Clegg Gareth - Storytelling in medicine: how narrative can improve practice

Storytelling in Medicine

How narrative can improve practice

Storytelling in Medicine

How narrative can improve practice

Edited by

Colin Robertson

BA (Hons) MBChB MRCP(UK) FRCPGlas FRCS Ed FSA Scot

Honorary Professor of Accident and Emergency Medicine and Surgery

University of Edinburgh, UK

Gareth Clegg

BSc (Hons) MBChB PhD MRCP(UK) FRCEM

Senior Clinical Lecturer

University of Edinburgh, UK
and

Honorary Consultant in Emergency Medicine
Royal Infirmary, Edinburgh, UK

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Version Date: 20160513

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Contents

Colin Robertson, Gareth Clegg

Graham Easton

Fiona Nicol

Jim Huntley

Jacques Kerr

Allan Cumming

Sarah Richardson, Colin Robertson

Jim Huntley

Colin Robertson, Fiona Nicol

Our profound gratitude to the many friends and colleagues who have, directly and indirectly, shared, stimulated and guided the stories and writing of this book. My particular thanks are due to David Currie, Eillyne Seow, Wilson Cheong, Mads Gilbert, Azra Hasan, Chris Robinson, Yuen Yen Ng, Andrew Stevenson, Lindsay Robertson and Corey Gill.

CR

To Alistair Bryce-Clegg, Eric Clegg, Denis Brazell, Nick Blair, Paul Gowens and Karl Martin for helping me appreciate the pleasure and power in good stories well told. Alice Clegg for helping me learn to listen better.

GC

Thanks to Katrina Hulme-Cross, Joanna Koster, Julia Molloy, Vivianne Douglas and Jamie Etherington for their assistance, direction and forbearance in its production.

CR and GC
Edinburgh
May 2016

Stories are the most important thing in the world. Without stories, we wouldnt be human beings at all.

Philip Pullman

The real problem is not precise language. The problem is clear language.

Richard Feynman

BECAUSE WE SWIM IN the river of change, we forget its pace. To paraphrase Arthur C Clarke, the Medicine that we practise would be Magic to our clinician forebears of even a century ago. Some humility is needed, however. Although frequently forgotten or marginalised, the largest contribution to human health and well-being has come from public health measures: the provision of clean water and sanitation, safe housing, reliable techniques of birth control, and employment. Added to this, immunisation and antibiotic and antiviral drugs have eliminated or dramatically reduced many of the scourges of infectious disease. Indeed, few students or younger clinicians have ever seen the common childhood illnesses such as measles, whooping cough or mumps experienced by their parents. Imaging techniques such as CT and MR scanning have transformed both diagnosis and treatment and have provided unique insight into physiological processes. Anaesthetic, critical care, innovative surgical techniques and transplantation have opened up treatment possibilities previously considered to be the realms of science fiction. The potential benefits of genomic diagnosis and treatments, promised for so long, are now becoming a reality, while controlled trials and evidence-based evaluation are now standard components of healthcare provision.

With these extraordinary developments an observer could be forgiven for considering that satisfaction with the state of medicine should be high. We live longer. In rich countries infant mortality is low. For most, death results from the diseases of senescence: cardiovascular and cerebrovascular disease, cancer and dementia. Wherefore then is the dissatisfaction of patients and practitioners? In any survey of patient experience communication failure comes high in the list:

The doctor looked at the screen, not at me.

I was talked at, not with.

I was asked a list of questions and expected to answer Yes or No.

Nobody listened to my story.

Clinicians commonly cite time pressures and targets to excuse these problems. They are feeble, diversionary justifications. Some specialists, focused solely upon their organ or disease of interest, fail to see the need to contextualise the patient and their problem. It is worrying to see it stated recently in a major medical journal: when physicians take into account the needs and circumstances (that is context) of their patients when planning their care, individualised health care outcomes improve (Weiner