John Launer: Letting patients’ stories breathe

I spend quite a lot of my time teaching about narratives in medicine. By narratives I mean stories, although both words can be confusing. The word “story” makes some people think of fairy tales or fiction, while a “narrative” can sound like something long and literary. In fact, either term can potentially mean a statement as short as “I’ve got a bunion” or as long as a life story. I prefer the word “narrative” mainly because it carries more of a sense of flow. (You can turn it into a verb: she is narrating, he narrated, and so forth.)

Many teachers of narrative medicine talk about “the patient as text,” a phrase that goes back to the great Canadian physician William Osler. Patients’ stories certainly require interpretation just like poems or novels, although they move and change as they’re told—texts in motion, if you like. A better way of capturing the nature of spoken narratives comes from another Canadian, the philosopher Charles Taylor. He wrote that “we inescapably understand our lives in narrative form”1: in other words, we tell stories not only to describe the world but to make meaning out of it, for ourselves and for our hearers.

Spoken stories are never static, and nor are they solitary. Nearly always, the ones that people bring to doctors have been crafted in inner dialogue and conversations with family and friends. They’re then recrafted with a purpose: to gain our attention, arouse sympathy, and get us to do the things we’re paid to do. Once we join in the conversation, the stories change further as we negotiate an agreed new version that fits with both parties’ expectations of a good medical story.

Every spoken story carries its own momentum. As every doctor knows, it has the potential to reach places that neither the speaker nor the hearer expected. The quality of our own curiosity and the precision of our questions are the key. Good questions can lead people to say that “something has just popped into my head” or that “I never realised what I thought until I heard myself say it.”

I sometimes think that listening to a patient’s story is like letting a dog off a lead. Instead of holding onto its leash tightly you let it explore wherever it wants, following it around the park as it does. It will often find the ball far more quickly than if you drag it where it doesn’t want to go. Patients’ stories, when witnessed and gently questioned, will usually reach their own resolution more effectively than if you try to control them.

Another helpful metaphor comes from the sociologist Arthur Frank (another Canadian, as it happens), who talks about “letting stories breathe.”2 If we allow the narrators we meet to take a deep breath and exhale a story, they may end up saying everything that both we and they need to know. “Narratives are made of air,” Frank writes, “but they leave their mark.”