Thursday, August 18, 2016

can you hear me now?

Clearly, storytelling is important in the practice of medicine. All day long patients tell us their stories. During hospital rounds colleagues discuss interesting and difficult cases. This often continues over lunch, after office hours, even on the golf course…wherever health care providers convene.

We tell stories hoping that someone will listen, and by listening, understand…and by understanding, come to care. This helps patients make sense of their illness, find meaning in it, and begin the healing process. Storytelling helps answer the questions: Why me? Why this? Why now? It enables providers to share information and experience, to celebrate when patients recover, and to bear the loss when they don’t.

We all benefit from telling our stories…but who benefits from hearing them?

In fact, listening connects us in extraordinary ways. Not just cognitively and emotionally, but physiologically. This is a measurable phenomenon. Yay for technology!

Functional MRI scans detect changes in blood flow and oxygen uptake in different regions of the brain. It has been shown that when listening to a story, changes occur in the listener’s brain that coincide with or mirror the pattern in the teller’s brain. This is called speaker-listener neural coupling. The greater the coupling, the greater the understanding. The extent of speaker-listener neural coupling predicts the success of the communication. (Here is a link to a highly technical paper on this subject for any skeptics out there: )

The concept of neural coupling has enormous implications for narrative medicine. If we want to understand a patient’s illness, we need to listen to his story. Not interrupt his narrative. Not redirect him to satisfy our own agenda. Not fix our gaze on a computer screen and check off boxes.

Miscommunication between patients and health care providers can lead to misdiagnosis, and misdiagnosis can lead to inappropriate treatment. The patient’s condition can worsen because the doctor doesn’t understand the patient's illness. He didn’t listen to the patient’s story.
"Histories must be received, 
not taken."
~Sir Richard Bayliss~

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