Historically linked[i] with practices of healing and alleviating distress, in recent years healthcare has increasingly embraced storytelling, acknowledging its vital role in addressing burnout, nurturing resilience, and driving behavior change. In the America, Surgeon General Vivek Murthy advocates for ‘story-based’ interventions for youth mental health;[ii] Atul Gawande, surgeon and researcher turned writer and storyteller, employs narrative to carefully engage in challenging discussions about such topics as end-of-life care and to help develop mutual understanding for a shared vision of a more accessible healthcare system; and Dr. Dean-David Schillinger argues in a recently published memoir Telltale Hearts: A Public Health Doctor, His Patients, and the Power of Story, that storytelling is the best way to find “shared humanity in a world that is constantly pressuring [doctors] to take shortcuts and to rely on impersonal ways of managing very complex human problems.”[iii] While we are most familiar with the US health system, where we work directly, the once dismissive myth that storytelling is merely ‘soft stuff’ in medicine has largely been replaced by widespread and international recognition of the significant impact of narrative practices in healthcare.

Acceptance is not always active support.

When we watch our colleagues in their day-to-day work, there is the critical story too often missing: our own. Most clinicians are neither encouraged nor equipped to utilize the power of our narratives. With clinical practices like motivational interviewing and narrative medicine, we know how to elicit and recount the patient’s story. But we are also trained to suppress our feelings and respect boundaries that dictate a separation of the personal and the clinical. It is supposed to be about them, not us. Because all too often the stories we are professionalized to engage are in service of others, we fail to bring our own experiences into the clinical setting. And that is a disservice to our colleagues, our patients, and ourselves. Living with this narrative dissonance – my story doesn’t matter; it is not about me – comes at a cost. It is a cost healthcare can no longer afford.

Anecdotal evidence and cross-disciplinary[iv] research demonstrate that often the emotional connection needed for both patients and colleagues to share their stories begins with an internal calculation about the trustworthiness and relatability of the person across from them. While it may be counter to the norms we are taught, sharing our stories with patients – even in small, episodic ways – cultivates trust, inviting them to share their stories with us. With our colleagues, sharing our stories flattens the felt presence of hierarchy and power and invites others to shift the conversation from “What’s the matter?” to “What matters?”[v] Knowing the story of the other helps us share our own story. Stories invite storytelling. Moreover, sharing our stories is foundational for human connection – one of the fundamental drivers that led us into medicine in the first place. And human connection is vital for fostering the health we aspire to within our teams and the broader system. However, not every clinician will have the storytelling facility of an Atul Gawande or a professional writer like Dr. Dean-David Schillinger. What’s more, we must be clear-sighted about the cultural reality that persists within healthcare that discourages us from using narrative, both for ourselves and with others.

Good news: we have examples of how to begin broadening and deepening our storytelling practices.

In 2017, at the American Conference on Physician Health in San Francisco, Dr. Vivek Murthy took the stage as the keynote speaker and presented a compelling case for how powerful it can be when healthcare professionals share their stories. He explained that when he managed clinical staff, the quality and performance measures began to exhaust his team leaving everyone feeling trapped by metrics and quantifications, so he chose to begin Friday staff meetings with a short personal story. One team member per meeting: a personal photo; an anecdote highlighting an unknown or unseen passion; any small vignette that helped express the fullness of life outside the clinic. Dr. Murthy described staff sharing images from various adventures– foreign travel, a child’s band concert. With every story, the concept of, ‘the team,’ became less abstract. His colleagues began to see each other as more than professionals. They were mothers and siblings and explorers with experiences others could relate to, respect, and call on. These reflective practices can be easily replicated and adapted.

There are also powerful examples of collective storytelling as a driving force of institutional action. In October of last year, American employees of Kaiser Permanente participated in a nationwide collective strike[vi] for bargaining purposes. Their demands centered on specific workforce needs and shortages in staffing. Their stories conveyed urgency, hope, and a desire to serve and be of service more meaningfully. In the latter half of 2024, unionization efforts will continue to shape the healthcare landscape in the US. Effectively, our storytelling has the power to cultivate a shared community across professional silos, thereby inspiring joint efforts toward collective action.[vii] And if we don’t find ways to share our stories as part of our demands for collective change, others will assume our motivations and author the silence on our behalf. We must speak up.

