Once upon a time, in casualty: What doctors know about story

Monday, July 6, 2015

It's a well-kept secret, but doctors love a good story. They want and need your story, all its nitty-gritty detail. Because, quite simply, your story could save your life. Here's how the people who save lives for a living rely on our storytelling skills.

The ears have it


William Osler was a pioneer of modern medicine. From beneath his magnificent Victorian moustache, he said:

Listen to the patient. He will give you the diagnosis.

As any medical student could tell you, 70% of a diagnosis is in the initial conversation between doctor and patient. In other words, it's in the story.

We can learn a lot about storytelling from how the best doctors listen to a story. Here, doctors old and new tell us how real listening is done.

1) Think like a detective

Asking intrusive questions, sampling bodily fluids, drinking hard – your archetypal doctor and detective have a lot in common. Both use your account of a situation to join dots and find culprits.

Leave no stone unturned. Don't assume that banal details – my hand feels hot, my snot turned blue – are irrelevant. Listen, open-minded, to everything.

Dr Gregory House might not the best example of an empathetic doctor. But he does go after a diagnosis like a dog after a bone.

2) Use all your senses

Mary, a retired anaesthetist, qualified in the 1940s. She remembers:

We were always told to LOOK first. You can tell a lot from doing that, straightaway. Does the patient have sallow skin? Could be jaundice. Red sores around the mouth? Might be iron deficiency. If he smells really bad and dresses like a scarecrow, he might be telling you that he struggles to look after himself.

Laura, a junior doctor, explains:

These are all tiny bits of invaluable data. You put your pen aside, but you note them all, mentally, for later.

3) Just be nice

We're used to high and mighty doctors on TV – strutting down corridors, oozing arrogance. But in the real world this behaviour isn't just annoying, it's also ineffective.

A patient who feels inferior, silly or like a time-waster will probably tell the story they think the doctor wants to hear. And it might well be full of holes.

Aisling, an experienced GP, says:

It's so important to make patients feel at home. Look them in the eye, lean in, and reach out a hand if they cry. Even if you're rushed, they need to feel welcome.

That's because patients tend to respond better to kindness and empathy. They're just people, after all.

Think Dr Greene in ER, not Dr Cox in Scrubs.

4) Ask wide open questions

Dr Lisa Sanders wrote the book that inspired the hit TV show House. She says patients will mimic a doctor's conversational style.

Unsurprisingly then, narrow dry questions will get narrow dry answers. The bare bones of the story, if you will. You'll never get to the juicy stuff.

Instead, the best doctors ask: How can I help you today? And what worries you about that? Do you have any idea what it might be? This is when the diagnosis magic happens.

5) Don't judge. Ever

Laura, our junior doctor, avoids any kind of judgemental language in consultations.

I'd rather say 'recreational drugs' than 'illegal substances' and I'll often remind patients that we see their symptoms all the time. The last thing you want is for them to feel ashamed or embarrassed.

6) Bring on the mess

Dr Sanders puts it brilliantly in this lecture when she says:

Being sick is very upsetting. Being sick has a lot of meaning to people. Meaning that you don't even think about. Meaning that is far beyond whatever discomfort people have with this illness. Being sick has a lot of different kinds of meaning to people and you will never know what it means to this person if you don't let them tell you.

Crying, hesitation, anger, remorse – all signs that you're getting to the heart of the story.

7) Check you speak the same language

Being sick is an experience that's unique for each person. And so is the language they use to describe it.

One medical student realised that many patients simply couldn't find the words to share their suffering. So she used abstract art to help them articulate their pain.

On canvas, she showed stabbing pain as red and spiky and nauseating pain as yellow and billowy. She used these as visual aids when taking medical histories.

Matheos is a trainee GP:

Some people will say they feel 'dizzy', when they are just a bit light-headed. Others will use exactly the same word, but for them, the room is spinning and they've fallen flat on their face. There is quite a difference!

8) Treat the whole person

Look at the whole person. Look at their whole life. What are their fears? Their desires? What about their family? Are they grieving? Are they alone? Dr Sanders calls this the 'bigger story'.

You might unearth personal circumstances or past trauma that is very relevant to the pain – physical or otherwise – the other person is feeling.

The red-nose wearing, compassionate doctor Patch Adams – famously played on-screen by the late Robin Williams – says:

You treat a disease. You win, you lose. You treat a person. I guarantee you, you win. No matter what the outcome.

9) Piece it all together

At this point, a doctor might make a physical examination or order further tests. But the medical history they've taken – a simple story – will be their starting point in all things.

The patient will tell it again and again, every time they transfer to another doctor's care.

As a listener, hopefully you've understood how to get to the heart of what your friend, colleague or character is feeling. Where they've come from. What they need. How they feel.

You know how to really hear – and tell – their story.

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