).

Published Online: August 21, 2017. doi:10.1001/jamainternmed.2017.2996

Conflict of Interest Disclosures: Dr Silverman is the founder of the The Nocturnists, which receives financial support from the Social Good Fund. Events are funded by ticket sales and donations.

References
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