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Telling the Whole Story

Ben_3Ben Bryner -- When I was a teenager I loved documentary films, and I thought making them was what I wanted to do for a living. I loved watching sprawling films about the Civil War or Watergate or basketball players. I came pretty close to majoring in film and pursuing that route, but by the end of high school certain experiences had pointed me pretty firmly toward medicine.

I haven’t had much time in med school to watch documentaries, but I’ve managed to see a few. One of the better ones I’ve seen is The Smartest Guys in the Room, which describes the collapse of the energy company Enron brought on by fraud committed by its top-level executives. It’s a fascinating story; maybe to some people it’s fascinating because of the business and financial aspects. But in the documentary, Bethany McLean, the reporter credited with breaking the story observed, “[P]eople, especially outside the business world, think that Enron is a story about numbers and complicated financial transactions that you couldn't understand even if you wanted to, but the Enron story is really a story about people.” This made a lasting impression on me, and it really helped me understand my interest in medicine. (Not because there’s any connection between the Enron scandal and medicine.) It was because McLean found the people involved to be the most important aspect of her story, and in medicine as well, the people involved are the most interesting and important element.

Don’t get me wrong, for all the time you spend studying in medical school you have to have a strong interest in physiology and disease. If you don’t have a high baseline level of curiosity about the ways in which disease can occur and can be treated, I think a career in medicine would be unbearable. For me as well as most other people in my med school class, every so often a particularly enthralling disease would be discussed in lectures and some of us would think about specializing in that field to have more involvement in researching and treating that condition. Some rotations that I’ve done have allowed for the most interesting teaching opportunities I can imagine: rare inflammatory diseases, even rarer genetic conditions, medical mysteries that unraveled over the course of the month.

But to me, there’s no more interesting aspect to a disease than how it affects the patient. Since every patient is different, in a way every episode of a disease is its own special case study. This is something we’re told fairly often, but I understood it first on the cardiology service, where over the course of the month I was assigned to a number of patients with the exact same condition. Of course, the same disease affected each patient in a different way. Each patient’s social, financial and educational background influenced the way they dealt with disease, and the disease in turn affected each aspect of their lives in various ways.

This is what I think makes the medical student’s experience so valuable; as a student you have time to dig a little deeper into these individual histories to pick up on unique aspects of each case. The more you get to know the person, the more you put together an often-remarkable story.

Plenty of attendings and residents will give you the same advice when it comes to the student’s duty to present patients: “Tell a story.” Sure, the presentation has to include certain elements and unfold in a formal way, and in some situations you don’t have the time to really get into it all. But whenever you get the chance, especially on rotations where rounds and presentations make up a big part of your day, my advice is to try to make your presentations as much of a story as you can. An efficient but engaging story can convey a lot –- it illustrates the context of the patient’s life before the disease of interest, it conveys the patient’s goals for treatment, it helps the team focus on that patient and effectively discuss his or her needs. As in a good documentary, a good medical story isn’t just about a disease, but about a person.

May 15, 2008 in Ben Bryner | Permalink

Comments

Gday.

I like the way the author put it in his article and it has certainly sparked something that I always sort of knew but never realized.

A lot of my teachers would disagree with presenting a story as they would like the presentations to be as short as possible. But it would still be our responsibility as students and future doctors to know our patients as individuals with their own angle of the disease so we could better provide management options that would be suitable for them instead of opting for a 'one for all cure'.

I guess this is another reason to continuously be in the field instead of reading our ass off to get to know the difference personalities and backgrounds that exist. It would certainly prepare us on the various possibilities we would encounter when we practice that will have a big impact on our management of our patients.

This would indeed make us better by treating a person instead of treating a disease.

Posted by: Zaim | May 25, 2008 2:51:36 AM

thank you very much for your precious advices.i do share the same hobbie with u...i like writting & expressing my self but i choosed medical studies cuz i loved it above all others. talking from my personal experience,i tried many time in the past to "tell the whole story" & beleive me the residents didn't find it interesting the big boss either,they said that it's not the point of the presentation,what matters is to tell what's helpful to point out the dignosis.....all the rest,means nothing;well maybe as a student i am supposed to ask every possible question& to investigate about every thing but i should keep it for my self & tell them only what(after a wise thinking& puting stuff together) might help solve the case. thanks again

Posted by: ibtissam marwany | May 26, 2008 1:18:05 PM

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