Bedside stories and the tales doctors tell

Dr Muiris Houston

Readers will be familiar with my deep interest in patient stories. But what about the tales that doctors tell?

In a recent edition of the Journal of the American Medical Association (JAMA. 2017;318(2):124-125. doi:10.1001/jama.2017.5518), Dr Tracy Moniz and her colleagues examined some 158 physician narrative reflections that had been published in JAMA, the New England Journal of Medicine and the Annals of Internal Medicine between 2011 and 2013.

Using a narrative inquiry approach, they explored stories about the practice of medicine in narrative sections of these journals, focusing on the lessons conveyed, the narrative strategies used to convey them and the relationships between the two.

Each of the stories conveyed a lesson for the reader. The researchers identified five recurring lessons: practising medicine is a privilege; patients are vulnerable; physicians are fallible; humanity matters; and the ‘system’ is flawed.

These last two lessons — humanity matters (focused on physician and patient as “person”) and the system is flawed (focused on systematic challenges and the need for change in care delivery) — were the most common, constituting nearly two-thirds of all the narratives.

It is customary to analyse stories according to the type of narrative strategy: a lament, a hero story, a quest, an awakening, a rediscovery, and a testimony were the themes used by doctors in this study to tell their stories. Of these, awakenings and laments were the commonest.

Interestingly, the researchers identified a relationship between the type of lesson and the narration strategy.

Lessons that humanity matters were most often narrated as awakenings. Perhaps unsurprisingly, lessons about system flaws were most commonly narrated as laments.

In one story, two physicians lamented the increasing industrialisation and standardisation of medicine: “Despite the lip service paid to ‘patient-centred care’ by the forces promulgating the new language of medicine, their discourse shifts the focus from the good of the individual to the exigencies of the system and its costs… This vocabulary should not redefine our profession.”

Commenting on their findings, Dr Moniz and her co-authors say: “Physician writers’ use of the lament — an expression of sadness, frustration, or regret — to narrate their stories suggests a sense of helplessness and resignation in their work, as if they stood apart from ‘the system’ and lacked the power to effect change, particularly as a single voice.

This may have an impact on the level of engagement, commitment, and satisfaction physicians feel toward their work.”

It seems physicians’ writings illuminate a pressing need in medicine — one not fully met by conventional continuing medical education opportunities.

Professional development tends to focus on increasing knowledge and updating skills and does not typically give space to the existential struggles around humanity and professional identity associated with a career in medicine.

At this year’s dotMD Conference we ran our first medical storytelling session. It went down a treat and so Dr Ronan Kavanagh, Dr Alan Coss and myself have decided to dedicate a whole event to medical story telling.

“It’s an effort to use stories to build a community where medical storytelling is used to celebrate the human side of medicine, as well as an antidote to its frustrations. These are areas that are hugely important to doctors and which are not addressed in medical education,” Dr Kavanagh says. We also hope it will go some way to preventing burnout and reducing isolation.

It’s nice to have our gut feeling about the value of doctor stories unexpectedly validated by the JAMA paper and to chime with the authors’ conclusion that “the need for these conversations appears undeniable, and the profession may benefit from creating more spaces in which they can safely take place”.

The event, which will take place in The Mick Lally Theatre, Galway on December 1 this year will feature stories from doctors working in general practice, psychiatry, public health and hospital medicine. Speakers include Prof Jim Lucey, Drs Maire Connolly, Aideen Henry, Pat Harrold, Paul Reynolds, Steve Martin, Kavanagh and myself. Music will be provided by pianist and composer Paul Broderick.

You can sign up at www.bedside.ie or follow @bedsiders for updates and ticket information. Do come along — we’d love to see you.

Bedside Stories. Mick Lally Theatre, Galway 8pm Friday, December 1, 2017.