Why storytelling is critical in medicine [PODCAST]

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“I love stories, either told, written, or listened to. Songs tell stories, as does art. Blogs such as the rich content open so many doors for rich conversations. Telling stories is part of who I am. My father loved to tell them, as did my grandfather, whose name I took. They were called bull-sh*tters – and perhaps some refer to me that way at times. In medicine, I find storytelling to be critical. Each time we present a case, we are telling a story. Those residents and students who can present a case to me in a way that draws me in while giving me the necessary facts, but goes the next step that allows me to see that person in their life are the ones I know will be amazing doctors.”

John F. McGeehan is an internal medicine physician.

He shares his story and discusses his KevinMD article, “Why storytelling is critical in medicine.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we welcome back John McGeehan. He’s an internal medicine physician, and he wrote the KevinMD article “Why storytelling is critical in medicine.” John, welcome back to the show.

John F. McGeehan: Thank you very much for having me.

Kevin Pho: So we’ll get into the article in a little bit, but for those who didn’t get a chance to listen to our first episode, can you just briefly share your story and journey to where you are today?

John F. McGeehan: Sure, thank you. I’m a primary care physician. I’ve been doing primary care internal medicine for over 42 years now. Currently, I teach full time, in the classroom and at the bedside. My main interest is medical ethics, so a lot of what I weave into the stories has a background in that as well. I love every single day, I love what I do, and retirement is not on the right.

Kevin Pho: One of the things that you said struck me: You still teach by the bedside, and I think that’s important, because now we do a lot of medicine by screen, by electronic medical records, and sometimes we lose that. Tell us why it’s so important to continue teaching medical students and residents by the bedside.

John F. McGeehan: Yeah, COVID was so difficult for me, because they shut me down at my age. They said, “Don’t come into the clinic, and do telemedicine.” You can do good medicine technically, but you can’t be a doctor in that particular way.

I personally love Malcolm Gladwell’s writing, and he emphasizes that there’s something we can’t really put in writing, that we get a feel when we’re in the room. You get a feel of the patient, you get a feel of the students, you know what they’re uncomfortable about, and therefore you can focus your teaching around what you’re feeling. You can focus your questions to the patients. You can’t do that in telemedicine.

Kevin Pho: Even more so than telemedicine, everything is just so computer-based, screen-based. I hear stories about residents: They spend more time just typing out their notes in front of a computer than they do in front of a patient. In that context, how can emerging physicians, medical students, and residents maintain their contact and connection with patients?

John F. McGeehan: I’m very optimistic in general, but I have reasons for optimism now. I know that where I work, at Cooper University Hospital, they’re test-driving a recording system now, where the conversation that you and I are having gets put into a progress note. That’s going to allow us to start looking in the eyes again, having that face-to-face contact and not spending all that time at the keyboard. So I think this is a dark time of medicine, and we’re going to see a horizon soon where that emphasis on the doctor-patient relationship is going to be renewed.

Kevin Pho: And we’re going to talk more about the importance of story in your KevinMD article, titled “Why storytelling is critical in medicine.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

John F. McGeehan: Yeah, thank you. I’ve always loved to tell stories. It’s gotten me invited to a lot of dinner parties, and it’s gotten me a lot of speaking invitations. I just love to tell stories. Even more so, I love to read stories, which is like, I love what you do.

But what I found was, very briefly, I got very sick a few years ago, and I lost my memory. I was in the hospital for a very long period of time, had encephalopathy and a lot of other problems, wasn’t supposed to recover, but I love proving doctors wrong, so I fully recovered. But then I realized I had all these stories that I hadn’t written down. So amid COVID, it was my opportunity to write them all down, for me, as a way to get my memory back.

And then when I looked at them all and shared them with people, they made them laugh, and they made them think. And then I thought, “I wonder if anybody would be interested if I put all these together in a book.” And that’s how it all came together. It really was a mechanism to restore and test my memory, and the book was a totally secondary, unexpected event of it.

Kevin Pho: Some say that the doctor-patient relationship can be distilled to stories: stories between the doctors and patients, stories between doctors themselves. I’d like to hear from you and your perspective. Why is storytelling such an essential part of medicine?

John F. McGeehan: It makes it real, Kevin. I think that students should realize that everybody’s always working for that next thing, and it’s surrounding a test: Will I get into this school, and will I pass the MCAT and get a score high enough? They get so focused on the test that life is not multiple choice. Once you get into medical school, you have to realize you’re studying for something completely different. Now you’re studying for the ability to help another human being, and sometimes to help populations, and I think to drive that home, we need stories.

Most medical schools, I know ours, have a small-group format where we take a story. We take a patient, we make them up, you put them in there, you hang everything on it to make them real. What I suspect is, by making that real, having the students learn about cell differentiation, learn the difference between a polyp and a cancer becomes more than just test material. It becomes something that they need to know to help their relatives, their friends, and their patients for the rest of their lives. So it makes memory totally different. It’s not short term; it’s long term, and it’s meaningful, and the story brings that to life.

