“Tell Me a Story”
 

Stories are the basic tool and great reward of medicine. Stories enrich the lives and experience of both patient and doctor (teller and listener). They give an account of people, events and feelings that extend over time, and this longitudinal dimension is a fundamental part of the long-term relationship between a GP and a patient. For many patients the GP record is the only sustained written record of their lives. The existence of this concrete documentation of their suffering, coping and endurance gives tangible form to the GP’s role as witness to the patient’s unfolding life story.

Stories of illness

The patient comes to us to tell a story of his or her illness; to give an account of when he/she became aware of things being not quite right within the body or mind; of how it all seemed to begin and how it developed to the point when he/she felt that it needs the attention of a doctor. The story may include details of who else has been told and from whom else advice has been sought, of what he/she and others may think have caused the problem to arise at this time. However the evidence suggests that the story is seldom heard. On average the doctor interrupts after 18 seconds of the patient’s narrative. Yet if the patient is allowed to proceed, the full story averages only 29 seconds.

Stories of Disease

“Illness is what the patient has on the way to see the doctor and disease is what they have on the way home”. Anon.
Having listened to the patient’s account of his/her symptoms we seek those parts of the narrative that fit the stories of disease, the patterns that medical science has defined in an attempt to make sense of the suffering caused by illness, and to find relief or cure. As a result do we distort or coerce the patient’s story to fit the patterns of Science? Scientific medicine offers much benefit but also carries great dangers of iatrogenic disease. If illness caused by unhappiness, anger, grief or other emotions is misinterpreted as being due to disease, the patient is exposed to the dangers of scientific medicine without benefit. Society also incurs the considerable costs of high technology medicine.
The taxonomy of diseases represents the nearest that Science has got to Nature, but it is a theoretical construct only.
 

Stories of Endurance

“Cur’d yesterday of my disease, I died last night of my physician”.
Matthew Prior, poet 1664- 1721

“When a lot of remedies are suggested for a disease, that means it can’t be cured”. The Cherry Orchard. Anton Chekov 1860-1904

Once the technical transactions of medicine are complete, doctor and patient still have to come to terms with the debility, pain and fear that comes with illness, disease and treatments. When there is no cure and no scientific explanation for the arbitrariness of suffering we construct a narrative of endurance and survival. This task is central to the relationships in general practice in which the GP and the patient may be left to find a way forward together after the specialists who investigate and treat have finished.

If the full potential of the patient’s story is to be realised the doctor needs to be willing to listen, to hear and to be literate at many levels.

After Iona Heath in Narrative Based Medicine (Greenhalgh & Hurwitz)
 

TASK

(for workshop, Birmingham Conference 2005)

All of us have stories to tell. We have stories of our own and tales of others.
You have 15 minutes to construct the outline of a story that you feel is worth passing on to others, perhaps concerning a patient, the physician or healer, and the ethics or issues involved, or for any other reason that you fancy.
It might illustrate a moral, point of view, element of humour, dilemma or just entertain. It will inevitably be an opportunity for learning.
Then in turn you will present your story, hear another’s story and observe the processes going on.