Everything is Stories

There's this belief out there, that the practice of Medicine is a science; That there are absolutes; That there is a "best" doctor in a certain field. 

These beliefs aren't incorrect, they are simply incomplete. Why?

 

Because - Medicine is stories. Everything is stories. 

Clinical Medicine is at once scientific (not a science, but a practice that employs and learns from science) and deeply rooted in inconsistencies, observation, history, myth, and necessarily intuition - which I often describe as "a clinician's internal discernment between options".

• There are some who call themselves doctors, who see patients as diagnoses and treatments, protocols and percentages, imaging and labs, relying on these either out of fear or hubris. 

• There are some who call themselves doctors, who see patients as energy bodies, archetypes, self-healing, lacking love, deficient in xyz, tapping into nature's power - relying on these, either out of fear or hubris.

Neither of these people are doing their jobs.

We need the algorithms, metrics and risks ratios, we need evidence-based treatments, we need the belief that things happen & heal through unknowns, we need to be able to listen without solving, we need it all. 

 

The 3 Laws of Medicine sum up to the reality that we actually don't know much about you, but we do know some general rules.

And most times when your condition is outside the rules, a Hunch and a Hail Mary is what we go on, and hope that our intuition or clinical judgement proves correct.

All physicians would do better work if their fear and hubris were laid out as givens, transparently.

There is a burgeoning field out there called "Narrative Medicine". (For all the Change Members and Change Doctors, it translates as: swoon.) The work of Narrative Medicine is to understand and honour the stories that underlie illness; to honour all that we can do today in medicine because of science, and do better still because of compassion; to recognize that it is important to take care of both the patients and the caregivers.

 

The best doctor for your case, is one who knows you.

One who has heard your hopes, wishes, & fears, one that understands that you walk in the door with more than your body. The best doctor for your case is also granted the time for learning; about your condition and about you. 

"Not only the personal dimensions of disease but its biological dimensions become clear only over time: to understand what disease a patient might have requires schooled longitudinal curiosity about that person's state of health. Sicknesses declare themselves over time, not in one visit to the consultant" - Rita Charon, Narrative Medicine

Or in the words of House, M.D. "Everybody Lies" - which I translate to "Everything Is Stories"

Many forms of medicine say that they work to improve listening and empathy/sympathy, that they are capable of relationship-based care, that they are "holistic", but I call their bluff. Most health education pays lip service to a curriculum, but not many schools of medicine even know where to begin when teaching the almost impossible task of:

Holding the responsibility of accurate diagnoses through scientific lenses

while simultaneously

Allowing space for lenses that see the singular, unique experience of illness, that comes with a person's beliefs, values, and fears.

Schools of Psychology, Anthropology & Literature have the best resources for dealing with the individual's experience, and Biomedical Sciences, Surgery & Internal Medicine have the best resources for objective evaluations of patterns within the physical realm. Rarely do these two intersect.

Our lived experiences - our stories - are interwoven with our illnesses. We cannot separate the realities of physical illness from the experience of our own personal narratives. We cannot chalk everything up to the Psyche or Spirit nor the Radiologist report. We are a mixed breed of science and story.

 

The scenarios we don't want to promote are:

1. Training healers who lack clinical medical knowledge, while being adept at understanding in your story. Narratives should move us to act appropriately with our training as physicians, and that training must teach us when to treat and when to advise for another opinion.

2. Training physicians who lack self-reflective listening skills while being medically proficient. Questions & checkmarks, risk factors and objective data, although enough to begin the inquiry, are not enough to help a patient. 

Bringing both together is rare and requires patients and doctors to build bridges toward one another.

 

The scenario we want is:

Patients, who trust that their physicians care deeply for them, and come to them with hopes, rather than demands, while being patient with the slow uncovering of information and the potential of undesired consequences.

Physicians, who are not afraid of being wrong or faulted, while still standing up to hold the liability and responsibility of informing, choosing, and walking along with patients as they traverse through this unpredictable, frightening, and often lonely path.

We want to take out the suspicious undertone that no one calls out but everyone feels: That patients don't trust that their doctors care about their best interests, but also feel powerless about their options; and some doctors shield themselves from litigation and blame from patients, or others eschew the science within medicine in favour of the unknown and fate. All, mind you, attempting to maintain their pride.

 

When the truth is, we want simply, to care for one another again. 

If you are interested in who is doing this well, I'd highly recommend the listening to the deeply reflective internist, Dr. Rita Charon, MD.

The one major obstacle that Narrative Medicine faces and is doing its best to navigate, is that of already existing systems and procedures. How does a broken payment system - riddled with liabilities, blame and pressure - encourage patients and doctors to relate again?  How do we use the time we have between patient & doctor, so if we have 45 minutes, we do not waste it in irrelevant questioning & discussion, and that even in 10 minutes we can allow for deep listening?

Do you know how we start building that? With Change. Change doctors choose to trust that if we work together, we won't fall apart.