Every Patient Tells a Story

When gathering information from a patient, whether it be their health history on their first visit or a report of progress on a follow-up visit, I think it is vitally important to recognize patients are telling a story. Unfortunately, storytelling is something that has become downgraded in our society and our interactions with one another. Increasingly our use of language is constrained and abbreviated: by technology and other communication tools, by moving in and out of different micro-cultures, by perceived judgment from outside, and by the censure of our own inner judgment. People are rapidly losing the ability to tell a good story with all of its important aspects: who the other characters are, what happened, what the context was for what happened, how that made them feel, what that motivated them to do or or not do certain things, and what the consequences were for their actions.

A short story is not a small story.
— Alice Munro

All health conditions are rooted in and arise out of a personal story. But in the standardized forms of most medical organizations, there is only a list of check boxes: what is happening and possibly what has happened. That’s it…end of story…and end of storytelling. And patients often remark that when they do try to tell a story, those other aspects, that refined granularity that provides so much context, are thought to be peripheral and hence irrelevant or unnecessary. If you removed all of the minor characters and occurrences from a story, what would you have left? Would there be something there to read and engage you? Are we all not longing for a good story, with every detail accounted for, even those that might be seen as peripheral?

Even the briefest of stories, a simple statement, an expression of feeling, a re-telling of a situation, serves to create further context in which to view a person’s health condition, provides a foot hold on which to build a treatment, and reveals the places that require the most care and attention to reinforce. Like a scaffolding structure, the more stories you hear, they higher and more complex it can be built. But to do so, even a simply story, a short story, requires that all of its details be taken into account, even those that appear to lie in the periphery.

The periphery is only the periphery from a certain vantage point. If you change the point from which you are viewing the story, then the peripheral details may move to a different location of emphasis, and in this shift may become a central aspect of the story. There is an importance as a practitioner to seek out those different vantage points in order to see if those peripheral details remain at the periphery or move into a more focused place. There is a purpose and an advantage to listen to and appreciate the whole story. 

Trauma is not what happens to us, but what we hold inside in the absence of an empathetic witness.
— Peter Levine