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.
2 thoughts on “Doctor, tell me a story.”
The thing about health, though, is that so much is at stake. He can live with flecks on his dishes every few cycles without much problem. But his patient’s fatigue may be life altering. At that point, it isn’t a question of faith in rationality versus belief in stories; it’s a question of fighting for one’s life. You can believe in experts all you lie, but when they have nothing to offer, it’s pretty tough to just abandon your own intelligence and trust them. In fact, I’d argue that it isn’t very rational.
Agreed! For me, one of the takeaways is that the doctor needs to acknowledge the patient’s story, not dismiss it. Telling someone that their theory about why they’re sick is wrong and that the truth is “we don’t know what’s wrong with you” doesn’t help anyone.