Narratives have become required activities for family medicine residents. And usually bring muted groans and eye rolls. If not stated explicitly, most residents question the utility of this activity, and at best look at it as a hurdle, a necessary exercise. You can see some at http://www.cfpc.ca/Stories/.
“Stories beat statistics, and relationships beat stories.” That’s a quote, and I’m not trying to steal it; I just can’t find the reference. Tried, “stories beat statistics”… true. Someone must have said that. And, “relationships beat stories.” Come on. Who said this? How about, “stories work, statistics don’t.”
Because it just sings truth. Sometimes truth just sort of hits you in the gut, and you know the veracity of the statement.
Physicians learn a lot of statistics. Perhaps that’s not correct: the numbers fade, but we remember the trial, and the outcome. There’s an example right there. We remember that less people die if such and such an intervention occurs. I often can’t remember the actual numbers, or the percent decrease in risk, the NNT. Even when it comes to basic science, the human brain is affected most by, and remembers best, the story.
When pregabalin first came out, more than ten years ago, I jumped on the wagon with the rest of you, and wrote out my first script for this apparently miraculous, non-sedating, non narcotic pain reliever. The patient is still vividly painted in my memory. It was a good first case, a middle aged woman with diabetic neuropathy. Not out of the box, not pushing the limits, an ideal first case for a first prescription.
Well, in that first experience, I had to hospitalize that patient to get her off the drug. She appeared to have full blown Alzheimer’s dementia. Imaging negative, screening urine/ bloods negative, slow improvement off the drug. I think she was in for over a week.
Needless to say, I didn’t touch the drug for years. It took my partners prescribing that very drug, very successfully, to my own patients before I picked up my prescribing pen again. Now was that, “statistical”? No, that was a story. No, that was more than a story, that was my patient.
But what’s the best example? Sure, it’s your patient that suffered. But more than that, the best example is if it happened to, or affected you. Or your family member. And what do I mean by, “best?” The thing that works. That seems to register, with your patient, because nothing else matters.
Whoops, that’s a faux pas, isn’t it? That’s something we can’t do. You can’t talk about yourself. Trained from year one, day one, class one. You need to keep at least a 5 mm separation from that human being in front of you, that person in pain, struggling with a diagnosis, that bereaved parent, the orphaned child, the 32 year old with a brain tumour. Better if you can slide a piece of bullet proof glass into that 5 mm space. Things will just ricochet right off.
You’ve got dinner on the table at 1745h, right?
Stories work, statistics don’t. How’s that for a quote. The best trial in the world, the best researched, best presented stack of numbers just don’t. Stack. Up. To a story. Eyes cloud over, there’s uncomfortable shifting in the seat, surreptitious glances at wristwatches. Or iPhones these days. You see them again next month, heavier with worse sugars.
And shoulders shrug.
What are some of my best narratives that I use in family practice? They’re brief, and won’t take too long here. They don’t take too long in a patient encounter, either. There’s my best friend, first business partner that died in his early forties from melanoma. Stings to this day. Because of this, I think my patients get their partners to check the skin on their backs. There’s the time I flunked my treadmill. That’s me, skinny, non smoker, non drinker, who never uses elevators and was taking karate at the time. Wasn’t stacking active minutes. I tell them my schedule, and look at them hard, and tell them they have time.
And you know what? They find time. Because stories are good, but relationships beat stories.
You have a relationship with your patient. Yes, stay professional. You can’t be buddies with your patients, or you can’t make the appropriate decision. Medicine does need to be kept at bay or it can start overtaking your entire life. Sure, try to keep it at the office.
If you feel comfortable, use that relationship.
Tell your story.