The Rx Narrative: Story as Medicine
Medicine is at heart at a narrative activity; its daily practice filled with stories.
“Medicine begins with storytelling. Patients tells stories to describe illness; Doctors tell stories to understand it.”
— Dr Siddhartha Mukherjee
Medical historian, Stanley Reiser wrote in his his 2009 book, Technological Medicine: The Changing World of Doctors and Patients, “Before stethoscopes, the coin of evaluation was words — the doctor learned about an illness from the patient’s story of the events and sensations marking its passage.”
Doctors take this story and turn it into medical information, returning the story to the patient as a diagnosis. However, the patient’s story includes many things that are beyond the reach of the health professional’s narrative.
Clinical choices are not isolated from all else that happens in people’s lives but are part of an ongoing narrative. Patients are part of a network of relationships and responsibilities. They may have unspoken beliefs, fears, and expectations about what their illness means which will affect the healthcare choices they make.
The medical narrative breaks down at the point where the patient story goes unheard.
What happens when the patient narrative doesn’t match the physician’s version?
Conflicting illness stories will hinder treatment because the meaning we give to our illness is significant in terms of managing our illness and contributing to our well-being.
Medicine organized around meaning encourages more humanizing care rather than the current standardized care.
I have shared the story of my own experience as a young woman diagnosed with breast cancer and how my doctors didn’t think to discuss fertility preservation options with me before I started treatment. Perhaps my doctors assumed what mattered most to me was saving my life– and of course that mattered a great deal to me — but what also mattered was the story of that life to be saved. It may have been possible to make different treatment choices in terms of the toxicity of chemotherapy, or explore options to preserve fertility during the brief window of opportunity that exists before treatment began.
But my story went untold. So while I received professionally competent care the legacy of that care left wounds that medicine couldn’t fix.
In light of my own experience, my plea to physicians is to be sensitive to the context of the illness experience; to establish a diagnosis in an individual context, instead of merely in the context of a systematic description of the disease.
When stories are missing from healthcare, the result is often confusion, dissonance, a breakdown in communication, resentment and withdrawal. But when we include stories in medicine, we can create understanding, humanity, empathy, meaning, and connection.