Monday, May 21, 2018

Storytelling can help your health

MarketWatch

Did you hear the one about the patient who tackled his high blood pressure because of a friend's remark that stuck with him? Or the doctor who finally cracked an elusive diagnosis after letting his patient talk longer?

No, it's not a joke. A growing number of doctors and public-health experts are tapping the everyday habit of casual conversation to get their messages across. Instead of relying solely on data, educational material and medical language to talk to their patients, some are going back to the kind of vernacular give-and-take more often heard around the kitchen table.

Storytelling seems hardwired into human behavior, and more physicians are leveraging it to try to improve patient care or even change health care policy.

"People in the health world now are beginning to explore narratives or stories as intervention," said Dr. Tom Houston, chief of the health informatics division at the University of Massachusetts Medical School, who also works at the Veterans Affairs Medical Center in Bedford, Mass.

Storytelling comes naturally to people, said Dr. Neal Baer, a writer and former executive producer of the TV dramas ER and Law & Order: Special Victims Unit, in a January presentation to physicians and medical students at the University of California at San Francisco.

"Stories are the currency of our lives," said Baer, a pediatrician by training. "They are the measure of our days."

"I've found the best doctors to be excellent storytellers," he said, noting that those who listen to their patients, ask sensitive questions and refrain from viewing them in an impersonal way tend to elicit the most valuable clinical information.

Doing the opposite — approaching patients like they're academic cases instead of people living full, complicated lives — can make them feel too uncomfortable to disclose any socially undesirable habits they may have that can negatively affect their health. In those cases, Baer said, patients will withhold vital data — an alcohol problem, say, or risky sexual behavior.

Baer, whose newest show, CBS's A Gifted Man, features a neurosurgeon working in a family clinic, hasn't shied away from tough topics. While at NBC, his shows included plot lines about the backlog of rape kits at DNA labs that keep predators on the streets, childhood obesity and soda consumption, and teenagers' access to abortion.

"Good TV relishes complexity," Baer said. "We sit rapt as characters battle it out over the issues that define our lives."

PERSONAL LOSS, PUBLIC CRUSADE

Dr. John Maa, director of UCSF's surgical hospitalist program, described the power of storytelling in a more intimate way. Last summer, he chronicled the last four days of his 69-year-old mother's life in an overextended emergency-care system in a piece called "The Waits that Matter," published in the New England Journal of Medicine.

The story of how his mother succumbed to a massive stroke after a long wait for treatment that likely would have saved her life received widespread attention. As he traveled across the U.S. to compare problems and approaches at 50 different hospital emergency departments, Maa also met with many of the people who had been moved to write to him upon reading his narrative.

"What was striking was the recurring theme of personal losses they too had suffered from an overwhelmed emergency system," Maa told the doctors in the UCSF audience.

Maa is using his story to try to draw lawmakers' attention to several emergency-care issues that he says need to be addressed in two federal health care laws.

"Ultimately, identifying ways to support those courageous physicians willing to place themselves on the front lines of clinical care will be key to solving the emergency-care crisis," Maa said.

PATIENTS HELPING OTHERS

"Storytelling is really part of our lives, and it's how we make sense out of our own existence. It's a natural fit for trying to promote health," said Houston of the University of Massachusetts.

Houston's research interests cast him in a role similar to that of a documentary filmmaker.

He recently led a study that tracked 230 African-American patients in the South who had doctor-diagnosed high blood pressure. They either watched videos of fellow patients delivering personal narratives about their experiences with high blood pressure or generic public-health messages.

Those with uncontrolled high blood pressure who watched other patients from similar cultural backgrounds discuss such things as how they reduced their salt intake or talked to their doctor about their hypertension saw their blood pressure improve significantly, compared with similar patients who watched impersonal health videos. Most participants in the study, which was published last year in the Annals of Internal Medicine, were women with an average age of 57.

"Blood pressure is an ideal thing for storytelling because it's kind of a silent killer and it doesn't produce (symptoms) you can see early on, so it's hard to attend to," Houston said.

Seeing real people talking about their experiences may help patients overcome barriers such as denying that they have hypertension or distrusting doctors.

"You can create what experts call a parasocial relationship," Houston said. "You connect with a character."

"A physician's advice is good but not necessarily sufficient," he said. "There is a strong potential for the peer voice and talking to people who are like you."

The study authors were careful to let patients speak in their own unscripted words, but factually inaccurate statements were left on the cutting room floor, Houston said. "We do feel like we're the curators of these stories and don't want to manipulate them."

The study couldn't tease out exactly how participants improved their blood pressure — whether they watched their salt intake, exercised more, learned how to take their medications more diligently or did all of the above. It's all speculation, Houston said. "They may have talked to their doctor and the doctor might have added medications or adjusted their medications so there were fewer side effects."

Another blood-pressure study rolling out across the national VA system will step outside the medical model and include theater methods to help patients tell their stories, he said.

The act of telling a story may turn out to provide a health benefit for the storyteller as well, Houston said.

"We don't have that in the pipeline yet, but it would definitely be a great thing to study."

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