July 2007 | Back to Table of Contents
Editor's Note
The Inside Story
Stories are the threads that make up the fabric of medical practice. Every day we physicians listen to tales of pain and pathos as the panoply of the human condition walks in and out of our offices. As privileged spectators of this drama, we should be naturals at unfolding these stories in poetry, prose, film, or art. This month’s issue showcases the drama of medicine as told with pen, brush, or camera.
As evidenced by the continuous stream of medical television programs that started with the stern Vince Edwards’ portrayal of the crusading Ben Casey in the 1950s, medicine’s stories evince the grit and perceived glamour that feeds Hollywood’s screenwriters. Writers such as Anton Chekhov and W. Somerset Maugham, who were trained as physicians, tapped into their medical experience for many of their works. Medical practice is a treasure trove of human experience with drama enough for artists without end.
Physicians should be connoisseurs of stories. Not merely art or entertainment, stories are a fundamental tool of the trade. They are glimpses into our patients’ worlds, an initial look that tells us who the person is and what might be causing his or her struggles. The patient history that we learn to take as second-year medical students is nothing more than a story that we parse into the logical compartments of present illness and past medical problems and then analyze for clues. But just as wine connoisseurs savor flavor and bouquet before categorizing a vintage, physicians need to cultivate an alert appreciation of their patients’ stories while dissecting their problems.
Spearheaded by Columbia University physician Rita Charon, a movement dubbed “narrative medicine” is gradually seeping into medical training. Reduced to its core, narrative medicine means finding and listening to the patient’s story.
And that means the whole story. For if there is a recurring theme in patient complaints about physicians, it is that the doctor didn’t listen and that they didn’t get to tell the doctor what they wanted. The oft-quoted statistic that, on average, physicians interrupt patients 20 seconds into an interview is dismaying; but any practicing physician knows why those interruptions happen. Pressed by the schedule of the day, we take shortcuts, try to sandwich a patient’s problem into compartments, and interrogate them in a way that makes them give answers that fit into our hastily formed preconceptions. When that happens, the patient’s story never gets told.
Imagine how one familiar tale would play out if told to an interrogator:
“Once upon a time, there was a little girl who loved her grandmother very much, and her grandmother loved her. Her grandmother gave her a red velvet hood that the little girl wore all the time.”
“Was there a reason that she wore the hood all the time?”
“No, she just liked it.”
“Did she have headaches or was she losing hair?”
“No.”
“Did she have cold intolerance and need to keep her head warm?”
“No, uh, maybe I could continue with my story. …”
If we never let our patients’ stories unfold with them as narrator and with us as listener, we’ll never get to the wolf. Stories need a beginning and an end. Physicians need to savor the entire message.
Charles R. Meyer, M.D., editor in chief
Dr. Meyer can be reached at
cmeyer1@fairview.org