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The man behind the curtain and other lessons

February 23, 2012

I think a lot about the overlap between storytelling and health care.  Partially that’s because it’s the job I do every day- trying to fit facts and figures about this industry into some sort of narrative arc. I know how hard it can be to make this stuff interesting and approachable.

But what about the act, not of telling stories ABOUT health care but story telling IN health care? Boston University School of Medicine does both in this article and video about end of life conversations.  Watch here-


The house visit between cancer patient Charles Swanigan, Dr. Eric Hardt and his students  is an aspect of the Boston University’s School of Medicine’s geriatrics clerkship. Professor Matthew Russell says he stresses the importance of asking open ended questions, allowing patients to tell their stories.

…mere yes-no questions about symptoms fumble the chance to be of real help, he says. He exhorts the students to remember who their patients are as people. “It’s the spouse of 60 years who’s going to lose a wife, the family who’s going to lose a matriarch. Our bread and butter is a patient and family’s worst day.”

Russell says those stories can reveal important things about a patient. Doctors offering routine treatment might miss important details.  Perhaps it’s a patient’s goal to make it “the next few weeks to their granddaughter’s christening.”

It’s scary to talk about death. That’s usually the kind of story people avoid. It’s easier for doctors to promise to prolong life, or at least avoid the hard truth that death is very near. That’s why Russell advises his students to learn from another great story, The Wizard of Oz

The dying crave a miracle that will save them, Russell says, but healers must not oversell their powers in hopeless cases. “Remember the lesson of the Wizard of Oz,” he urges.

“There’s no place like home?” ventures a student.

“Oh, sh–,” says Russell with a laugh—he’d forgotten that famous moral of the story. “That’s not it. Another lesson.” He’s referring to the movie’s insight that the man behind the curtain is just a man. “We have to be mindful of our participation in that illusion of Oz,” he says. “Patients will often want us to be the wizard. You owe it to your patients to be true to what you know—which is limited.”

Doctors out there- how have you learned to have these tough conversations with your patients? How do you use their personal stories to create an end of life plan?

Thanks to @Brownmedicine for first tweeting a link to this video.

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