Researchers replace guidelines with fables, to test doctors’ memories

    Dr. Zachary Meisel

    Dr. Zachary Meisel

    Can person-to-person storytelling help doctors remember key information?

    Two researchers at the University of Pennsylvania recently decided to tackle a big problem: why don’t doctors adopt the latest scientific guidelines?

    “There’s lots of literature showing that doctors do a pretty terrible job when it comes to following guidelines,” said Dr. Zachary Meisel, assistant professor of emergency medicine at the University of Pennsylvania.

    The literature Meisel refers to shows that, as research abounds, doctors are slow to change their clinical practice to incorporate new scientific evidence.

    To get at what kinds of communication might be more effective, Meisel and recent graduate of Perelman Medical School Austin Kilaru turned to a field called “narrative medicine.” Medical students learn “narrative medicine” in school as a way to use stories to cultivate empathy for patients, but it’s not generally used to convey clinical information to doctors.

    Meisel also pointed out that doctors most often receive information that is scientifically accurate, but divorced from clinical context.

    “So the most common ways that physicians are instructed are to follow guidelines, often presented to them in a very narrow, probabilistic way.” He adds that doctors already operate under the influence of stories, in the form of their own experiences and anecdotes.

    Putting stories to the test

    “Our hypothesis is, once we know that information is evidence-based, we can use stories to make that information ‘sticky’ and get doctors to actually remember the evidence,” said Meisel.

    At a conference in 2013, Meisel and Kilaru tested about 80 doctors. Half got a story about “Frank,” a middle-aged man who suffers from lower back pain, and half got an excerpt of the guidelines from the American College of Emergency Physicians. The two samples had the exact same word count of individual guidelines, to eliminate as many possible factors that would effect recall.

    After an hour, researchers asked the doctors to share what they remembered.

    “The results were really astonishing,” said Kilaru. “The level of recall for people who had just read the guideline itself was really quite low. It got to the point where people were making up guidelines because they knew they were supposed to remember something.”

    And there’s science to back up the “stickiness” of stories. Princeton University professor Uri Hasson studies the neuroscience of interpersonal communication.

    “What we find over and over and over is that these stories are really powerful for the brain,” said Hasson. “They evoke strong responses in many different parts of the brain that are highly reliable.”

    Hasson looks at what happens inside our brains when we hear a story – one that we can relate to. He finds that stories activate parts of the brain associated with memory and which are not as active when we hear information that is easier to “tune out.”

    He also highlights that this kind of communication – person-to-person storytelling – is one that our brains have a lot of practice doing. “It’s automatic, you do this with your friends, whatever happened in your daily life. So how do we do it? You can think about it like wireless communication,” said Hasson.

    Wireless communication? Go on. 

    “I have brain waves that are related to my memories, and I translate them into sound waves and that evokes the same responses in your brain. So basically what I am doing now is I am trying to make your brain similar to mine,” said Hasson. Thay way, “you get me and we have communication.”

    In short, “these are very effective stimuli to induce memories in people,” said Hasson.

    Remembering is one thing, but changing habits is another. Kilaru and Meisel next want to look at whether stories can affect doctor’s behavior – like registering for their state’s prescription drug monitoring program.

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