The pandemic has been a time of painful social isolation for many. Few places can be as isolating as hospitals, where patients are surrounded by strangers, subjected to invasive tests, and hooked up to a series of beep and gurgle machines.
How can the experience of receiving medical care be made more welcoming? Some say that having a compassionate ear can go a long way in healing patients who are under the stress of hospitalization.
“It’s even more important now, when we can’t always see or touch patients’ faces, to really hear their stories,” said Dr. Antoinette Rose, an emergency doctor in Mountain View, California who now works with many patients who have Covid.
“This pandemic has forced many caregivers to immerse themselves in the human stories that are playing out. They have no choice. They become “family” at the bedside, “said Dr. Andre Lijoi, medical director at York Hospital in Pennsylvania. Doctors, nurses, and others who assist with patient care “need time to slow down, take a breath, and listen”.
Both doctors find their inspiration in narrative medicine, a discipline that guides doctors in the art of listening deeply to those who come to them for help. Narrative medicine is taught in some form in approximately 80 percent of medical schools in the United States today. Students are trained in “sensitive interviewing skills” and the art of “radical listening” to improve the interaction between doctors and their patients.
“As doctors, we have to ask those who come to us, ‘Tell me about yourself,'” said Dr. Rita Charon, who founded Columbia University’s landmark medical narrative program in 2000 We know the questions we need to ask. We have a checklist of symptom questions. But there is an actual person before us who is not just a collection of symptoms. “
Columbia currently offers online training for medical students like Fletcher Bell, who says the course is helping to change the way he sees his future role as a healer. As part of his training as a storyteller, Mr. Bell stayed in virtual contact with a woman who was being treated for ovarian cancer. He described the sharing experience as both heartbreaking and beautiful.
“It can be therapeutic just to listen to people’s stories,” noted Bell. “If there is fluid in the lungs, drain it. If there is a story in the heart, it is important to bring it out as well. It is also a medical intervention that is not easy to quantify. “
This more personalized approach to medical care is not a new art. In the not too distant past, general practitioners often treated several generations of the same family and knew much about their lives. But as medicine became increasingly institutionalized it became faster and more impersonal, said Dr. Charon.
The typical doctor visit now takes 13 to 16 minutes, which is usually all insurance companies pay for. A 2018 study published in the Journal of General Internal Medicine found that the majority of doctors at the prestigious Mayo Clinic didn’t even ask people what the purpose of their visit was, and often interrupted patients talking about themselves.
But this fast food approach to medicine is sacrificing something substantial, says Dr. Deepu Gowda, assistant dean of medical education at Kaiser-Permanente School of Medicine in Pasadena, California, led by Dr. Charon was trained in Columbia.
Dr. Gowda remembers an elderly patient he saw during his stay who suffered from severe arthritis and whom he found angry and frustrated. He came to fear her office visits. Then he began to ask the woman questions and listened with interest as her personal story unfolded. He was so intrigued by her life story that he asked her permission to photograph her outside of the hospital, which she granted.
Dr. Gowda was particularly impressed by a picture of his patient, stick in hand, clinging to the railing of her walk-in apartment. “This picture for me represented their daily struggles,” he said. “I gave her a copy. It was a physical representation of the fact that I cared about who she was as a person. Her pain didn’t let up, but there was an ease and a laugh in these later visits that weren’t there before. There was some kind of healing that took place in this simple human appreciation. “
While few working doctors have the free time to photograph their patients outside of the clinic or delve deep into their life stories, “people take it in” when the doctor shows genuine interest in them, said Dr. Gowda. You will trust such a doctor more and will be motivated to follow their directions and come back for follow-up visits, he said.
Some hospitals have started conducting preliminary interviews with patients before clinical work begins in order to get to know them better.
Thor Ringler, a family therapist, started the My Life, My Story program in 2013 at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. Professional writers are hired to interview veterans – via telephone and videoconferencing since the pandemic broke out – and write a brief bio to be added to their medical record and read by their attending physician.
“My goal was to offer veterinarians an opportunity to be heard in a large bureaucratic system in which they do not always feel heard,” said Ringler.
The program has expanded to 60 VA hospitals, including Boston, where more than 800 veteran stories have been compiled over the past three years. Jay Barrett, nurse manager at VA Boston Healthcare System, said these biographies often provide important information that can serve as a guide to treatment.
“Unless they have access to the patient’s history,” said Ms. Barrett, “healthcare providers do not understand that this is a mother who is caring for six children or who does not have the funds to pay for medication. ” or this is a veteran with severe trauma that needs to be addressed before even discussing how to deal with the pain. “
Dr. Lewis Mehl-Madrona, a family doctor who teaches at the University of New England in Biddeford, Maine, has examined veterans undergoing pain management. Those asked to share about their lives had less chronic pain and rated their relationship with their doctor higher than those who hadn’t. The doctors who requested the stories also reported greater job satisfaction and less emotional burnout, which has become a particularly worrying problem during the Covid pandemic.
The demands on the time of the health care workers have never been so high. However, proponents of narrative medicine say it takes only a few moments to establish an authentic human connection, even when the communication is online, as is often the case today. Dr. Mehl-Madrona argues that remote video conferencing platforms like Zoom can make it even easier to keep tabs on people at risk and solicit their stories.
Derek McCracken, a professor at Columbia University who helped develop training protocols for using storytelling techniques in telehealth, agrees. “Telehealth technology can be a bridge,” he said, “because it is a balance that forces both parties to slow down the conversation, be vulnerable and listen carefully.”
The critical point for Dr. Flour madrona is that people asked to speak about themselves – whether in person or on screen – “don’t just throw themselves in to the doctor for repairs. They are actively involved in their own healing. “
“Doctors can be replaced by computers or nurses if they feel their only job is just to prescribe medication,” he added. “If we are to avoid the fate of the dodo bird, we need to establish dynamic relationships with patients and place symptoms in the context of people’s lives.”