Sunday, February 19, 2017

Storytelling in Medicine: Introduction

I'll be posting about politics soon enough, but I thought I'd introduce a new blog topic in which I'm not my usual ornery self.

Since the study of science is the most common route taken to a career in medicine, there’s a tendency among doctors to neglect, if not outright scoff at the arts and humanities. That’s a shame, and not only because an appreciation of history or philosophy might make you a better doctor. I’m in complete agreement with that notion, but as an opinion it can’t be definitively proven.

Instead, I think it’s worthwhile to talk about the benefits of the humanities in medicine—specifically crafting and sharing medical stories—independent of any effects the effort might have on your success as a doctor.   

Medical storytelling, or “narrative medicine” can be tricky to define, unless perhaps you start with what it isn’t. Narrative medicine isn’t case presentation, chart reviews, or Morbidity & Mortality rounds. The purpose of telling the story is not the correct clinical answer, nor to uncover what when right or wrong for the patient in question. Precise details are critical to M&M discussions, while no such requirements exist for medical narratives.


Narrative medicine isn’t genre writing like a Robin Cook or Michael Palmer medical thriller. Those books can be a fun read, but for the most part they’re wildly unrealistic, and the medical content plays second fiddle to the storytelling conventions of the genre and momentum of the plot.

Rather, narrative medicine is much like the ancient Greek myths: stories that are flexible, enduring, and offer any number of truths or insights beyond the immediate details at hand. They can be recorded in writing, or passed from person to person by word of mouth alone.

For example, I have a story that I’ve shared for over fifteen years, describing my first night of call on the Internal Medicine wards as an intern. My wife, also an intern on the Medicine wards, had given me handover on a patient with terminal lung fibrosis. The patient would have periodic spells of respiratory distress, spells that settled only after injecting of a few milligrams of morphine through his IV. When I was summoned to deal with the man’s distress later that evening, I ended up injecting just enough morphine to inadvertently settle his breathing for good. His family was grateful that their loved one would suffer no longer, and though I was shaken, I carried on with my night of call without further incident.


For years, I’ve employed the story primarily for its morbid humor, or to showcase the realities faced by a rather hapless intern, trapped in hospital apart from his significant other. While relating the story on a recent podcast, though, it dawned on me that the same story can also illustrate doctors’ collective discomfort with terminal disease, or spark a discussion around the limits of medical science and the role of physician-assisted death. It’s worth noting, though, that whatever the chosen thrust of the story, there are very few details required to keep its essence the same: the patient needn’t have been a man; the disease could just as easily have been emphysema or congestive heart failure; the other intern need not have been my wife; and the injected drug could have been any narcotic, or even a potent sedative. For the purposes of medical education or quality control or public policy, all those details matter, but in no way do they matter to the intangible value of the “story” itself. Still, it’s only in the telling of the story that we ask the questions—and hopefully find answers—that aren’t revealed in the nitty-gritty clinical data.


More importantly, medical storytelling in cathartic in the Classical Antiquity sense of the word (the medical sense of the word is better embodied by the word ‘laxative’). That is, in the telling of a good story, both the storyteller and the audience can experience and release the whole spectrum of emotion, through a medium in which no patient or caregiver need suffer undue harm. And unlike visual arts, literary fiction, or poetry, a good story is one that’s accessible and immediately engaging.

Narrative medicine isn’t for everyone, and many health professionals despise using their spare time to write. Storytelling and narrative writing are related but distinct crafts, and each demand training, practice, and motivation. But there’s enjoyment in the exploration of both, even as a casual observer, and I hope you’ll come along for the ride.  

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