Have you ever written something that didn’t seem to come across the way you intended? Because I have, many times, almost every day. Not necessarily works of art, but text messages, emails, and pretty much every writing assignment I completed in high school and college. I happened to be thinking about this recently while reading through a story I had written about a patient experience during my residency.
My mind drifted to thoughts of “I wonder if my point got across,” and “I’ve read through this so many times that it’s lost all of its original luster.”
Then I started thinking about more than written stories and messages, but real-life stories and conversations I have with patients every day.
Do you think patients feel the same?
Many people have lived years with the same disease process and have re-read their own story repeatedly.
Do you think they wonder if the subscribers to their life story really understand the message?
I bet they wonder.
Each sign they exhibit and each symptom they describe tells a story, they provide the rough draft and as physicians, we often do the editing.
But how much editing should we do?
Students are often assigned two-page essays, double-spaced, one-inch margins as their guidelines; patients are often assigned fifteen to twenty minutes, yes or no questions, no margin of flexibility. From elementary school we are taught to stay inside the lines, only use one page, only use black ink. Medical training occurs in time limits, quality metrics and measures of performance.
How much editing do we really do and how much editing should we really do?
In all practicality, heavily editing a patient’s story makes sense, it helps us compartmentalize and organize signs, symptoms, and data into templates that lead to a solution. An upper respiratory infection doesn’t take much editing, nor does a classic appendicitis or a myocardial infarction.
But what about the undifferentiated patient?
Their story is like a running narrative without grammar, without new paragraphs, without capital letters.
Do you ever think they wonder how their story comes across?
I bet they do. (In fact, I know they do.)
These are the patients that seem to reserve most of our time and most of our frustrations. Imagine if a textbook was written without page breaks, chapters or diagrams, we would feel the same. I remember the first time I ever read Shakespeare (Eighth grade, English studies class). I had no idea what was happening; nothing made sense, it made me feel like I had never learned the English language even though I was a native speaker. However, over time, the more I studied, the more I learned from my teacher, the more Cliff Notes I read (yes, Cliff Notes), I started to understand some of the key points. In many ways, our undifferentiated patients are trying to speak to us in Shakespeare and wondering if anyone has studied them long enough to understand.
In my limited experience thus far, I have found that just as in storytelling on paper, storytelling in person can often be confusing, frustrating and scary when there’s uncertainty about whether the story-reader will understand the message attempting to be disclosed. However, just like an eight-grader learning Shakespeare for the first time, every physician must study each patient’s stories as if they were works of art. Granted, this is incredibly difficult to do within the well-established time constraints of modern medical practice. However, continuity of care, teamwork, and listening, real listening, can help to interpret the stories our patients are trying to tell us in their raw form.
Medicine is fast becoming a field of editing for the sake of efficiency, but how much farther can we go before the story we are left with is not at all a reflection of the author?
Joe Andrie is a family medicine resident.
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