stories to live by

typewriter

We tell stories all the time. Whether we are working clinically in the department or unwinding over dinner at home, we are continuously reframing and recounting our daily experiences—everything from mundane commutes to crashing patients. Each history of present illness is a story. Every shift change inspires dozens of impromptu stories. Our stories range from funny to heartbreaking; short quips to epic tales; heroic to shameful; and more often than not are punctuated by bodily fluids of some sort or another. As emergency physicians, we become experts at telling stories to consultants, to students, to our friends and family, and most of all to each other.

Throughout history, storytelling has served as a primal means of organizing and communicating the human experience [1]. Stories reveal the fundamental attitudes, values, and beliefs of a culture. When a resident impresses a medical student by remembering the time that he successfully resuscitated a patient without calling his attending, the student learns that the best residents do not reach for backup. When an attending wistfully reminisces about her days as an intern working overnight call in the hospital every other day for months on end, her residents learn that they must be weak-spirited to feel fatigued after working just 80 hours in one week. This is the culture we create for ourselves.

Even more revealing are the stories we do not tell. Stories of personal hardship, battles with depression and suicidal thoughts, or an ongoing struggle with alcohol. Occasionally we hear of a terrible event in the news, but these stories often do not filter down into our day-to-day work in the trenches. We tend to avoid our everyday stories of insecurity, frustration, and minor irritations. We keep quiet about the shameful bits—forgotten dosages, missed intubations, lost arguments against consultants. We do not talk about second-guessing our career path, missing important deadlines, our rising cholesterol, or an impending divorce.

Perhaps not surprisingly then, emergency physicians suffer from some of the highest rates of burnout compared to other physicians. A 2012 survey across multiple medical specialties in the U.S. found that up to 60% of practicing emergency medicine physicians admit to feelings of burnout [2]. Furthermore, as many as 75% of residents meet criteria for burnout in some studies [3].

Most of us intuitively understand burnout as a state of mental, emotional, and sometimes physical, exhaustion. Burnout may be transient for a day or omnipresent for years. It can range from mild feelings of dissatisfaction to full-blown major depressive symptoms and the consequences can be tragic. Physicians commit suicide at twice the average national rate [4] and younger physicians may also be at higher risk compared to older physicians. One study reported that up to 9.4% of fourth-year medical students and interns admitted to having suicidal thoughts during the previous two weeks [5].

Telling stories has the therapeutic potential to combat burnout. We currently exist in a culture of medicine that holds up an unrealistic ideal—a physician who works all hours, never falls ill, and never makes mistakes—and simultaneously creates an environment of shame that prevents us from sharing our true experiences and thereby isolates us from each other. By sharing our stories, we can directly address certain factors leading to burnout and also perhaps change the culture of medicine into one that is more forgiving.

Hearing our common experiences reflected in other people’s stories can ease our isolation when faced with a crisis, whether professional or personal. Lack of personal efficacy, or the sense that we have no impact on the world, is a well-known contributor to burnout. But if we are given the opportunity to hear the endings of our stories—that our patient in cardiac arrest walked out of the hospital neurologically intact two months later or that our pregnant pre-eclamptic patient eventually went home with her healthy newborn—we can finally feel that we made a difference.

Little has been published on the value of stories and storytelling in medical education. However, given what we understand about the culture of medicine and burnout, storytelling about our clinical experiences may be an effective method to cultivate resilience and promote wellness among medical students, residents, and practicing physicians. Stories can be incorporated into written reflections, small group case-based scenarios, and larger lecture settings. Stories can be told by students, residents, attendings, patients, families, or guest lecturers. Stories can appear in formal didactic settings or informal mentor sessions. Simply put, storytelling can come from numerous sources in a variety of settings. With the specter of burnout and physician suicide growing darker each year, educators must face the challenge of addressing wellness from the undergraduate level all the way to continuing medical education. By incorporating stories and storytelling as an innovative educational tool early in the career of our physicians, we can hopefully continue to effect cultural change, fight burnout, and make a difference of in the lives of not just our patients, but for ourselves as well.

References

  1. Charon, R. At the Membranes of Care: Stories in Narrative Medicine. Acad Med. 2012;87:342-347.
  2. Shanafelt TD et al. Burnout and Satisfaction With Work-Life Balance Among U.S. Physicians Relative to the General U.S. Population. Arch Intern Med. 2012; 172(18):1377-1385.
  3. Ishak WW, Lederer S, Mandili C, et al. Burnout during residency training: a literature review. J Grad Med Educ. 2009. 1(2):236-42.
  4. Gold KJ, Sen A, and Schwenk TL. Details on suicide among U.S. physicians: data from the National Violent Death Reporting System. Gen Hosp Psychiatry. 2013; 35:45-49.
  5. Goebert D, Thompson D, Takeshita J, et al. Depressive symptoms in medical students and residents: a multischool study. Acad Med. 2009; 84(2): 236-41.

This article originally appeared in the New York American College of Emergency Physicians Empire State EPIC Volume 33:03:16 p. 12.

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