Jessica Bylander - Narrative Matters: Writing to Change the Health Care System

1. Abraham Verghese
2. Maureen A. Mavrinac
3. Maria Maldonado
4. Elaine Schattner
5. Siddhartha Mukherjee
6. Jonathan Friedlaender
7. Katti Gray
8. Charlotte Yeh
9. Timothy Hoff
10. Cindy Brach
11. Donna Jackson Nakazawa
12. Raya Elfadel Kheirbek
13. Aroonsiri Sangarlangkarn
14. Laura Arrowsmith
15. Leana S. Wen
16. Louis W. Sullivan
17. Gayathri Subramanian
18. Yasmin Sokkar Harker
19. Cheryl Bettigole
20. Diane E. Meier
21. Patricia Gabow
22. Dina Keller Moss
23. Myrick C. Shinall
24. Louise Aronson
25. Gary Epstein-Lubow
26. Carla Keirns
27. Gautham K. Suresh
28. Katy B. Kozhimannil
29. Janice Lynch Schuster
30. Travis N. Rieder
31. Pooja Lagisetty
32. Otis Warren

What a treat to write a foreword a second time for a second collection of the best essays submitted to the Narrative Matters section of Health Affairs. The last such volume was over a decade ago. I love seeing how the grand experiment by Fitzhugh Mullan and John Iglehart in adding a new section to the esteemed journal Health Affairs has become so established that most readers will assume it has always been there.

When Narrative Matters was first conceived, I wondered if it would survive. The very idea of a highly respected medical journal publishing stories that captured poignant human lessons of heartache, joy, and redemption was still new; those of us who wrote such pieces were suspect and we admitted to authorship sheepishly, knowing full well the coin of the realm, particularly in a journal read by those in the C-suite (who often paid my salary), was data. When the time came to economize, would this qualitative section of the journal (or in the parlance of undergrads, the fuzzy as opposed to the techy section) be jettisoned to keep the ship afloat? I find it delightful to see how well it has thrived.

We have come a long way. Story and story seminars and finding your story are all the rage now, the staple of executive coaching seminars and business school retreats within and without the health care enterprise. Thank God for that.

Kants Critique of Pure Reason opens famously with the words, That all our knowledge begins with experience there can be no doubt. In medicine, for the longest time it seemed true that experience meant the quantified experience with raw numbers valued over the subjective experience of care; what the doctor or patient felt was less important than what could be measured. But Narrative Matters drew a line in the sand. It said that in the world of health care, in the $3 trillion trough at which we all feed and where reimbursement drives practice, stories matter. Stories change our lives.

If you dont believe stories have power, think of Harriet Beecher Stowes Uncle Toms Cabin: that story is what ended slavery in America. It wasnt a president, a congress, or an army but a change in public sentiment triggered by that tale that ended slavery. The book The Citadel, by A. J. Cronin, is thought to be responsible for the birth of the UKs National Health Service, because the fictional tale of health care conditions in a coal-mining region reflected a shocking reality and rallied the public. The stories of Ryan White and Magic Johnson changed the tenor of conversations around AIDS. From the Tuskegee story of rogue research in syphilis to the story of Henrietta Lacks, stories shape health care, shape trust. Narrative has always mattered.

The reflective essays found in this volume are the very best of the recent years. Although the editors have put them in categories, the authors surely did not write them with a category in mind. Instead, they wrote because of something that deeply affected them, something they lived through or observed, and you can be sure it was always personal and heartfelt.

And for us, the readers, the effect is striking and uniform: we are moved and we carry away some new understanding, one we would be hard pressed to convey to another except through story. Narrative moves us. It drives us to the kind of insight and realization that William Stafford captures in a few lines from his poem You Reading This, Be Ready:

lift this

new glimpse that you found; carry into evening

all that you want from this day. This interval you spent

reading or hearing this, keep it for life

What can anyone give you greater than now,

starting here, right in this room, when you turn around?

So, dear reader. Start now. Be ready.