The style of medical writing that residents are exposed to, both in medical school and throughout training, revolves around the many. We are taught to think in terms of evidence-based medicine – and with evidence, the power is in the numbers. Most literally, a study with more participants is highly powered, but more practically, we prioritize the results of reproducible, peer-reviewed, meta-analyzed, systemic research. Most specialties require a capstone scholarly activity and/or quality improvement project to graduate residency because, to practice medicine, one must understand the wiring of our greater consciousness. We learn to think alike. However, along the way, we are asked repeatedly, throughout interviews and on applications, to return to our individual story – a task that seems oddly counterproductive to our hospital hive mind. Each personal essay demands reflection, frequently on challenging or motivating moments in the life of the author, which subtly exercises the muscles of empathy and perspective. We find ourselves at a crossroads: caught between speaking our truth and speaking the truth.
“During residency, our days consist of a string of patient interactions, rapidly weaving into a quilt of tragedy. But patients do not only get lost among each other, they get lost in their disease process.”
In a recent article from The Harvard Gazette, Neal Baer, a writer for television dramas, introduces a concept from University of Oregon psychologist Paul Slovic: the value of a single life diminishes against the backdrop of a larger tragedy (asamonitor.pub/3Tsg6kJ). During residency, our days consist of a string of patient interactions, rapidly weaving into a quilt of tragedy. But patients do not only get lost among each other, they get lost in their disease process. We evaluate the history of a patient “from a scientific perspective, not keeping in mind [the] patient’s personal experiences” (Int J Environ Res Public Health 2020;17:1135). We come to find ourselves several seats away from our patients, and we are comfortable here; this is where our colleagues, friends and mentors sit, too. But every so often, we wake up frustrated that we are so distant. I recall feeling disconnected from patients as a second-year medical student, jealous of those years above me who were already working in the hospital. I wasn’t alone in this sentiment, so the dean of my medical school prescribed my entire class homework: go read your personal statement. Remind yourself why you are here. The power of a narrative, of storytelling, in bridging the gap between the personal and the scientific, the student and their purpose, the physician and their patient, is too often dismissed as inferior to the evidence-based mentality among residents. We see ourselves as being in the business of efficiently diagnosing and/or treating an illness rather than the individual. But there exists a marriage of the two models, where the story of the individual informs the treatment of the disease: narrative medicine.
The term “narrative medicine” was coined by Rita Charon, MD, PhD, in the early 2000s and has only continued to gain traction in medical training. Defined in her original JAMA publication as “medicine practiced with narrative competence… the ability to acknowledge, absorb, interpret and act on the stories and plights of others,” narrative medicine seeks to provide a framework for comprehending a singular person’s situation unfolding over time (JAMA 2001;286:1897-902). The interaction of the one inside the many, (i.e., the physician seeing their 10th consult for uncontrolled diabetes) could be met with “monolithic, [hierarchical] meaning,” or a sweeping generalization of the patient’s story and thus outcome (JAMA 2001;286:1897-902). Only with practice and intention to elicit an individual’s history do “local – and possibly contradicting – authority replace master authority” (JAMA 2001;286:1897-902). Facing this new patient-centered authority, our hive mind, usually so focused on the irrefutable, evidence-based truth, dissipates. The collective “we” becomes an “I.”
“We see ourselves as being in the business of efficiently diagnosing and/or treating an illness rather than the individual. But there exists a marriage of the two models, where the story of the individual informs the treatment of the disease: narrative medicine.”
Like any skill, the ability to hear a history and create a story requires practice. Some institutions have formalized narrative medicine training, but I believe we, as residents, are accidental masters of the trade. Every H&P, op note, radiologic impression, or preop assessment has required us to pause. For brief moments, we author a patient’s story, inherently intertwining our own perspective. Beyond the hospital, we share stories with our peers or read anecdotes from across the profession in journals or on websites. We take ownership of our patients through our retelling of their illness, and we serve them better as a result. Stories have a purpose in medicine, and I encourage all residents to continue sharing theirs.