A
path through the woods at Kripalu.
This summer I'll be attending the third annual conference on
Narrative Medicine at Kripalu Center for Yoga and Health. For the
past two years, this is where I have found my inspiration as a physician
and a writer.
All week long we will listen to leaders in the field
describe the healing power of storytelling and how to practice it. Physicians
from Harvard, Yale, Columbia and Stanford, published authors, health care
providers, and holistic and native American healers will share their amazing
stories with us.
So, why hasn’t narrative medicine taken off? Why
aren’t physicians and patients everywhere engaged in storytelling as part of
the therapeutic process?
“I’m not telling you it’s going to be easy.
I’m telling you it’s going to be worth it.”
~Art Williams~
To put it bluntly, if it doesn’t make money the CEOs and
CFOs who head up competing hospital health systems aren’t interested.
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.
It’s no wonder patient satisfaction is at an all-time low,
and physician burnout is at an all-time high.
“Burnout
occurs when passionate, committed people
Become
deeply disillusioned with a job or career from which
They
previously derived much of their identity and meaning.
It
comes as the things that inspire passion and enthusiasm
are
stripped away and tedious or unpleasant
things
crowd in.”
~mathewgates.co~
What would it take to reverse this trend?
Numbers.
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.
“Stories
are not material to be analyzed;
they
are relationships to be entered.”
~AW Frank~
Or, maybe something like this will have to happen:
Let’s say the CEO of your hospital (let's call him
Tom) experiences an episode of severe chest pain. 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.
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.
~corticare.com~
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. Exercise? 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.
“Writing
and humanities studies
produce
better physicians…
because
doctors learn to coax hidden
information
from the patients’ complaints.”
~Rita Charon~
Maybe one of his investments bottomed out. Maybe he 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 the 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 modern medical 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.
jan
