Stories


Stories are such powerful gifts

Given, shared and developed they can have a profound effect on people’s lives. Indeed, they are why I became a GP.

The main storytellers in my life were family - my parents, my maternal grandfather and my maternal great aunt. With only the slightest encouragement, I could elicit tall tales and true from them about the fascinating lives they had led and stories they had been given. I do not have time to share their lifetimes of stories, but I can tell you that none of them were boring.

As I grew, I realised that within a few minutes of them starting a story about someone, I could predict the outcome whether it be happy or sad. All our family had experienced times of boom and bust, joy and sorrow, war and peace so the sad stories predominated.

I resolved that I wanted to be able to insert myself into the stories of the lives of others and do what I could to ensure that their stories would end up, if not good, then just a little better. So I chose to become a doctor; but not just any doctor, I would be a GP!

Stories helped me learn anatomy, for every structure I have a tale if not about applied anatomy, then something I had heard or seen when doing dissection or being tutored on it.

When I started clinical training, the skills of the storyteller came to the fore. There was so much to learn, so many stories to hear and so many to share. I met master storytellers, clinicians whose example and teaching inspired and developed my abilities. They taught me to listen to not only what is said but what is omitted - to recognise the silence, the void that occurs when nothing is said when logic demands something should have been mentioned. (Arthur Conan Doyle’s ‘bark of the dog in the night’.)

I was taught that the key to diagnosis is the patient’s history. ‘If the history does not reveal the diagnosis, take a better history’. 

I realised that every story is told for a reason - be it to entertain, to educate, to warn, to encourage, to comfort or to inspire or all of the above. The purpose varies according to the occasion and stories are adaptable.

Sharing stories - to the point of narrative therapy - is a major skill of the GP. It helps the patient to talk about themselves and their life. While they may consider it a simple chat or polite conversation, these talks are vitally important. They allow the GP to develop an idea about who they are, their relationships, occupations, hobbies, hopes and dreams. It tells us how this person reacts to stressors and to illness, about their strengths and weaknesses and how they seek help and support. It is the mark of an expert that they make a complex task look straightforward. The good GP does this with aplomb. However, I fear we do it too well because everyone wants to do our job!

In another life I was engaged in regular meetings with personnel from the security services (a long story for a later time) and an executive was trying to give me a vague outline of what his organisation was then doing. Seduced by the thought that I was a humble GP he talked. He had no realisation that I was almost as trained an interrogator as those in his employ and revealed so much information that I felt compelled to repeat none of it.

The good GP knows that it is good to elicit the diagnosis and good to determine the appropriate treatment but another thing altogether for the patient to accept the treatment and then persist with it long term. Knowing the patient’s story and their motivation gives you a chance to encourage them or at least a hope of detecting non-compliance.

When we use stories to reassure, we can use anonymous details of people with similar problems – ‘there is a lot of this going around at the moment’, ‘I have had several / many / a lot of patients with this, so I know you will be fine / are doing well / have a great chance’.

 We can extrapolate from what we are told to be able to identify what we are not told to build trust and confidence. This is very useful when people with panic disorder first present - ‘You mentioned palpitations and sweating but how about the sense of impending doom? The tightness in your chest, the urge to empty bladder or bowels, the breathlessness and tingling of your lips and cramping of hands and feet’.

We use stories to explain, to warn - ‘Let me tell you what happened to an old mate of mine who would not stop ….. (insert inappropriate lifestyle choice)…’

As we get older we use our own health experiences as examples - ‘When I say I know how you feel - I know how you feel. I had (insert significant condition) and survived, although it was not as smooth a recovery as yours.’

If we are fortunate, we get to be parents, grandparents, teachers, lecturers or writers and get to hand on our tales. When we are dead, the only thing that survives of us are our stories. I am the keeper of many stories, some of which I can share and others that I will take to my grave.

The one thing a storyteller loves as much as a new story is an audience. Thank you for reading. I look forward to your stories.

Associate Professor Chris Hogan

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