getting the whole story

 

 

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