Doctors at the University of Pennsylvania say storytelling helps them care for patients.
Geriatrician Jason Karlawish says a good tale needs a well-developed character and that character needs a struggle, some kind of actual or psychological conflict.
That doesn’t sound like the kind of thing they teach in medical school, but Karlawish says many very good doctors are also savvy storytellers.
Doctors ask, “How can I help you? Why are you here?”
“Then the challenge of the physician is how to put that into a clear and coherent story that explains what the cause of the patient’s problems are,” said Karlawish, a medical ethicist and author of the novel, “Open Wound: The Tragic Obsession of Dr. William Beaumont.”
He said stories have a unique power to motivate. A study in Alabama found that patients with high blood pressure were more likely to manage their illness after hearing other people recount success at getting their own diet and stress under control.
“Compared to just the standard dump of facts about what are the good things to do and what are the right medicines to take — embedding treatment recommendations in stories of real patients,” Karlawish said. “People can identify with that, take ownership and better adhere to treatment over time.”
Lung specialist John Hansen-Flaschen works in the intensive care unit, the place where staffers care for the Penn hospital’s sickest patients.
Hansen-Flaschen is also a photographer. For years, he documented the students, staff and commotion in the hallways of Penn’s ICU, but rarely turned his lens on his patients.
“So often in intensive care we meet our patients sedated and mechanically ventilated, we don’t know them any other way,” Hansen-Flaschen said.
A static photograph of an unconscious person doesn’t communicate much, he said.
Photos offer insight into singular stories
When he began noticing the memento boards at the bedside, he took note, and started taking pictures of those.
“These assemblies of photographs, the shrines that people assemble in the bedrooms give us an opportunity to get to know our patients more completely,” Hansen-Flaschen said. “That’s my father, that’s my brother, that’s my son lying there and this is his world and the life he comes from.”
That knowledge — beyond each patient’s bare-bones diagnosis and symptom — makes him a better doctor, he said.
Karlawish said stories also help him care for patients and could help scientists better disseminate research into medical practice.
He and Penn’s Zachary Meisel made that case in 2011 in The Journal of the American Medical Association.
The authors discuss the “hardworking” members of the U.S. Preventive Services Task Force who released a recommendation against routine prostate-specific antigen screening for healthy men.
“They issued this very well-researched, evidenced based guideline and it flops,” Karlawish said.
One of the reasons it flopped, he said, was because people countered the taskforce recommendation with anecdotes. Former New York City Mayor Rudy Giuliani, for example, talked about how the PSA saved his life.
Karlawish says scientists need to be ready with their own counter-narratives, with stories of people who were harmed by routine PSA testing, for example.
Both data tables and stories are needed, he said.
“We are arguing that scientists need to become good storytellers,” Karlawish said.