View from the Other Side of the Stethoscope: What's the Story?
2010; Wolters Kluwer; Volume: 32; Issue: 4 Linguagem: Inglês
10.1097/01.cot.0000368871.73133.e7
ISSN1548-4688
Autores Tópico(s)Injury Epidemiology and Prevention
ResumoWhether it's a pink-ribbon pin on your patient's lapel or a wink she gives your nurse, you can be sure of one thing: If you ask, she'll tell you the backstory. Because that's what people do. We share stories. When we are children, folklore helps us know who we are, where we came from, and what's happening around us. Stories teach us values and shape our dreams for tomorrow. My family-lore includes a tale I first told my children when they were young. Maybe you, too, have heard about a heavenly angel who flies around, sprinkling the perfect amount of invisible “baby-dust” that flutters to earth. When a smidge lands on a newborn, it makes that baby sweet, smart, adorable, entertaining, loving, and irresistible. To this day when one of my kids says something thoughtful, I might say, “See? This proves my case: When you were born, the angel tripped and spilled her whole basketful of baby-dust on you!” More than simply telling my children they are wonderful, my silly story communicates the intensity of my feelings. Stories help us understand risks and follow rules, too. In school, students aren't just told, “Alcohol damages unborn babies; it leads to car wrecks.” These kids are also shown photographs of small, pickled brains or FAS facies, and a variety of horrific car accidents. Teachers know that anecdotes stir empathy in ways that isolated facts can't. And more than anything, they want their students to know the risks with their head and with their heart. Consequently, every day we all use stories to help us adjust to the twists and turns of our lives, as well as to increase the chance others will listen, care, remember, and respond favorably to whatever we say. Like any instrument of power, stories can be used for good or for evil. A boy who is repeatedly told “You are just like your Uncle Jeff” may become a marathoner, inspired by the image of his fit and spirited uncle. In another family, being told “You are just like your Uncle Jeff” can cripple a child who now feels destined to vegetate in front of a television—smoking and coughing, too obese to move. When it comes to cancer survivorship, stories play a vital role in illness and healing. Patients spin stories to make sense of their disrupted lives and to revive their self-identity when feeling unrecognizable. Uplifting stories—their own and others’—can motivate them to enroll in a clinical trial or to endure difficult treatments. Conversely, stories of helplessness or hopelessness can lead to despair. As oncologists, you play a star role in your patients’ narratives, whether you want to or not. For anyone doubting this, the next time you walk through the atrium of your hospital or ride the elevator of your office building, watch the patients. They are calling or texting friends and loved ones, repeating verbatim what “the doctor” said. Then these friends and loved ones tell their friends and loved ones. Such storytelling reminds me of the children's game “Telephone,” where messages get progressively mangled as they are whispered from one player to the next. Only it's no fun at all if your patients mistakenly foreshadow a tragic ending, having imbued your throat-clearing or the twitch of your eyebrow with unmerited significance. It's also a problem if your cheery greeting leads a terminally ill patient to think you've found an answer. In either case, your being unclear can unwittingly lead your patients’ stories astray. Just as importantly, your voice may fall on deaf ears if your recommendations or encouragement don't mesh with the setting of your patient's story. A single parent working two jobs and without family support will probably ignore your advice to rest in the afternoon. Your prescription for PT may remain untouched in a kitchen drawer. When it comes to knowing patients’ stories, the rare physician who makes house calls has an advantage. Nothing offered by modern hospitals and clinics can compare with the intimacy of examining patients in their own beds and then talking with family members over a cup of tea in their living room.WENDY S. HARPHAM, MD, is an internist, cancer survivor, author, and mother of three. Her books include Diagnosis: Cancer, After Cancer, When a Parent has Cancer, (selected as a #1 Consumer Health Book by the American Journal of Nursing), Happiness in a Storm, and most recently, Only 10 Seconds to Care: Help and Hope for Busy Clinicians. She lectures on “Healthy Survivorship” issues, including recovery and late effects, raising children when a parent has cancer, clinical trials, and finding happiness in hard times. As she notes on her Web site (www.wendyharpham.com), her mission is to help others through the synergy of science and caring. She also writes her “On Healthy Survivorship” blog at wendyharpham.typepad.comThat is not to suggest I yearn for yesteryear. Sophisticated tests and treatments—not words or kindness—saved my life. My future survival depends on the researchers and clinicians who are looking to personalized medicine as the Holy Grail. Even so, I hope that along with physicians’ efforts to target therapy to patients’ genomic fingerprints, they keep striving to understand patients’ illnesses in the context of their lives. For it is this knowledge that fosters compassion. So I have three suggestions: Listen to your patients’ stories. Since storytelling comes more naturally than providing a “history of the present illness,” give patients a chance to tell their story. It doesn't have to take long. Try asking about their hopes for today and tomorrow. Have your patients bring in one or two favorite photos. In just seconds, you might learn a thousand words’ worth of your patients’ life stories. You may gain insights that make your evaluations and treatments as efficient as possible. Use stories to help patients heal. Tell anecdotes that teach, comfort, and encourage patients. Refer to reputable resources where stories of help and hope can guide patients through treatment and recovery. Guide patients’ stories. Teach patients that a diagnosis does not determine the ending. Encourage patients to embrace the power to affect both the outcome and their quality of life. Offer words of hopefulness that can be repeated over and over long after the visit, woven like golden threads that glitter throughout the tapestry of the patient's survivorship. Whatever the changes brought on by 21st century medicine, the key to preserving compassion lies in the stories we share.
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