Doctor, tell me a story.
I really like Kent Sepkowitz’s essay in this week’s Science Times. Sepkowitz, vice chairman of medicine at Memorial Sloan-Kettering Cancer Center, describes an interaction he had with his plumber. He tells the plumber what he thinks the problem is, and the plumber dismisses his explanation out of hand. Sepkowitz has a flash of insight,
I realized how similar these exchanges are to those I sometimes have with patients.
When we’re faced with evidence–medical, scientific, or plumbing-related–our human instinct is to create a story to explain it. Sepkowitz’s dishwasher was putting black flecks on his dishes. The human mind abhors uncertainty, so Sepkowitz invented a cause to explain the flecks. The same thing happens when a patient comes in to Sepkowitz’s office with a nonsensical explanation for a symptom.
The essay provides a vivid illustration of how stories help us process information. This line, in particular, shows why it’s so hard to replace a certain, yet wrong, story with a factual one that’s seeped in uncertainty. Sepkowitz is retelling how he’d shot down a patient’s theory of his illness.
After I finished, we stared at each other in awkward silence. I had broken his heart a little, and I too was demoralized. It is not enjoyable to trample hope.