Customize your JAMA Network experience by selecting one or more topics from the list below.
Bishop JP. Residents and Patients: Telling Stories to Cope With Stress. JAMA. 1998;280(22):1960E. doi:10.1001/jama.280.22.1960
Edited by Ashish Bajaj, Department of Resident Physician Services,
American Medical Association.
All residents have a story about a patient situation that got under
their skin. Mine occurred at 4 AM when I was the resident in
charge of medicine in the emergency department (ED). I had patients in
all three of our cardiac booths, a psychotic patient waiting to have
medical causes ruled out, and six of our nine monitor beds occupied by
patients with chest pain, congestive heart failure, and drug overdoses.
A young woman came into the ED hyperventilating; she was certain she
was dying because she had carpal-pedal spasms. I put her in our
nonurgent waiting area. After about an hour, her boyfriend, who I
learned had induced the hyperventilation during a heated argument, came
to me asking why his girlfriend had not yet been seen. I replied that I
was taking care of the critically ill patients first. He then informed
me that his girlfriend was critically ill and threatened me with
battery if I did not see her soon. I had security guards escort him to
When residents and other physicians gather, we share these "war"
stories. The stories do not just convey medical information; they help
us develop camaraderie and build community because we use stories to
relay our feelings. Most people outside the medical profession cannot
understand our stories; they lack the context to understand how we must
continually balance the work of treating patients with compassion. They
do not see the humor that sometimes accompanies the trauma of our work
and are frequently shocked by our cavalier attitudes. They cannot fully
understand the semidelusional, sleep-deprived state that residency
induces. So we share our stories with each other, drawing energy and
comfort from the fact that someone else understands their gory
details and can empathize with the stress of patient
Stories have always revealed the values of a community. Ancient epics
such as the Iliad, the Odyssey, and the
Aeneid conveyed what their societies held most sacred. Our
stories take on the same importance and can serve as therapy cloaked in
narrative garments. When a colleague shares a case with you, your
colleague is attempting to convey his or her interpretation of a
situation. If you listen carefully, you might hear about more than just
a medical condition. You will probably glimpse a new understanding of
the human condition. Stories can build bridges that link us together in
the humanistic endeavor of medicine.
While such informal sharing is therapeutic and reaffirming,
storytelling can often take on a negative aspect. The downside is that
we have no one to challenge us to look at the other side of the
story—the patient's side. Left unexamined, our stories can lead to
stereotypes; they can also become empty rhetoric used to maintain an
unhealthy distance between patient and physician and create a "them
and us" dichotomy. Unexamined stories become little more than urban
legends that serve to make us laugh, but scarcely uphold what we ought
to hold as sacred.
Stories are powerful and they must be told; it is healthy and
therapeutic to hear the community-building stories that convey the
values of the medical community. However, we must become literary
critics with the ability to discriminate the sacred story from the
rhetorical legends. In the short-term, such legends may lighten our
loads and provide humor, but in the long-term they do violence to the
sacred relationship we share with our patients.
Create a personal account or sign in to: