As Important as the Numbers: The Stories Patients Tell
by Beth Toner, RN, Senior Communications Officer, Robert Wood Johnson Foundation
Patient information: 99-year-old female, status—post hip and elbow fracture. Temperature 98.1 F. Pulse 73. Respiration 17 BPM. Pain 8/10.
As health care professionals, we learn a lot about someone from this kind of shorthand. It's our own language, designed to give busy nurses and physicians the maximum amount of information in the minimum amount of time. It is invaluable. It also has a serious shortcoming: It doesn't tell the whole story.
What this shorthand doesn't tell you is that this "99-year-old female" is someone's great-aunt (my husband's great-aunt, in fact). It doesn't tell you she's outlived two husbands (one lost in the Pacific during World War II and one who passed away just four years ago). What you can't learn from her vital signs is that she values her independence and that she lives for her weekly trips out with her niece for chili and a Frosty at the local Wendy's. Most of all, it can't tell you that she has had a marvelous life and doesn't feel up to extending it if it means enduring multiple surgeries and lengthy physical therapy.
We need that narrative—the story of the patient's life, his or her context—to provide the best possible care. That narrative helps us understand that while protocols (which are important and necessary) may declare the importance of working toward a particular outcome, it's possible the patient values an entirely different outcome altogether.
Patients need to tell their story, too; it helps them make sense of their struggles and can offer healing.
Finally, as health care professionals, we also need to be conscious of our own story—our context, our motivations, our fears and our joys—to be the best care providers we can be and to remember the joy that called us to our profession in the first place.
That's why, in February, the Business Innovation Factory—with support from the Robert Wood Johnson Foundation—gathered patients, performing and visual artists, writers, entrepreneurs, physicians and nurses to talk about the role narrative can and should play in health care. Each attendee brought a unique perspective to the gathering; each is applying or employing storytelling, theater and other types of arts in their health care work.
Over the course of two days, this eclectic group brainstormed the types of situations in which narrative could be helpful to patients, their caregivers and health care professionals, then thought about the types of narrative that would be most beneficial in each situation. The outcome? The Power of Narrative, an interactive "playbook" designed to make it easy for anyone interested in experimenting with the power of narrative and storytelling to improve health and health care.
I wish my husband's Aunt Sissy had had the benefit of health care providers who valued her story as much as they did the medical procedures that they pressured her to undergo in the name of "better outcomes." Thankfully, after one hip surgery, this brave woman declared "enough is enough." She returned to familiar surroundings—and passed away peacefully three weeks later.
The good news is that, as a health care professional, you have the power to create a culture of storytelling that will empower you, your patients and caregivers alike:
Listen: Getting the patient's story doesn't have to be time-consuming. Try asking open-ended questions—and really listen to the answers—while you're taking vital signs or performing other routine tasks.
Read: Spend time reading memoirs by both patients and health care providers, as well as patient blogs and other social media. Getting different perspective helps you deliver better care—and will remind you why you became a health care professional in the first place. Some of my favorites:
- A Whole New Life (Reynolds Price)
- Brain on Fire (Susannah Cahalan)
- Medicine in Translation: Journeys With My Patients (Danielle Ofri)
- Critical Care: A New Nurse Faces Death, Life, and Everything in Between (Theresa Brown)
- Lisa Bonchek Adams' blog
Know what resources your facility offers: Arts or other types of creative therapies can be helpful for adults and children alike!
Use "down" time to allow the patient to express himself or herself with writing, drawing or other creative arts. For instance, provide a writing pad and pen while waiting for test results.
Learn more and be an advocate: How can you help your workplace incorporate patient narrative into practice?
Set a good example: Being a health care provider is both rewarding and emotionally intense. Make an intentional practice of processing your feelings about the work you do and the patients you care for (while protecting their privacy of course!) by journaling, drawing, painting, quilting—whatever helps.