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Storytelling in Medicine – Practical Wisdom for a Beleaguered Profession

 

For Aristotle, practical wisdom was a key to the good life. He believed in flexibility in thought and in learning from experience, not in cold calculations or in rigid rules. Someone who tries to live their life by applying unbending rules to situations of uncertainty or conflict is like an architect who tries to measure a fluted column with a straight ruler, he wrote. Aristotle taught us to be “ready for surprise” and “prepared to see,” philosopher Martha Nussbaum says.

Could story-telling help give today’s beleaguered doctors the gift of Aristotle’s practical wisdom? Could simply sharing tales from the trenches help them become more flexible thinkers?

I recently visited with a young family doctor who sees storytelling as a way to push back on the relentless, dehumanizing emphasis on efficiency in health care. Storytelling allows doctors to pause, “make peace with bad outcomes, honor patient relationships, and process the meaning in our work,” says Hugh Silk, associate professor of family medicine and community health at UMass Medical School in Worcester. He didn’t mention Aristotle, but the parallels are striking to me. Our narratives are a living form of practical wisdom that highlights the particular, the unique, the mutable in life. They both reflect and cultivate the kind of nimble, responsive knowledge that we need in a time of overload, speed and tech-centrism.

Weaving storytelling into the fabric of doctoring isn’t easy. When Silk began sharing around stories and poems by family medicine and community health staff, there was some initial grumbling. Although patient identities are hidden, some feared that lawyers would scour the often raw, candid pieces for potential lawsuit fodder. Others feared that the stories contravene patient privacy. But now the “Thursday Morning Memo” listserv is read by 450 people in the department and beyond. And the idea is being adopted by three other UMass primary care specialties, an expansion celebrated October 5 with a reading and reception. As well, the school’s family medicine residents now are given time several times a year to reflect, and assigned two reflective essays, based on home visits to patients.

Is this worthwhile? Perhaps it’s a mistake to expect neat metrics from a part of life so achingly mysterious and immeasurable. It is interesting that Silk’s efforts fall at the crossroads of two swelling movements in medicine. “Narrative medicine,” pioneered by Columbia’s Rita Charon, links the study of literature with stories from the medical front, mainly to inspire practitioners to listen attentively to their patients. At the same time, medical educators are becoming more interested in reflective writing as a means of inspiring their students to pause, digest and better understand their learning. Again, there are skeptics, yet both movements show intriguing gains: more empathy, better diagnostic skill, less burnout – more joy.

And the stories? Let them speak for themselves. If you can, take a minute and read “Primary Care Ride,” the story of a family doctor who, upon learning of the death of his 10-month-old patient, was torn deeply between doing his bureaucratic duty and listening to his heart. It’s a story of practiced wisdom, flowering within one of life’s darkest moments.

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