Monday, February 27, 2017

Storytelling in Medicine: Spoken or Written?

A simple rule of thumb for sharing your best medical anecdote.

As I noted in the introduction, there are good reasons to share your stories as a health care provider. They're reasons having nothing to do with the clinical issues, and are as varied as the purposes of ancient myths: teaching a moral lesson; catharsis; entertainment; personal reflection; inspiring others; raising awareness for public debate; opening a "window" into the realities of medicine health care - the good and the bad; and others.

One thing that's not straightforward, though, is how to share a story you're itching to tell. When people think of narrative medicine - and when professionals talk about it, for that matter - they're referring almost exclusively to the written word. That's bizarre, because there are dozens of TED Talk videos alone on health care and medicine that are full of compelling narratives, to say nothing of the rest of the YouTube, or countless live speakers out there. And many of those narratives have been consumed by more people than any book on the shelf without 50 Shades or Harry Potter in the title. Suffice it to say, a good medical narrative will work comfortably in one of spoken or written form...and both if you're lucky or talented. Still, there are ways to think about your story before deciding which platform to offer it from, independent of your skills at (or dislike of) public speaking or writing. What are the strengths and weaknesses of each?

Oral storytelling is typically more engaging, as the communication is with an audience rather than a reader. You can use facial expressions, alterations in tone and pace of voice (or imitate others' voices), hand movements, and so on. As long as you don't speak in monotone or complete word salad, storytelling with a live audio stream or podcast can be just as effective - for those of us that shy away from public speaking, audio might be an ideal way to get your message across. Comedians offer some of the best examples of live storytelling, as illustrated by this medical narrative from Louis CK:

The major downside of live or audio stories, apart from the obvious need for performance skills, is that they consume a lot of time. It's far quicker to read the transcript of an interview or TV/radio program than it is to watch or listen to it (try it for yourself if you don't believe me). If your story takes a long time to reach its dramatic climax, there's a risk of audience attention drifting away.

Written stories, on the other hand, can be consumed in much less time. Even a many-thousand word essay can be read quickly if it's written well. The written word also allows for every kind of rhetorical trick or clever phrasing, and endless variety in pacing and tone. The written word can either get out of the way of the story - the "Hemingway" model - or give an otherwise lackluster story more impact.

The other upside to a written story is that it's safe, and by that I mean it's a less forward and more accessible way tell a story with unsettling subject matter. A doctor's career is going to be full of disturbing, even horrific stories. I'm still haunted by patients that were victims of violence or rape or incest. Their stories need to be told, though, because if they aren't the issues can't ever be addressed by health care or society as a whole. That being said, relating these sorts of stories can be distressing, even traumatic, for both teller and audience alike. It's something few of us are ever comfortable with, but the written word - including poetry - lets these stories and ideas see the light. It's essentially what big-L literature is for. 

The biggest downside to writing, of course, is that it's a craft in its own right. Most of us can relate a funny story competently (if not well), simply because we learn to repeat jokes or tattle from an early age. Health care professionals most often come from the sciences, so writing for non-technical purposes might be something unexplored since high school. I enjoy narrative writing, but it's not for everyone.

The other challenge with writing is the flipside of live storytelling: it's hard to be funny with the printed word, because so much of comedy - timing, facial expressions, comic voices - is nowhere to be found in text. Humor certainly can work in writing, even if it's tasteless. Still, books by the greatest comedians in the world, containing nothing but the cream of their stand-up material, can't hold a candle to their live acts, and sometimes even fall flat.

It's not hard to see where I'm going with this. My basic rule of thumb for a would-be doctor/storyteller is this: The more lighthearted and funny your story, the better it's likely to work if you tell it by mouth. The more tragic or upsetting the story, the more it belongs in print.

Next time: does a story need to have a point?


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