by Jay Baruch, MD
For every voice crying that medicine is lost, there are assertions that technology will come to our rescue. I’m both beguiled by where technology might take medicine and suspicious that our enchantment with it will ignore the foundation of the physician/patient interaction, which is so undeniably low-tech it’s been around for tens of thousands of years. If a Cro-Magnon man injured his leg hunting mammoths and visited Dr. Hairy Shoulders in the emergency cave, the basics of the care would be no different than what will run between me and my patients during my emergency department shift this evening. We will share stories.
In one of his books, the esteemed physician/writer Robert Coles said, “The people who come to see us bring us their stories. They hope they tell them well enough so that we understand the truth of their lives. They hope we know how to interpret their stories correctly. We have to remember that what we hear is their story.”
Medical educators and attending physicians dutifully encourage students and residents to attend to the patient’s story. This is well-intentioned advice that may inadvertently set up our physicians-in-training on a task that’s akin to chasing windmills. The stories patients tell me are rarely well-conceived buried treasures waiting to be discovered. In the narrative disaster zone of the emergency department, patients’ stories often feel like a first draft, and first drafts–for most of us–are typically raw and messy.
Patients’ stories are complicated, intensely personal and disorganized. Crafting cohesive narratives requires effort under the best of circumstances–a comfy chair, a steamy cup of coffee, a quiet room. But our patients come to us sick, frightened, tough and maybe distrusting. They face a daunting task that we sometimes take for granted: to construct deeply personal narratives for nurses and physicians who, until that moment, were complete strangers.
In my article, “Creative Writing as a Medical Instrument,” I propose that for healthcare professionals to become story experts, they must think creatively, through the mind’s eye of a writer. Studying the creative writing process by building stories from the ground up helps us become intimate and acutely sensitive to the elements of craft and story construction. Once we have fiddled with dialogue, backstory and point of view, we understand the many different choices that affect how a story is told. Developing stories offers first-hand experience that can help nurses and doctors understand the degree of difficulty and the stumbling that happens when patients tell their stories, as well as how feedback, editing and rewriting are instrumental to telling stories well.
In my paper, I point out that most of my patients have not been to medical school. Certain patients are over-writers–telling stories bulging with information, unsure which pieces might be relevant. They write large, and my work involves helping them edit down to their key concerns. Other patients feel like stoic minimalists. They can seem like difficult storytellers, bearing illness with a tough resolve, or guarding against a worrisome diagnosis by withholding revelatory details. These cases involve intuition and effort, suspecting and examining story gaps while simultaneously resisting the decision-making brain’s tendency to be satisfied with available information.
Healthcare professionals make decisions, including the appropriate use of technology, based on the stories patients share. It makes sense that healthcare providers should be story experts. Thinking more creatively makes us more accepting of challenging stories. By probing and questioning, we can ensure that the story we are hearing is the one our patients are trying to tell.
Story becomes the ground that patients and healthcare professionals travel together: an unpaved road, potholed and puddled, that often lacks signposts, that makes no great rescue promises. But it’s a meaningful journey where we will get muddy together.
Jay Baruch, MD is Associate Professor of Emergency Medicine at the Alpert Medical School at Brown University, where he serves as the director of the Program in Clinical Arts and Humanities and co-director of the medical humanities and bioethics scholarly concentration. He’s the author of the short fiction collection, Fourteen Stories: Doctors, Patients, and Other Strangers (Kent State University Press, 2007). What’s Left Out, his new collection of stories, is forthcoming from Kent State University Press in 2015.
