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Storytelling in Medicine

Emily Silverman, MD and Neda Frayha, MD
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Why does storytelling in medicine matter? How can it impact our lives, and the care we provide our patients, for the better? In this segment, Neda sits down with Dr. Emily Silverman, academic hospitalist at the Zuckerberg San Francisco General Hospital and creator and host of The Nocturnists, to learn more about the role of narrative medicine in our work and well-being.

Pearls:

  • Narrative or storytelling in medicine, the art of crafting a story, is often missing in medicine as we are pushed for more patient volume at a faster pace. However, storytelling is a powerful way to connect with ourselves, patients and other health practitioners.

  • Freytag’s Pyramid is a helpful framework to craft a story that includes exposition, rising action, climax, falling action and resolution.

  • The Nocturnists is a storytelling event created by Emily. Learn more at www.thenocturnists.com.

 

  • The Heider Simmel illusion: 1944 psychology study where college students were shown an abstract film of shapes moving on a white background. They were then asked to report what they saw. Each student saw the shapes as characters with emotions and motivations. Humans seek connection and meaning wherever we can find it.

  • The Importance of storytelling:

    • Story if a kind of mirror we hold up to ourselves

    • Connects us to others - patients and other practitioners

    • Transmits information

    • Fun - engenders sense of culture, community and playfulness

  • Healthcare practitioners are storytellers:

    • Taking a history and physical to transform it into a narrative and persuasive argument on rounds

    • Documenting our findings the medical record

    • Signing out patients to the oncoming doctor

  • Are patient stories becoming too removed from context?

    • Suzanne Koven at Harvard writes about stories in medicine with a Cinderella analogy where her story has been dissected into pieces of a medical chart (problem list, social history) and the overarching story is lost

  • Words matter:

    • Study at Hopkins called “Do Words Matter?”: trainees randomized to two different vignettes about patient with sickle cell disease, one with neutral language and the other with subtly stigmatizing language. Those who read the stigmatizing language were more likely to report having a negative attitude toward a patient and treat their pain less aggressively.

  • Who to bring narration into medicine:

    • Using patient quotes

    • Including little moments of description and flair that can make the entire practice a bit more joyful

    • Freytag’s Pyramid: Gustav Freytag was a German novelist and playwright who put forth the idea of a story as a pyramid

https://en.wikipedia.org/wiki/File:Freytags_pyramid.svg

    • Example:

      • Exposition: Patient is shoveling snow

      • Rising Action: Develops severe chest pain

      • Climax: In the emergency room find ST elevations and troponin of 20

      • Falling action: Catheterization

      • Denouement: Gets better and leaves the hospital

  • The Nocturnists:

    • During Emily’s 2nd year of residency, noticed a lack of narrative in medicine and a personal disconnect from her creative side, so started a list storytelling event for physicians to tell narratives about what it is like to work in medicine

    • Learn more at: www.thenocturnists.com

 

REFERENCES:

  1. Charon R. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA 2001; 286(15):1897–1902.

  2. Charon R. What to do with stories. Canadian Family Physician 2007; 53(8):1265-1267.

  3. Arntfield SL, Slesar K, et al. Narrative medicine as a means of training medical students toward residency competencies. Patient Education and Counseling 2013; 91(3):280-286.

  4. Heider F & Simmel M. An experimental study in apparent behavior. The American Journal of Psychology 1944; 57:243-259.

  5. Koven S. As hospitals go digital, human stories get left behind. STAT. https://www.statnews.com/2016/04/06/electronic-medical-records-patients/. Published April 6, 2016.  

Goddu, A.  Do words matter? Stigmatizing language and the transmission of bias in the medical record. JGIM 2018; 33(5):685-691.

Ian L., Dr -

Freytag wrote Soll and Haben :Debt and credit a vile anti Jewish and anti -Slavic rant .
It's a disgrace he is honoured on this production .!

Neda F., MD -

Ian, thank you so much for letting us know. Dr. Silverman and I had researched his story structure pyramid but not the totality of his writing. Thank you for teaching us about his other works, which are deeply disappointing and not at all in line with our podcast or our company. -- Neda

Brian F. -

Ian, thank you for pointing that out

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