Every patient has a story. Narrative medicine helps doctors hear it
If you ask Fiona Reilly, a senior paediatric emergency physician, what the key to good healthcare is, her first answer might be a little unexpected. "The fundamental building block of medicine is stories," Dr Reilly tells ABC RN's Life Matters.
But Dr Reilly says doctors often don't allow patients to share these stories, which could include the feelings, concerns and experiences they bring into a medical consultation that impact their medical interactions.She points to a 2019 US study published in the Journal of General Internal Medicine that looked into the time it takes before a doctor interrupts a patient for the first time.
"It's devastatingly bad. It's 11 seconds," she says. But when they are given that space, Dr Reilly says a patient's experience is vastly different — and so is the feeling they walk away with.
A worried mother's story
When patients visit a doctor they bring "complex and sometimes quite ambiguous problems", Dr Reilly says. And these aren't always answered by a purely scientific approach to medicine. Dr Reilly believes it's essential that health professionals also have skills in listening deeply to their patients. Without those skills, they'll miss valuable information and a valuable opportunity to build trust and connect with their patients. For example, Dr Reilly recalls meeting a family at her paediatric emergency department several years ago. Their three-year-old daughter had a fever and doctors treating her believed it was likely a viral illness and that the child wasn't too unwell. But the family remained highly anxious about the child's illness. It led the doctors to do a number of extra tests — including a urine test, chest X-ray and blood test — which were "building up in terms of the complexity and cost, both to the patient and to the system", Dr Reilly says.
The tests returned as normal, but the family's concern was undiminished. As a result, "the doctors began to second guess themselves", wondering if they were missing something, Dr Reilly says. She was brought in to give a second opinion. The first thing she did was speak with the child's mother, who was on the verge of tears. "What transpired was a really important story," Dr Reilly says. The mother explained that years earlier, when she was 34 weeks pregnant, she sensed something was not right with her pregnancy and sought medical care. At the hospital, she'd been reassured that everything was okay after a number of tests. But, tragically, after she returned home the baby had died. "It was as the mother told me this story that I understood how that story connected to the story of why she was so worried about this child today," Dr Reilly says. It meant all the doctors could approach the family with a greater understanding of their concern and a better chance of managing it. Dr Reilly says the more patients feel listened to, the more likely they are to have closer and more productive relationships with their medical providers. "When patients come to me, they come with a story about their illness, that narrative of their illness experience," she says. "That storyteller has power."
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