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Storytelling Unveils the Heart of Medicine

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woman performing on The Nocturnist
UCSF hospitalist Larissa Thomas, MD, tells a story at the first Nocturnists event in January 2016 

By Chris Cai, MS I

In a hushed theater in downtown San Francisco, Emily Silverman, MD, sits amidst the crowd. Those on stage have taken off their pagers and white coats, signaling their transition from provider to storyteller. They are The Nocturnists, healthcare professionals and patients who tell and share their stories.

“As an intern, you grapple with questions of life and death, but are often so busy that it’s hard to find time to reflect on an experience. Storytelling buoys me and connects me to my human side,” said Silverman, an assistant professor of medicine, who created The Nocturnists. “Stories in medicine are getting lost. I hope The Nocturnists gives people the time and space to dive back into these narratives and reconnect with the deep meaning present in their jobs,” she said.

Founded in 2015 and akin to the storytelling program The Moth, The Nocturnists has hosted 11 live, sold-out events on themes like diversity and identity, justice, and wonder. The events now draw hundreds of attendees and have received local and national media attention. Silverman relates an example of the stories told by a participant:

“A woman, who worked as a hospital administrator, told us about the day the refrigerator in the hospital morgue broke. Through her narrative, she showed us the logistics of how a hospital functions, but touched on powerful themes of death and dying. She has since moved back to the East coast to start a post-baccalaureate program and will soon apply to medical school. She told me that participating in The Nocturnists was one experience that influenced her decision to pursue an MD.”

While developing The Nocturnists, Silverman wanted to meet others interested in medical humanities, and connected with Louise Aronson, MD, MFA, professor of geriatrics and director of UCSF Medical Humanities. Aronson is the author of “History of the Present Illness” and regularly contributes to major newspapers, medical journals, and literary magazines that cover humanities-related topics. Her advice and perspectives have been instrumental to the program.

“Emily’s initiatives in this area are amazing,” said Dr. Aronson. “Her work has really touched a nerve. The Nocturnists humanizes every part of the medical process.”

The success of the program, Dr. Aronson explained, reflects how physicians are increasingly recognizing the importance of narrative medicine, a movement to use stories to promote health and healing.

“Stories humanize medical practice and are crucial to communicating medical evidence and promoting health,” said Aronson. “If you try and fight a compelling story with a group of statistics you will often lose. Brain scan studies have shown stories recruit more parts of the brain than statistics alone and help increase retention.”

Recognizing this, Dr. Aronson worked with UCSF colleagues Alice Chen, MD, Sharad Jain, MD, Vanessa Grubbs, MD and Anda Kuo, MD, to develop the Writing for Change Seminars. Part of the Partnership for Physician Advocacy Skills curriculum, these seminars teach medical residents how to publish compelling arguments in leading medical journals and newspapers.

“We wanted to move beyond the notion of narrative medicine as an end itself and instead harness the craft of writing to advocate for patients and ever-improving healthcare,” said Dr. Aronson.

Inspired by the success of Writing for Change, Dr. Aronson developed a longitudinal training program for students in which they learn from a broad range of UCSF physician-writers and begin to develop their own writing skills. The series culminates with a course in public medical writing, where any UCSF student can draft articles for publication.

“Ten or twenty years ago, most medical journals focused on the science. Today you’ll also find opinions and perspectives. In newspapers, the opinions and story sections are often the ones that go viral,” said Dr. Aronson. “Residents and medical students often write different types of articles, reflective of their stage of training. The residents, comfortable with their physician authority, can focus on advocacy. Students, still transitioning from layperson to doctor, often write about personal or family illnesses or about the process of becoming physicians.”

In response to a growing demand, Aronson is also providing continuing medical education (CME) courses for faculty, typically one-time lectures or longitudinal courses. Workshops extend over several weeks and allow participants to learn the skills to write and publish their own pieces.

Aronson encourages students to get involved and learn how to communicate science to the public. 

“All other professional training programs, whether it’s business or law, teach persuasive public communication. For a while, medical education didn’t. At UCSF, we are starting to change that.” 

Sample Publications

Armchairs and Bowties, Sara Catherine LaHue, MD, in JAMA
“We asked each other what field we were applying into. Career choice became a proxy for personality and values. When my turn came, I said I was going to be a neurologist. ‘I considered neurology,’ a dermatology applicant offered. ‘But I want to actually make my patients better.’ The other applicants were silent; some looked at the floor. I was not far from home, but I felt alone.”

How Safety Net ERs can save health care reform, Andrew Lim, MD, on
“Emergency departments occupy a unique position in American health care — so close to the poorest communities, yet at the doorway to the most expensive interventions of modern medicine.”

The Patient Rotation, Jason Nagata, MD, in JAMA Pediatrics
“After dining on all-you-can-eat seafood shabu-shabu with my cousins, I suddenly began vomiting bright red blood and passing black tarry stools. I shrieked for my parents before passing out on the white tile of our bathroom floor. In those few seconds, I transitioned from physician-in-training to patient. For the next 30 days in the hospital, I learned invaluable lessons in my journey to becoming a physician.”