Hey, Doc, I’m a story, not just a symptom
Having moved so many times in my adult life, I’ve rarely had the chance to really connect with “my” doctors. Some make it easier than others. They are the ones who know how to listen, who want to know the context of whatever symptoms walk through the door. They want to know my story.
A doctor who stands out in my mind took a storytelling course from me through the University of Washington’s Experimental College. During introductions, he told us why he was talking the class.
He led Grand Rounds at the University of Washington Medical Center. He knew talking about symptoms and treatments was not enough. He wanted students to understand no one’s health deteriorates in isolation. His goal was to tell patients’ stories in a way that would teach diagnosis as an art, not just a skill. Judging from the stories he told during the course and his intense listening when others spoke, I’d say his students had a good chance of becoming better doctors thanks to his influence.
So I was keenly interested to find the story Dr. Jack Coulehan tells on the Alaskan LitSite. He writes about his internal medicine practice in a rundown neighbourhood in Pittsburgh in the 1970s. He was a young doctor, with a scraggly beard that amused his patients. “But the thing they found most strange about me was that I spent so much time listening to their stories.”
He goes on to describe his experience as a junior faculty member at the nearby university hospital. He writes, “When students tried to tell their patients’ stories during rounds, the resident would caution them to stick to the point.”
That attitude turned the people he knew into objects. They were transformed, like the self-educated, paraplegic teetotaler who was an expert on Pittsburgh history. The medical team labeled him an “alcoholic” because of his red nose and colorful vocabulary and sedated him into a “zombie who couldn’t think straight”.
Coulehan says that medical students receive mixed messages. They take classes that focus on narrative as the heart of medical practice, then enter hospitals where they are taught that stories “may actually obscure the problem” and where the technical fix and objective data overrule patients’ narratives.
In British Columbia a new program is trying to address this, by training volunteers to influence a health system that too often talks “about” rather than “with” them. Patient Voices Network has launched with a large and hopeful intention: “We expect that as experts in their own lives, patients can provide health system administrators and care providers with important information about [how] to best serve them and involve them in their own care as partners.”
One of the things volunteers have asked for is training in storytelling. They understand intuitively that change happens when we hear, understand, and honour each others’ stories. Perhaps through their influence there will be many more doctors like Dr. Coulehan and the doctor who came through my class many years ago.[Have you had a doctor who really heard your stories? Taught physicians to tell stories? Share your experiences in the “comments” section below.]