So I love to tell stories every time I teach, to let the listener know this isn’t just a group of facts that they need to organize and spit back. This is a concept, this is a person, this is important. And I think that’s what stories do.

Kevin Pho: I think what you’re saying is so important. I think storytelling is really an essential skill for anyone in health care. It could be, in medicine, a resident presenting a patient; it could be an attending physician doing grand rounds. We all have to be storytellers. Now, some of us, of course, are better storytellers than others. Tell us, what can we do to be better storytellers?

John F. McGeehan: Don’t try to be who you’re not. If you’re not funny, don’t try to be funny, and if you are funny, just don’t try to be serious. The listener knows. They know if this is real. A story is only good if it’s real, and I don’t mean factually real, but coming-from-the-heart real, that it’s expressing what you wanted to do.

So each of the stories in my book were all true. I didn’t make up anything. I changed all the names, I changed some events to be protective, and I even called people to see if it was OK to use the stories. I think real stories make a difference, and when you tell the listener that this is real, their ears perk up a little bit more. They’re paying more attention to it. So I think that’s critical when you tell stories.

Kevin Pho: Now, you mentioned a little bit about authenticity and being genuine. What are some techniques that medical students and residents, or even physicians, for that matter, can be more genuine when they tell their stories?

John F. McGeehan: Yeah, from my experience, and that’s a good word to use at my age, don’t make them long. You lose the attention if you make them long. Make them short, make them about a patient, make them about a circumstance, and make it come to life. Give enough adjectives. Put it in perspective. If it’s winter, make it winter. Put it where you were in your particular part of your practice. Make the examining room come to life as much as you can in words spoken or words written. Make the environment real. The story then is driven home.

Kevin Pho: We’re talking to John McGeehan. He is an internal medicine physician, and he wrote the KevinMD article “Why storytelling is critical in medicine.” John, over your decades-long experience as a primary care internal medicine physician, you’ve certainly seen so many changes within the field. What are some of the biggest ones that come to your mind?

John F. McGeehan: Yeah, the big change to me was two things. One, the electronic medical record. It’s wonderful because of its safety and its ability to track labs and medications, but I think it did put a barrier between us and the patients, and it’s so difficult to teach my residents and students to keep their eyes on the patient, to not just stare at the computer screen. As I said, I think this will go away, but I think it’s a necessary evil that has run its course, and we should find a better way to utilize it.

The second thing for me is, I love hospitalists, and I think they are just such masters at what they do, but it was very difficult for me as a primary care physician in a small town to turn over the care of my patient to hospitalists. In fact, it’s the reason I left my practice and went into teaching full time, because I just couldn’t be there when they needed me most. When you get a relationship with a patient, which for me was over decades, and you get to know what they want and don’t want at the end of their lives, to not be at the bedside and not be brought into the equation at that time, I think that’s difficult. We have to find a way to get our hospitalists throughout the country to communicate on a more real-time basis with their primary care providers of that patient, to bring that to the bedside, to help the patients at their time of greatest need.

Kevin Pho: As you know, there are fewer and fewer physicians going into primary care. You’ve been in primary care for 40-plus years now. Tell us some of the rewards of being a primary care physician.

John F. McGeehan: I think it was driven home two weeks ago, Kevin. A bunch of my patients organized a book-signing event up in the Scranton area, Scranton, Pennsylvania, and I went there, and I realized these weren’t patients; they had become family.

What they have to realize, when you’re in primary care: Yeah, you’re delivering care, but if you open your heart and mind, you develop a whole new family, a group of people who will tell you things they won’t tell anybody else. They share their lives with you. You’re able to make their lives better, sometimes in little ways, sometimes in big ways. Primary care is so fulfilling. And what I’ll tell you now is true: When you close the door and you’re in the room with the patient, it is exactly the same as it was 42 years ago, when I first started my practice. The magic in the room is there. It hasn’t changed.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

John F. McGeehan: Everybody has stories to tell, and if you’re in medicine, everybody realizes the real rewards aren’t financial. They’re interpersonal, and they come through stories. I would strongly recommend that everybody start to write down their stories, whether they’re a first-year medical student or someone at my stage of my career. It brings thoughts to life. It lets you realize that experience was really meaningful, that wasn’t just a code I put down on a billing encounter. This was an interpersonal relationship, and it lets you learn from it.

And write them down, start sharing them. And even if you don’t share them, I can guarantee by writing them down, reading, and reflecting on them, you’re going to feel a whole lot better about what you just did.

Kevin Pho: John, thank you so much for sharing your stories, time, and insight, and thanks again for being on the show.

John F. McGeehan: Thanks for having me. Have a good day, and enjoy the holidays.

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