February 15, 2015 / Paula Carter

Narrative medicine

In the age of big data, when doctors have access to new technologies that allow them to automate processes and capture info on patients galore, what impact can one person’s story really have?

What Data Ignores

I recently read an account of a man who had an extremely rare form of genetic stomach cancer. Because the instances of this cancer were so small, his doctors overlooked it as the possible start of his cancer. The data made it seem unlikely. However, the man’s mother had died of stomach cancer and he was convinced there was a link. After conducting his own research he found a few cases of Hereditary Diffuse Gastric Cancer and sure enough tests showed he too had this cancer. Although his findings did not save his own life, his story is saving others. His story—and the story of his family’s experience being tested for this gene—is now being used to educate doctors and patients about this form of cancer.

Medicine relies on rigorous testing methods and unbiased results—and we are all thankful for that. But is it possible, as the glut of data continues to accumulate in all sectors, that the pendulum has swung a little too far towards the impersonal?

Doctors Need Stories

Last fall, Peter Kramer, a psychiatrist and faculty member at Brown Medical, wrote an opinion piece for the New York Times stressing that doctors need stories.

Kramer says, “Beyond its roles as illustration, affirmation, hypothesis-builder and low-level guidance for practice, storytelling can act as a modest counterbalance to a straitened understanding of evidence.” In other words, stories can give texture and meaning to facts and figures. They can provide insights and information that numbers cannot.

Stories can be used in many medical situations to help doctors understand patients and patients understand doctors. Some examples:

  • In the education of both patients and health professionals, stories are more memorable, are grounded in experience and encourage reflection.

  • In research, stories help challenge conventional wisdom and generate new hypotheses.

  • In diagnosing, they can help provide additional analytical clues and promote empathy between clinician and patient.

  • In the therapeutic process, they offer an additional, holistic approach.

Narrative Medicine: Narrative as Medical Tool

Despite these benefits, stories and case studies have gotten a bad rap in some medical circles. After all, they can be subjective. But when used together with other information, they carry a unique power. In 2009, Columbia University started the Narrative Medicine master’s program in order to bring back the story as a medical tool. They hoped to get maybe 10 students the first year—instead they had 28.

Sayantani DasGupta, who teaches in the program, says, “What my colleagues in Narrative Medicine and I are urging is not that we forget all of our wonderful, lifesaving technological know-how, but rather that we once again train clinicians to elicit, interpret, and act upon the stories of others, that we hold in equal stead multiple ways of knowing.”

It seems that slowly, the importance of story in medicine is beginning to be recognized by wider circles.

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Perhaps as we are more engulfed in an era of big data and increasingly complex technological tools, we are also beginning to feel the deficit of a different way of relating and understanding. Kramer notes that the October 2014 issue of the New England Journal of Medicine opened with a case history and included the statement, “Data are important, of course, but numbers sometimes imply an order to what is happening that can be misleading. Stories are better at capturing a different type of ‘big picture.’” Highly respected, the journal’s inclusion of this statement seems to point to a shift.

The question becomes, how will medical professionals learn to listen, hold, interpret and tell stories?

In the past, Leadership Story Lab worked with Northwestern Memorial Hospital to help train their nurse managers and clinical coordinators to tell and listen to stories.

Just like learning anatomy and physiology, storytelling is one more tool in a complex medical world that deserves study and attention.

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