Monday, January 16, 2017

the whole truth

Last summer, when I came away from the first annual conference on Narrative Medicine atKripalu Center for Yoga and Health, I felt I had found my inspiration as a physician and a writer.

A path through the woods at Kripalu

All week long we listened to leaders in the field describe the healing power of narrative and how to practice it. Physicians from Harvard, Yale, Columbia and Stanford, published authors, health care providers, and holistic and native American healers shared their amazing stories with us.

So, why hasn’t it taken off? Why aren’t physicians and patients everywhere engaged in storytelling as part of the therapeutic process?

As my husband (also a physician) so bluntly put it, “If it doesn’t make money, corporate America isn’t interested,” referring to the CEOs and CFOs who head up competing hospital health systems.
Alas, I’m afraid he’s right. Administrators who drive health care systems forward are less concerned with, and less knowledgeable about hands-on patient care than they are about productivity, profit, and power.
Image result for corporate growth charts

It’s no wonder physician burnout is at an all-time high, and patient satisfaction is at an all-time low.
What would it take to reverse this trend?
Storytellers would have to prove that the practice of narrative medicine improves profits, shortens hospital stays, reduces the number of readmissions, or otherwise generates income and saves money. Forget patient satisfaction and physician empowerment.
Or, maybe something like this will have to happen:
Let’s say the CEO of your hospital (let's call him Tom) suffers a heart attack. He is impressed by the speed, efficiency and expertise with which he is evaluated in the ER, rushed to the cath lab, stented, and admitted to the CCU. Two days later he is discharged.
Image result for icu logo
He congratulates himself how well the system works. This is what drives him--efficiency, accuracy, and speed.
However, a couple of days following discharge, he experiences a syncopal episode during a board meeting. Again, he is rushed to the ER where his physical examination is unrevealing. His EKG is unchanged, and his chest X-ray and a stat CT of his brain are normal. He is admitted for observation. In the middle of the night, though, he suffers a cardiac arrest and dies.
Image result for EKG cardiac arrest

Why? Because no one thought to ask him about heroin addiction…and he wasn’t about to bring it up. It wasn’t one of the bullets on the EMR for patients admitted with chest pain. Smoking? Yes. Alcohol? Yes. Heroin? No.
If the possibility of heroin abuse crossed his cardiologist’s mind, he didn’t ask about it. Had he, however, asked about stress and how Tom coped with it, he might have uncovered the real story. Maybe one of his investments just bottomed out. Maybe he just found out his wife was having an affair. It was all too much for him even though he managed to project a veneer of confidence, authority and success. His addiction was a hidden demon that ultimately took his life.
We may be skilled at zeroing in on the diagnosis and treating the patient. We know how to increase productivity and reduce costs. We pride ourselves on technology.
But until we get the whole story, we can’t treat the whole person. Unless we know the whole  truth, the patient won’t get well.



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