What if I told you that, as your doctor, I’d rather listen to your memoir than to your lungs? Or that while I find the sound of a beating heart a marvel to behold, I’m more interested in hearing the jazz song that you wrote or talking about the words tattooed on your left wrist. What if I asked not only about your symptoms, but also about your life, your narrative, and the story behind how you’ve owned more than 100 cars in your lifetime?
This is not to imply that I don’t care deeply about clinical medicine. I love being a doctor. As a hospitalist, I specialize in the care of acutely ill hospitalized adults, and I’m passionate about helping my patients on their road to recovery.
But when it comes right down to it, it’s the stories that keep me going. Illness can’t exist without narrative, and stories are the currency of medicine.
Sometimes the tales are uplifting, like the centenarian who tells everyone she meets that an aversion to shrimp was her secret to long life. Other times you have to look for the beauty beneath the sadness, like the time a homeless man told me that he calls his cardboard home “The Fortress.”
And sometimes the stories are heartbreaking, like discussing trade secrets of smoked pork ribs with a 35-year-old woman who was just denied a lifesaving organ transplant, her eyes full of tears as she argues the merits of a vinegar-based barbecue sauce she will likely never make again.
I am privileged to hear stories like these — intimate, extraordinary accounts of self — almost every day. Passionately attending to these narratives allows me to empathically connect with my patients and to stay resilient in the face of suffering by remembering why I became a doctor in the first place.
People choose careers in medicine to treat human beings — not their diagnoses — and to alleviate suffering of the body as well as of the mind and the soul. Western medicine has historically been rooted in an obstinate focus on disease processes rather than on the people with the disease, a tendency to treat the physical while ignoring the existential and the psychosocial. It’s hard to feel compassion toward a disease, so what you’re left with is mechanistic, depersonalized patient care.
In the latter half of the 20th century, the medical humanities were established in an effort to rehumanize clinical practice and teach budding doctors not only scientific and technical skills but also empathy and humanity. And while the number of health humanities programs has more than quadrupled in the past two decades, they remain fragmented and unstandardized. Establishing humanities as an integral and universal component of medical curricula is essential. Doctors need to learn the human side of health care. They need to be taught how to relate to their patients on a personal level. And there is no better way to connect meaningfully with patients than to listen to their stories and to fully receive them.
My belief in the importance of narrative is why I, like many other physicians, write creatively about my experiences in health care. It’s why I read the trainees I work with not only the latest scientific studies from JAMA and NEJM but also poetry by Emily Dickinson. It’s the reason I work with the Northwest Narrative Medicine Collaborative, a nonprofit organization that believes in the power of story to treat a heartbroken health care system. And it’s why, when I meet patients in the hospital, I take the time to be humbled and amazed by the stories they share — stories of illness and often of suffering but also of love and triumph and the passion of a life well lived.
So don’t be surprised if your doctor wants to spend more time listening to your stories than to your organs. Don’t be offended when she or he asks not only about your cough or your rash but also your hopes and your dreams. About your secret to longevity, your cardboard fortress, or your personal opinion on barbecued meats.
Zachary G. Jacobs, M.D., is a hospitalist in Portland, Ore., with a passion for creative arts and storytelling and a board member of the Northwest Narrative Medicine Collaborative. The stories in this essay are based on actual patient encounters, although personal details have been omitted or modified to maintain patient privacy.