The deep human need for storytelling has fascinated Dr. Sayantani DasGupta for as long as she can remember. She feels the thread of a story holding together the various pieces of her life—her medical practice, her teaching, her writing and her family relationships.
"Stories are the way we all understand the world," she says. "Story is the way so many of us frame all of what we do."
DasGupta is an assistant professor of clinical pediatrics at Columbia University and co-author or editor of several books on narrative and health care. As a faculty member in the university’s Program in Narrative Medicine, she teaches literature and writing to medical students. She teaches them to read between the lines so they will learn how to listen closely to their patients’ stories.
"We would never graduate someone from medical school who didn’t know their pharmacology," DasGupta says. "We also shouldn’t graduate someone who doesn’t know how to listen to a story."
As the changing landscape of healthcare threatens to silence the patient, medical practitioners like DasGupta cling ever more fervently to the power of story. As the theory goes, clinical training is only part of the process of making a physician. The doctor who can understand the whole patient—mind, body and soul—will be a better healer.
Such understanding comes mostly through listening to the patient’s story. But DasGupta warns that it’s not always a simple process.
"You’re not Indiana Jones," she says. "A story isn’t a treasure that you’re going to dig up and hand to me. It’s a relationship."
The role of the physician is to elicit, interpret and act upon someone’s story. But as in many other fields, technology has a way of putting pressure on that human relationship. The simple presence of a laptop in the exam room can considerably alter the way a doctor listens to a patient. New medical technologies will be helpful only to the extent that physicians practice evidence-based medicine and narrative medicine side-by-side, according to DasGupta:
"Let’s put them all in our doctor’s bag. Innovation can be potentially harmful to the doctor-patient relationship if it replaces deep listening. A story and an MRI need to be considered equally. You need both of them to do good healing. They are both necessary to each other."
Empirically-minded medical students often feel challenged by the notion of stories as fluid, changing things. They may take a meticulous medical history of a patient one day, and be taken aback the next day when the patient tells a different tale to another physician. DasGupta says that patients modify their stories because that is the nature of human existence—it alters from moment to moment.
It is slippery ground, she says: "Stories change, depending on who is telling them and when. We have to allow for that ambiguity. You are interacting with people, and people are not fixed, undynamic entities."
Listening is the experience of one human being attending to, being present for, or witnessing another human being’s story, DasGupta says. This intersubjective relationship happens everywhere, but especially in the clinic. Listening is also an act of "narrative humility" that calls for a readjustment of ideas of power.
"I’m very cautious and concerned about power in medicine, the way we utilize it and misuse it," DasGupta says. "You need a certain degree of power to enact change, but the problem with power in medicine is that it is a hierarchy that impedes listening."
Efforts to dismantle that hierarchy, she says, are already transforming medicine into the kind of collaborative endeavor that could be a model for best business practices anywhere. Physicians are looking beyond test results and medical charts to listen more closely to not only their patients, but to their colleagues as well. Sometimes called integrative medicine, medical collaboration draws together teams of physicians, psychiatrists, nutritionists and technicians to create a more holistic and tailored approach to healing.
Storytelling lies at the very center of this emerging medical trend.
One word that DasGupta frequently uses to talk about storytelling is "rigor." Indeed, listening and being present for others is a deeply personal commitment that requires precision, thoroughness and generosity. Such qualities, DasGupta points out, serve us well in any field or in any relationship.
"I’m interested in pushing the idea of story in all of its derivations," she says. "Stories are the way that we all understand the world and the way all of our professions operate and thrive. They keep us self-critical, engaged. We’re all trying to figure out what it means to be present for stories, to receive them in meaningful ways, to co-create the stories of our lives and our world together."