Let Me Tell You a Story—No, Really!!
A thrilling adventure, a saga of epic proportions, a hero overcoming incredible obstacles to triumph, a chilling tale of horror, a goofy set of cartoons—irrespective of what our individual predilections might be, we all love a good story. Even the most stoic of us will admit to a tug of the heartstrings or a moment of joy and excitement when confronted with a tale well told.
Yet if I were to have suggested in the past that we should look closely at what we might learn from this interesting aspect of human behavior, and apply it to health care, I would likely have been met with a steely stare, if not asked to leave the room, or limit myself from such ridiculous considerations. After all, this is serious business, with people’s lives at stake, and we have no time for such frivolity. We have lives to save.
But as we begin to consider the power of relationships, the impact of emotions on our decision-making, and the need to engage patients in new ways, it behooves us to consider the power of story telling. I originally had the feeling that this applied mainly to our need to create a vision that would engage in their care emotionally. That itself would have been enough for me.
Which is why a recent randomized trial reported in the Annals of Internal Medicine captured both my attention and my imagination. Thomas Houston, MD, et. al. reported on the impact of story telling as an intervention in managing hypertension in an inner city population of African Americans in Birmingham, Alabama. ( http://bit.ly/KvOF54 ). Briefly they evaluated the impact of providing DVDs with stories from other patients who are dealing with hypertension as an adjunct form of therapy in treating their condition.
Without going into details, they identified that those who were provided with the DVDs carrying the stories of others experienced a substantial and significant improvement in blood pressure as compared to those not provided with such stories.
As is often the case with new findings, which might be incompatible with our existing beliefs about how to impact care, it is likely we’ll see many concerns and objections to the study. I can see them now—there is a selection bias, the populations are not distributed equally, it is a unique population, it’s an inadequate number of patients…the list goes on.
But it provides an opportunity to continue to learn more about how we can address our patient’s needs in new and perhaps more customized ways. The value of narrative communication as a support for behavior change has been reported by others, but raises many questions regarding the underlying mechanisms. While the authors recognize the lack of direct evidence, it seems worth considering the power of homophily (hearing of perceived similarities between the characters and the patient) and it’s ability to increase the receptiveness to behavior change messages. It provides us with fodder for continuing to think about new ways of interacting with patients and families and the importance of relationships. Of course, in reality, Kate Lorig, from Stanford, has demonstrated the power of relationships in her Chronic Disease Self Management Group (CDSMP) program for over a decade. The CDSMP is a program that uses patients as leaders of workshops for others afflicted with chronic disease in learning how to live with those conditions. We must pay attention to the findings of this recent article, acknowledge the work done by Lorig and others as we move toward having patients as partners rather than merely consumers of health care.
It is always stimulating to me to see something that challenges the framework in which I was trained, and offers another perspective to consider. After all, let me tell you a story……