At a time when the burnout[viii] of healthcare providers threatens to implode the healthcare system – an internal threat parallel to the external threat we all faced at the height of the COVID-19 pandemic – the transformative power of our storytelling is an effective tool for meaning-making, trust-building, and for motivating action. At a time when everyone working in healthcare – both in America and internationally – aches to feel less isolated and desperately wants to reconnect with and be re-inspired by the motivations that brought them into medicine[ix], it’s time to start telling our stories – with patients, peers, healthcare leaders, and with the wider community.

Now, more than ever, healthcare needs clinicians’ stories.

References

[i] Egnew TR. A Narrative Approach to Healing Chronic Illness. The Annals of Family Medicine. 2018;16(2):160-165. https://www.annfammed.org/content/16/2/160. Accessed May 18, 2024.

[ii] Yalda T. Uhls. How Storytellers Can Help with the Youth Mental Health Crisis. Published April 6, 2022. https://www.psychologytoday.com/us/blog/the-power-storytelling/202204/how-storytellers-can-help-the-youth-mental-health-crisis#:~:text=Key%20points. Accessed May 16, 2024.

[iii] Lawrence K. Altman, “The Telltale Heart,” The New York Times, August 3, 2024, https://www.nytimes.com/2024/08/03/health/schillinger-telltale-heart.html. Accessed August 3, 2024.

[iv] Renken E. How Stories Connect And Persuade Us: Unleashing The Brain Power Of Narrative. NPR.org. Published April 11, 2020. https://www.npr.org/sections/health-shots/2020/04/11/815573198/how-stories-connect-and-persuade-us-unleashing-the-brain-power-of-narrative. Accessed May 5, 2024.

[v] United Hospital Fund. Quality Leaders Forum Focuses on the Power of Asking, “What Matters to You?.” United Hospital Fund. United Hospital Fund. Published 2021. https://uhfnyc.org/news/article/quality-leaders-forum-focuses-power-asking-what-matters-you/. Accessed May 10, 2024.

[vi] Scott D. Kaiser Permanente Faces Historic Strike by Health Care Workers Nationwide. NPR.org. Published October 4, 2023. https://www.npr.org/2023/10/04/1203225614/kaiser-permanente-historic-strike-health-care-workers-nationwide. Accessed May 10, 2024.

[vii] Haapanen KA, Christens BD, Freeman HE, Speer PW, Crowell-Williamson GA. Stories of self, us, and now: narrative and power for health equity in grassroots community organizing. 2023;11. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1144123/full. Accessed May 16, 2024.

[viii] Weiland N. Why Health Care Workers Are Burning Out. The New York Times. Published October 24, 2023. https://www.nytimes.com/2023/10/24/health/doctors-nurses-burnout.html. Accessed May 2, 2024.

[ix] Press E. The Moral Crisis of America’s Doctors. The New York Times. Published June 15, 2023. https://www.nytimes.com/2023/06/15/magazine/doctors-moral-crises.html. Accessed May 15, 2024.

Authors

Matthew Lewis PhD, MTS

Co-Director of Relational Leadership Programs at Oregon Health Science University. Senior Trainer and Consultant for Intend Health Strategies.

Sarah Smithson MD, MPH

Vice President of Partnerships for Intend Health Strategies. Served as the Assistant Dean for clinical education at the University of North Carolina School of Medicine and Director of Relational Leadership. @Carolina

Kari Mader MD, MPH

Full-scope family physician. Medical Director for Aurora Specialty Care and Director of Integration for the General Practice Longitudinal Integrated Clerkships at the University of Colorado School of Medicine. Senior Trainer and Consultant for Intend Health Strategies.

Declaration of interests

We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.