Among the sea of new information and inspiring voices from today, I left grappling with one idea in particular. I’m contemplating the role of story telling in today’s data-driven world, where we are rapidly acquiring more analytics than we know how to make sense of.
Recently, during my time doing summer research in Baltimore, I began attending the weekly case conference of the Neuroimmunology department. The presentation of challenging cases was interesting in itself, but the response of the other physicians was what fascinated me most. I’ve been taught the power of the scientific method and evidence-based medicine for as long as I can remember. When the physicians were explaining their reasons for ordering or repeating obscure tests to rule out unlikely diagnoses for these tough cases, he/she almost always started with a story. We heard about that one patient that the physician had cared for as a resident who presented similarly and ended up with the 0.1% diagnosis. There was also, of course, citations of the recent relevant literature, and new data that just came out. However, I was struck by the power of that one case the physician had seen as a resident. It stuck with them, enough to change the way they were approaching the current problem. Their exploration of out-of-the box diagnoses and clinical decision making was ultimately informed by evidence based medicine- but grounded in what we all seem to remember best- a story.
The neurochemistry of cortisol and oxytocin release in response to Ben’s story, associated with distress and empathy, respectively, makes perfect sense. The emotional decision-making of participants in this study to donate money after hearing the story, I believe has a broader application. When we experience a patient’s story, when we are directly involved in their care, we encode an emotional memory of this event. This type of memory is distinctly different than memory for purely factual information or events. The emotional salience of clinical care not only allows us to connect to our patients in the moment, but also provides us with enriched memories that will continue to guide our practice for years to come. The importance of evidence-based medicine cannot be overemphasized, but we cannot ignore our human attraction to anecdotal information. We like to relate- to feel something. If we embrace the stories, allow them to lend open-mindedness and urgency to our practice, and simultaneously integrate the data into our decision making, we have a powerful tool on our hands.