is there a better way?

Rocky Mountain National Park

Nowadays, patients frequently complain about the fragmented and impersonal relationship they have with their healthcare provider. They often feel as though they aren't being heard, or understood. Important issues are dismissed or left untouched by physicians who appear hurried, distracted, or disinterested in their problem.

The physician can hardly help himself. He is forced to practice in a health care system whose number one priority is corporate profit. His schedule is overbooked. He struggles with an electronic medical record system that doesn't work for him. He has to navigate a baffling coding and reimbursement system, and he faces the ever-present threat of litigation. And, of course, he is tethered to his very own, personal productivity quotient, a.k.a. how much income he is expected to generate.

"Medical practice is not knitting and weaving

and the labor of the hands,

but it must be inspired with soul and

be filled with understanding and

equipped with the gift of

keen observation."

~Maimonides~

These stresses drive a wedge between the patient and provider, disrupting the fundamental patient-doctor relationship. The patient is disappointed in his care, and the physician is disappointed in himself. 

Is there a better way?  

Training in the practice of narrative medicine empowers the physician to elicit, assimilate, interpret, and respond to the stories patients tell us about their illnesses. In addition to tracking the appearance, location, and progression of their symptoms, it encourages the physician to explore the nature and course of suffering, attitudes about healing and recovery, and the ways family members, community, and circumstances influence these attitudes, all of which have been proven to affect patient outcomes.

"A physician is obligated to consider

more than a diseased organ,

more than even the whole man.

He must view the man in his world."

~Harvey Cushing~

The overwhelmed (or uncaring) physician may suggest this is what we have nurses, social workers, psychologists, pastors, and family and friends for. But by disengaging himself from the patient's psychological, emotional, and spiritual life, the physician sacrifices his connection with his patient, and with it, empathy. And with loss of empathy, morale suffers, and when morale suffers, physicians tend to burn out.

Storytelling is one of many art forms that encourages and enables patients to explore the full scope of illness and recovery. It is already built into the clinical encounter under labels like "the history (or story) of the present illness", "the past medical history" (or story), "the social history" (or story), and "the family history" (or story), almost as though an epic novel is about to unfold.

"Ask not what disease the person has,

but what person the disease has."

~Oliver Sacks~

In addition to promoting accurate diagnosis and effective treatment, this brand of storytelling remains a useful tool for the patient himself as a means of exploring the cause, effect, and meaning of his own illness. Narrative medicine then begins the process of narrative healing.

"But this, too, is true:

 stories can save us."

~Tim O'Brien~

jan