![]() I notice their response to the story and use it to guide my storytelling with them in the future. ![]() Sometimes patients find stories distracting, so I often ask permission before I begin. I wait until I know a patient well enough to determine which stories will be most useful, and I select specific illustrations tailored to individual needs. And if I tell you how I solved a problem, you won’t need to reinvent the wheel. (Other peoples’ stories are adapted to provide anonymity.) Two common themes are “your experience is common you are normal” and “here’s how someone addressed a problem similar to the one you are facing.” If I tell you of my mistakes, perhaps you won’t have to make them yourself. Over the years I have collected stories, from my life and the lives of others, which I use as fables, each with a specific message intended. Storytelling involves 3 skill sets: knowing the stories, choosing when to tell them, and telling them effectively. This cements the information in my own mind alerts me to any gaps in the story allows the patient to correct any mistakes and enhances the doctor-patient relationship by confirming that I was truly listening. Once the story is complete, I give an abbreviated version back to the patient. Whenever a patient says, “I’ve never told that to anyone before,” the story is always of great importance. Often what is missing turns out to be of greater importance than what is said. This enhances my own memory of the experience and allows me to recall details afterward with great precision. If there’s a moment missing, a detail gone astray, I track it down to fill in the gap. Taking a history is like painting a picture or watching a movie. When emotional issues are at the forefront, a non-directive approach is most likely to allow the patient to speak from the heart. While directive interviewing can be useful with a checklist questionnaire, such as an anesthetist might use, interactive interviewing is far more efficient for most purposes-allowing the patient to take the lead, with some input from a physician to stay on track and to fill in important details. But too much control can be as inefficient as none at all. ![]() I managed to summarize the story for my preceptor in 10 minutes he encapsulated its essence in 15 words: “You have a 65-year-old depressed hypertensive woman who is noncompliant with her medication.”Ī common mistake is to take over the narrative, to provide the structure that the patient lacks. I vividly remember interviewing one of my first patients in my family medicine residency program. To compensate, a good listener needs to acquire these skills. They don’t know how to focus a narrative, structure it linearly, abstract the important, and omit the trivial. Many patients are not intrinsically good storytellers.
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