Storytelling to connect with your patients

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Storytelling is a form of communication that can help people successfully cope with and reframe illnesses, Illnesses, treatment, or death to provide meaning and comfort for our patients.¹ Engaging patients through storytelling can make medical interactions more effective and meaningful. This blog will provide several strategies doctors can use to incorporate storytelling into their practice to enhance patient communication. This blog will discuss how stories can embellish the doctor-patient relationship. The potential beneficial effects of telling a story have been recognized in many cultures and have received attention from philosophers, social scientists, and medical practitioners.

Let me start with a brief history of storytelling. It is natural to tell stories and inform others of our life events. Storytelling originated 30,000 years ago with visual stories, such as cave drawings discovered in the Chauvet caves in France. Since most humans are visual, drawings have always been an effective way to tell stories. Another common form of drawing used to communicate stories is using hieroglyphs in ancient Egypt. These pictographs date back about 5,000 years and are recognized as one of the world's earliest examples of "putting pen to paper."

These prehistoric humans had an inclination toward visual representations of their stories. Putting these stories into writing allowed sharing them in a different format. However, writing limited sharing to those who were educated or members of the clergy. A significant technological advance in communication was the introduction of the printing press and the subsequent mass distribution of written stories. This made stories and other information more available to larger masses of the population.

The introduction of technologies such as the printing press, the camera, the internet, and social media has provided us with multiple methods of sharing our stories. Technology has allowed humans to create multiple forms of storytelling: visual stories in photographs, spoken stories in videos and recordings, and written words or blogs.

Stories are an effective means of getting our point across. The greatest storyteller of all time is Jesus. Jesus used parables to make his message understood by everyone.

Another great storyteller was Abraham Lincoln. One of his many famous stories was about his loyalty to his troops and his staff.

President Abraham Lincoln received a message during the Civil War saying a Confederate detachment captured a brigadier general and 100 horses. President Lincoln said out loud, "I sure hate to lose those horses." When asked about the brigadier general, he commented, "I can make a brigadier general in five minutes, but it's not easy to replace 100 horses." What it says is it's the horses that count, it's the troops that count, or it's your staff that counts. Give them directions, and then get out of their way.

Physicians and storytelling

Unfortunately, doctors may be reluctant to tell stories, believing it is unprofessional and that they are compelled to use medical jargon and data to get their point across. Today, more physicians and other healthcare professionals recognize the value of stories.

Today, storytelling is becoming part of the curriculum in some medical schools and training programs. The Narrative Medicine movement at Columbia Medical School believes that using stories increases empathy, enhances wellness and resilience, and promotes a more humanistic healthcare culture.

Sometimes, telling a story or relating an experience makes us more human. Other times, telling a story lightens our burden, as "getting it off our chest" makes a problem or a hardship easier to manage. One of Anton Chekhov's most memorable stories is "Misery,"² which opens with the quote: "To whom shall I tell my grief?" It is the story of Iona, a sleigh driver, ferrying late-night party revelers on a snowy Siberian night. Iona's young son died that week, and he desperately wants to share the story of his son with someone. None of the passengers in the sleigh are interested in listening to Iona. They are too caught up in their merriment. Iona rides all night with his emotional pain. Finally, in the stable where he is caring for his horses, he tells his story to his horse at the end of his long, lonely shift. The horse listens patiently and respectfully. I think this story is something that, as physicians, we can all relate to. We may have a difficult situation caring for a patient who is going to die. In such situations, don't we all wish that we might have a horse or, better yet, another human being with whom we can share our pain?

Storytelling is an invaluable tool for physicians, offering many benefits in patient care and professional development. Here are several reasons why storytelling is important for physicians:

Enhancing patient communication:

Sharing stories can help physicians build rapport and trust with patients, making them feel more comfortable and understood. Medicine is a complex vocation, and the concepts are difficult to explain to patients. We can use stories to explain diagnoses, treatments, and procedures in a way our patients can understand.

By actively listening to patients reveal their chief complaints, we can use our understanding to demonstrate empathy and compassion, which is crucial for patient satisfaction and compliance with medical advice.

Improved patient outcomes:

Stories can engage patients more deeply than raw data. Stories help patients better understand and remember medical advice, hopefully leading to improved compliance and ultimately improving health outcomes.

Patients are more likely to adopt healthy behaviors and adhere to treatment plans when they are motivated by stories illustrating the benefits and consequences of specific actions, such as making lifestyle changes.

Education and training:

Stories from experienced physicians can provide valuable insights, but these valuable lessons are not found in textbooks. The stories can illustrate the nuances of patient care, ethical dilemmas, and the human side of medicine.

Case studies, which are essentially structured stories, are a cornerstone of medical education. They help students, residents, and fellows understand how their knowledge can be applied in the real world.

Reflective practice:

Physicians can use storytelling to reflect on their previous patient experiences, understand their emotional responses, and learn from their successes and failures.

Sharing stories with colleagues can foster a sense of community, provide support during challenging times, and facilitate the exchange of knowledge and strategies.

Public health and advocacy:

Physicians can use stories to raise awareness about public health issues, influence health policy, and advocate for their patients and communities. Examples include:

• Climate change.
• The dangers of social media.
• The role of artificial intelligence in modern healthcare.³

Stories can humanize health statistics, making the impact of diseases like COVID-19 and health policies more tangible to the public and policymakers.

