Article from the Boston Globe’s On Call Magazine, May 2002

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting

Stories are more than just a listing of random incidents and anecdotes. They have a beginning, middle, and end and they include characters who convey feelings and communicate ideas that your listener needs to hear. That makes them powerful tools for healthcare communication.

Aurita Prince Caldwell, MEd, a policy liaison for maternal, child and family health issues for the Missouri Department of Health and Senior Services, and David Hatem, MD, an Associate Professor of Clinical Medicine at the UMass Medical School in Worcester, both use stories in healthcare settings. But they use them in different ways.

Caldwell uses stories when she speaks to students, community groups, and healthcare professionals. She says stories are an effective way to communicate with people who have trouble reading or concentrating. “Stories,” she points out, “can help people comprehend ideas as well as apply them to their own life.” Caldwell feels that the fables, historic events, and personal experiences she shares with her audiences work more powerfully than if she simply used statistics and slides for presentations. For example, when she trains community members how to be suicide “gate-keepers” (people who are in position to recognize when someone is considering suicide), her stories not only hold their interest but also help them focus on and understand key points. In a one-hour training session, she might tell 6 or 7 stories that highlight warning signs that someone is considering suicide. The stories will also illustrate specific ways gatekeepers can intervene.

Hatem, on the other hand, instead of telling stories, listens to them. He invites patients to tell their own tales. When he treated a woman with Parkinson’s disease, he noticed that she consistently under-dosed her medication. Instead of assuming she was simply non-compliant, he voiced his observation that she seemed to be taking too little. That led her to tell her story about having to decide how much pain medication to give her dying husband several years before and feeling guilty that she hadn’t given him enough. After hearing her story, Hatem had a better understanding why this woman was reluctant to take her medication as prescribed. “Stories like this make practice meaningful,” says Hatem. It makes people’s situations come alive.”

Making Stories a Part of Your Practice

Whether you use stories as teaching tools or encourage patients to tell their own, both Caldwell and Hatem offer tips for using stories to improve healthcare communication.

Give patients an opportunity to tell you their stories. Consider a patient’s medical history to be a story. Ask him or her to tell you about the details. For example, when a patient told Hatem that she had fifteen episodes of abdominal pain, he asked her to talk about one episode from beginning to end. That way, he could focus on her chief concerns and better understand her symptoms. “Don’t just talk about the disease experience,” says Hatem. “The real story is how this disease fits into a person’s life.”

Consider a story in its entirety. Whether you are telling a story or listening to one, think of the story as a whole rather than as a series of isolated incidents. If the story doesn’t make sense that way, find out what is missing or what is wrong. For example, when a patient tells you what it is like to have arthritis, find out not only about the pain and immobility but also how these symptoms affect day-to-day life. Ask the patient to use a story to take you through a typical day. At the end of the story, think about what you are missing in the patient’s story and work with the patient to fill in the gaps.

Use the details to be sure you understand what the patient just told you. When patients tell you their stories, repeat them back to make sure you understand. Be careful, however, not to substitute medical jargon and clinical terminology for the patient’s words and phrases. For example, if a patient talks about “chest pain,” try not to use the word “angina” as shorthand for his or her symptoms. Instead, summarize what you understand by saying “Let me tell you what I’ve heard” or “Correct me if I have any of the details wrong.”

Focus. When you tell stories, keep them brief and to the point. If your story is too long or has too many details, your audience may not understand the point you are trying to make. When patients tell you their stories, listen attentively and do not be overly concerned about the time it is taking. Hatem finds that even the most detailed of patients’ stories seldom take longer than three minutes.

Use stories to encourage discussion. When Caldwell uses stories, she looks for ones that her audience can relate to. She may tell stories about well-known people or familiar locations and use them as a way to introduce a topic or make a transition from one point to another. She is likely to say “Here’s what happened to someone I know” rather than “Here’s how to do it.”

Caldwell also finds that many people prefer to talk about characters in stories rather than themselves. She may invite audience participation by asking “Have you ever experienced anything like that?” or “If you were the person in the story, what would you do differently?”

Appreciate that not everyone likes stories. There is no one best way to get your message across. While many people enjoy and learn from stories, others may prefer more formal presentations. Be prepared to not only tell stories but also to back up your key points with facts, figures, and information from journal articles.

Stories Can Be Tools for Personal and Professional Growth. Health professionals see a lot of human suffering. This can be hard to deal with, especially for those who work alone. Consider writing stories as a way to better understand your day-to-day experiences. As you read your own story, ask yourself how this experience could have been different or what you would like to do the next time you are in the same situation.

Also remember, that whether you use stories in clinical practice or in educational settings, there are both risks and benefits in talking about your own experiences. When you share your story, you run the risk of taking attention away from the points you are trying to make or the person you are caring for. But, used carefully and told or listened to well, stories can be very effective ways that patients and health providers can each use to get their points across and to better understand what the other has to say.

How to Learn More:

Aurita Prince Caldwell, MEd, is a policy liaison in the city of St. Louis for the Missouri Department of Health and Senior Services. You can reach her by phone at: (314) 877-2869 or by e-mail at: princa@dhss.state.mo.us

David Hatem, MD, is an associate professor of clinical medicine at the UMass Medical School in Worcester. You can reach him by phone at: (508) 856-5972 or by e-mail at: hatemd@ummhc.org

Printed Sources

• Branch, WR, Suchman, A. “Meaningful Experiences in Medicine.” The American Journal of Medicine, January 1990, Volume 88.
• Hatem, D, Ferrara E. “Becoming a Doctor: Fostering Humane Caregivers Through Creative Writing.” Patient Education and Counseling, 2001;45:13-22.
• Pennebaker JW. “Telling Stories: The Health Benefits of Narrative.” Lit and Med 2000;19:3-18.