Storytelling in healthcare is worth the time.
Want to hear a story?
Ben is two years old. He has gray eyes, an infectious smile, and an s-shaped scar that cuts across his bald head. The scar is a war-wound from one of his three brain surgeries. Ben has Atypical Teratoid/Rhabdoid Tumor, a rare cancer of the brain and spinal cord.
Today, Ben is happy. His favorite nurse has brought him two shining Mylar balloons. Ben clutches the balloons’ silver ribbons and the entire infusion room breaks into song. As his mom bounces him on her lap, Ben gazes at his hospital friends in absolute wonder. Ben has just received his last chemo, and this is his “Coming-Off-Chemo” party.
Today, Ben’s dad Tom is also happy, but a different kind of happy. Tom is a dark-haired firefighter with a square jaw and a slight Southern drawl that you only hear when he gets upset. Ben’s infusion nurse has become familiar with that drawl over the past six months. She hears it again just after she and Tom say their final goodbyes. He’s grateful to her, he says, as he pulls her into a bear hug. How do you properly thank someone for giving you time?
You see, the chemo is palliative. In a few months, Ben will die.
As he carries Ben out of the hospital, Tom feels happy. But only the kind of fleeting happiness you can feel while someone you love is terminally-ill. The family crosses the parking lot to their car. Tom shuffles his son in his arms as he searches his back pocket for his keys. Ben, his chin still resting against his dad’s chest, looks up and smiles. Tom smiles back, even though he feels as if he has been pushed chest-first off a cliff. His legs and arms swing free — exhilaration, as long as he does not look at the fast-approaching ground.
So, did that story make you feel something?
I don’t mean to overstate my writing ability, but your answer is probably yes. This story was first told in a video from St. Jude’s Children’s Research Hospital, where Ben and Tom had sought treatment. Neuro-economist Paul Zak later used clips from that video in a landmark 2012 study. Subjects who watched Zak’s video were found to have produced the brain chemicals cortisol and oxytocin. Typically released at moments of distress, cortisol focuses our attention. Oxytocin produces feelings of warmth; in a sense, it helps us care about what we are seeing.
In other words: the story I have just retold to you has been clinically-proven to change people’s brain chemistry.
Now what if I had asked you to consider donating money to a children’s cancer fund? It’s possible you would have reached for your wallet.
Zak and his colleagues asked study subjects to donate money to a sick children’s charity. Subjects who watched Ben and Tom’s video were more likely to donate money than subjects who watched the control video. Not only that, subjects who produced more oxytocin donated the most money. The correlation between brain chemistry and charity was so strong that Zak and his colleagues were able to accurately predict which subjects donated money just by looking at their bloodwork.
What Zak’s study showed is that we internalize stories. We feel the characters’ distress as our own. We feel relief when things seem to go right. And if we have a chance to help, we often take it. Zak’s conclusion was that emotionally engaging narratives inspire post-narrative actions. Simply-put: good stories provoke scientifically-measurable empathy.
Empathy can be a buzzword. Consumer-focused healthcare has pushed ‘patient experience’ and patient suffering to the front of the national dialogue on medicine. Technology, from finger pulse oximeters to electronic health records, has reduced the amount of time and physical touch medical professionals spend with and on their patients.
Patients feel scared, or confused, or alone. Healthcare needs empathy.
Well, right, true, yes. But how do you produce a feeling in other people? You can make your hospital campus beautiful and your in-patient units peaceful. You can reduce noise and use circadian-sensitive lighting and aromatherapy. But if your doctors are cold and your nurses burnt out, your patients will still suffer.
Some have suggested looking for future doctors outside of traditional pre-med majors. Interdisciplinary humanities-to-medicine programs have sprung up at Wake Forest, Mount Sinai, and Stanford, among many other schools. The reasoning? Sensitive liberal arts majors have better people skills than science nerds. They’ll listen to their patients, and they’ll communicate better. English majors, after all, should be able to tell a story. And stories, as Zak reminds us —
Others have suggested teaching storytelling to the science nerds. Medical schools across the country have added writing seminars to their curriculums. Temple University’s Lewis Katz School of Medicine has a narrative medicine program. There, medical students write as if to commit these facts to memory: patients have stories. Patients are people. Patients need empathy.
But what about physicians and nurses and medical professionals who’ve been out of school for years? Narrative medicine has been touted as a “remedy to burnout.” Is it? What does storytelling look like in the emergency rooms outside of ivory-tower teaching hospitals? Does storytelling have any practical applications to real-world medicine at all?
It’s a silly idea to demand doctors and nurses take up journaling. My best friend is a registered nurse. She savors her time off like nobody in a nine-to-five could believe. There’s a million things she’d rather do than rehash a difficult shift into a notebook.
It’s also unrealistic to expect care providers to chit-chat with patients about the minute details of their lives. Medical professionals simply don’t have the time. Hospitals are often understaffed, with tightly-regulated schedules. It’s hard enough for care providers just to do their jobs. So how can doctors, nurses, and patients still reap the benefits of storytelling?
Storytelling in healthcare is supposed to remind care providers that patients are people. It might not require much to get that reminder to the people who need it the most. In fact, helping doctors and nurses to look for patient stories might be as simple as a story itself.
Here’s an old one from the Cleveland Clinic. Then-CEO hires a Chief Experience Officer. This Chief Experience Officer implements staff workshops on communication and oversees the production of a video called “Empathy.” The four-and-half-minute-long video is meant only for internal use, to remind the Clinic’s staff that their patients have lives and stories of their own. This story of stories proves to be so moving that many staff members feel compelled to share its message with the world. It’s posted on social media, and goes viral shortly thereafter.
Since 2013, “Empathy” has accumulated over four million views on YouTube alone.
The Cleveland Clinic example shows how powerful digital storytelling in healthcare can be. Cleveland care providers who watched “Empathy” engaged with it. They felt distress and relief and- that buzzy title- empathy. And when it was over, they wanted a way to help. One way was to make sure other care providers at other clinics and hospitals received the video’s message too. That’s clear by the video’s expanded reach — from the 43,000-employee clinic to four million people on the web.
But Cleveland care providers no doubt found other ways to help. Today, five years after “Empathy,” the Cleveland Clinic still ranks as one of the best hospitals in America.
The best way to understand what patients experience is to be a patient yourself.
In lieu of that, you should learn patients’ stories. They shouldn’t be hard to find if you work in healthcare. There are, after all, hundreds of stories in hospitals. All you should have to do is look around you.
There’s a slouching man in a waiting room. If you stopped to ask, he could tell you the wedding vows he wrote himself fifteen months ago. He still has them memorized, and believes he always will. He’s been silently repeating in-sickness-and-in-health for the duration of his wife’s routine appendectomy, which is just wrapping up in the OR.
There’s a fifty-seven-year-old elementary school music teacher walking out the main lobby. She just saw her orthopedic surgeon for a final follow-up. It’s been three weeks and her knee doesn’t ache anymore. She even did the Cha-Cha slide with her kindergartners this morning. She has film-footage-evidence. She would show you the video her student-teacher took on her iPhone, if you had time to watch it.
There’s a nerdy, twenty-eight-year-old internist with a DeLorean pin stuck in his tie. He could tell you how many days it’s been since he beat his childhood leukemia. Counting each day became his meditation. He hasn’t told a single patient that he is a cancer survivor. There never seems to be time.
Time, time, time. All the the think pieces on the internet will not change anything, if hospital staff don’t have the time to cultivate empathy. It might not take more than a five-minute video once a week, or a thirty-minute communication workshop once a month. But, as any emergency room physician can tell you, sometimes all you need is a handful of minutes to save a life.