Cultural competence:

Listening to and sharing stories from diverse patient populations can enhance a physician's cultural competence, helping them provide more personalized and respectful care. We must become more sensitive to the healthcare disparities in minority populations such as Indigenous Americans and the risks of disease that are more common in certain populations.

Stories can highlight health disparities and the social determinants of health, prompting physicians to consider these unique disparities affecting their patients' well-being.

10 examples of storytelling with our patients

1. Relate to the patient's experience

Share similar patient stories: If a patient is anxious about a procedure, the doctor can share a story about another patient who had similar concerns but successfully underwent the procedure and experienced positive outcomes.

• Example: "I had a patient like your situation who was really nervous about their surgery. After the procedure, he was surprised at how smooth the recovery was. He could return to work and sporting activities in just a few days. I believe you will have a similar experience."

2. Simplify complex information

Use analogies and metaphors: Analogies can make complex medical information more accessible to understand.

• Example: "Think of your bladder as an inflated balloon. When the balloon's stem is compressed, no air escapes the balloon. However, if the stem is loosely compressed, it leaks out. Your bladder is like that balloon, and we must fix the stem or the tube (urethra) that transports urine from your bladder to the outside of your body. We will start with exercises to strengthen the muscles around that tube."

3. Create a narrative around treatment plans

Outline the journey: Frame the treatment plan as a story with a beginning, middle, and end, highlighting milestones.

• Example: "Your treatment journey will start with these initial tests. Based on the results, we'll move to phase two, which includes medication and lifestyle changes like a weight loss program and exercise. We will also look into your diet by asking you to see a nutritionist. By the third phase, we'll assess your progress and make any necessary adjustments. This approach has helped many patients just like you regain their health."

4. Personal stories to build rapport

Share personal experiences: Brief, relevant personal stories can help humanize the doctor and build a stronger connection with the patient. These stories are especially compelling if the physician inserts themselves into the narrative.

• Example: "I, like you, had urinary problems like getting up at night to urinate. I made changes in my fluid consumption, including limiting caffeine and alcohol in the evening. I had marked improvement in my symptoms."

5. Highlight success stories

Inspire with positive outcomes: Share success stories to motivate and inspire patients.

• Example: "I once had a patient who struggled with weight loss for years. He used one of the weight loss injections seen on TV and lost 50 pounds over a year. This has significantly improved his health. He now needs less medication for his diabetes and his high blood pressure. It's a journey worth taking."

6. Use visual and interactive stories

Show visuals: Use images, diagrams, or videos to tell a story about the patient's health condition and treatment.

• Example to a patient considering a vasectomy: "Let's look at this rubber band, which is the same size as your vas, the tube that transports sperm from your testicle into the fluid or semen that is responsible for initiating a pregnancy. During your procedure, I will divide and seal the tube, thus preventing sperm from entering the fluid. This procedure will not decrease the volume of your ejaculation or affect your ability to engage in sexual intimacy. It will only make you sterile and will prevent future pregnancies."

7. Encourage patients to share their stories

Encourage patients to share their health stories and then listen attentively. Reflecting on their experiences can provide valuable insights and make them feel heard.

• Example: "Can you tell me more about your feelings since your symptoms started? Understanding your story will help me better understand the problem and find a treatment to improve your condition."

8. Address emotional aspects

Acknowledge emotions: Address the emotional side of the patient's experience through empathetic storytelling.

• Example: "Dealing with a chronic illness can feel like a never-ending battle. One of my patients described it as climbing a mountain. There are tough spots, but reaching each new peak makes the journey worthwhile. It's important to acknowledge these feelings and find ways to cope with them."

9. Tailor stories to individual patients

Tailor the stories to resonate with the patient's background, interests, and values.

• Example: "I know you love gardening. Think of managing your diabetes like taking care of your garden. The garden requires regular attention and care, but the results can be enjoyable and rewarding."

10. Incorporate patient participation

Create a story about their health journey and future goals with the patient.

• Example: "Let's envision your future health journey. Imagine six months from now, you've been following the plan we discussed. What does your life look like? How are you feeling with this new you?"

By incorporating these storytelling techniques, doctors can make medical information more accessible, foster more robust connections, and motivate patients to take an active role in their health care.⁴

These examples illustrate how storytelling can be a versatile and impactful tool in various aspects of a physician's practice, enhancing patient care, education, and professional development.

Bottom Line: One of the most prevalent problems in medical practice is explaining to our patients in a language that they understand the pathology and physiology of their medical condition. Storytelling is a powerful tool that can enhance the effectiveness of physicians by improving communication, fostering empathy, aiding in education, advocating for public health, and enhancing cultural competence. We can become more effective and compassionate caregivers by incorporating storytelling into our practices.

References:

1. Monteiro, . R., Kong, ., & Neto, . J. (2019). Intelligence, Creativity and Fantasy. https://core.ac.uk/download/304371203.pdf
2. Storytelling in Medicine: the Passion and the Peril – Danielle Ofri. https://danielleofri.com/storytelling-in-medicine-the-passion-and-the-peril/
3. The role of artificial intelligence in modern healthcare. https://www.medigroup.com/blog/the-role-of-artificial-intelligence-in-modern-healthcare/
4. The Future of Wearable Devices: Integrating UX and Healthcare for Enhanced Patient Outcomes - CIO TechWorld. https://ciotechworld.com/the-future-of-wearable-devices-integrating-ux-and-healthcare-for-enhanced-patient-outcomes/

Neil Baum is a physician in New Orleans and the author of The Business of Building and Managing a Healthcare Practice, Springer 2023