Thursday, October 29, 2015

Telling clinician and patient stories improves care

By Louise Kinross

“Paying attention to stories makes us better doctors, nurses and healers and is also good for patients, clients and survivors,” said Dr. Allan Peterkin a professor of psychiatry and head of the Program in Health, Arts and Humanities at the University of Toronto.

Dr. Peterkin was kicking off the Art Heals Health symposium yesterday that brought together clinicians, artists and educators to talk about how art can be used to improve healthcare and vice versa.

Dr. Peterkin’s talk looked at the healing power of stories.

Medicine has tended to “take the story of the provider and the person out,” Dr. Peterkin noted, and to distil to a few diagnostic words the patient experience “in a way that doesn’t do justice to it.”

This is a response to evidence-based medicine, he said.

In contrast, stories are about “what’s unique and particular” to a person, and care is improved by the clinician’s ability to listen to, tell, and make meaning out of stories over time.

Methods for doing this include reading and discussing medical fiction or illness stories by lay people and writing in response to a prompt that helps clinicians reflect on their work.

Clinicians "almost always write about things that have troubled them,” Dr. Peterkin said. Reading and discussing texts and writing about their experiences makes clinicians better able to communicate and connect with patients and families.

Dr. Peterkin noted that research shows that reading poetry and novels increases the level of empathy in any reader because it helps us imagine being in another person’s shoes. “Your worldview is being stretched by characters that are different from you. To try to understand them you need empathy.”

Dr. Peterkin noted that stories engage both the left and right sides of our brain and make us pay attention to detail and words. “One word in a poem can have 10 different meanings to 10 readers.” This leads to “narrative humility” in clinicians. “We may think we know what patients are saying, but we may not be on the same page.”

“Write about a mistake” or “Write about a goodbye” are examples of prompts for clinicians or healthcare students.

In narrative groups clinicians are asked to: “write about something that matters to them, or is unprocessed; include a beginning, middle and end; write as if you were telling a friend; and show what happened and how you feel about it.”

The act of organizing the story on the page “reorganizes the way we look at things and challenges our pre-assumptions about a story,” Dr. Peterkin said. We can revisit stories and slowly, at our own pace, make meaning out of them.

The other health workers who listen to a piece being read aloud in a narrative group can be “helpful editors as opposed to critics,” Dr. Peterkin said. They're often able to point things out that the author may not have seen in his or her writing.

A new four-day workshop on narrative healthcare is being offered by Mount Sinai Hospital and the University of Toronto in June 2016.
Check out Narrative Healthcare Atelier & Certificate Program.