‘Storytelling matters in medicine in the same way that storytelling matters in life’

What does a hairdresser, a bespoke tailor and a doctor have in common? How can cartoons be used in medicine? What can poetry teach healthcare professionals? Why are doctors so difficult?

The answers to these questions and more will be revealed on June 17th and 18th when a tribe of curious, interesting and interested healthcare professionals from a range of different specialities come together at dotMD – A Festival of Medical Curiosity.

The conference – described as “the Electric Picnic of medical conferences” and “medicine for the soul” – is organised by consultant rheumatologist Dr Ronan Kavanagh; GP, medical journalist and author Dr Muiris Houston; and consultant gastroenterologist Dr Alan Coss, and, according to its website, “aims to reawaken a sense of wonder and curiosity about medicine that some may have lost along the way – and help them find deeper meaning and satisfaction in their working lives”.

One of the speakers due to address the conference, which takes place at NUI Galway, is Dr Suzanne Koven, a primary care physician and writer in residence at Massachusetts General Hospital in Boston in the United States. Dr Koven, whose first book, , Letter to a Young Female Physician: Notes from a Medical Life, was published last year, will speak about why storytelling matters in medicine and why you should write a book. Speaking to The Irish Times in advance of dotMD, Dr Koven said: “Storytelling matters in medicine in the same way that storytelling matters in life. It’s how human beings communicate. It’s how we make sense of our experience or reality.”

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She explained that whether they knew it or not, doctors were telling stories all the time when, for example, they take a medical history or present a case at grand rounds.

Dr Koven said storytelling is “the currency” with which doctors practise medicine, and for patients being able to tell your story is “absolutely essential to healing”.

“It doesn’t matter whether it’s a psychological issue or appendicitis. If you can’t express your experience, your pain, your suffering, you can’t heal. And I think what all good clinicians know is that allowing someone to tell their story, helping someone to tell their story, making it clear to them that their story is being heard, is enormously therapeutic.”

Dr Koven said research shows that people who have a good rapport with their doctors have better outcomes, and patients who keep a journal of their healthcare experiences report improved emotional wellbeing. “This isn’t some sort of vague abstract concept. This is something that is very real and very central to what we do in medicine,” she said.

The importance of the arts in medicine was underlined for Dr Koven during the recent Covid-19 pandemic. As a writer in residence at Massachusetts General Hospital, Dr Koven runs reading and writing workshops with healthcare workers interested in creative writing and she also organises events such as poetry readings and author conversations. Her role is unique in that she is both a qualified writer and medical doctor and her writing work focuses solely on hospital staff as opposed to patients.

When the Covid-19 pandemic hit, Dr Koven immediately assumed her role would be redundant, as healthcare workers would need to prioritise a global pandemic over poetry. However, she said it was a time when the “human need for storytelling was never greater”.

Asked if creative writing and the humanities helped with the trauma suffered by frontline healthcare workers in the pandemic, Dr Koven said it was difficult to quantify. However, she reflected that those she worked with during that time reported that writing helped with the isolation many felt due to restrictions and lockdowns. “The need for self-expression was greater so people certainly told me that it helped. It certainly helped me,” she said.

One of the things that makes dotMD unique in the world of medical conferences is that it encourages pressurised healthcare professionals to catch their breath and look up from the sometimes-held view of medicine as a science and embrace it as an art, something that Dr Koven is passionate about. “The arts, literature, storytelling, narrative – these are not things that are sort of niceties or kind of extracurricular to medicine, this is medicine, anything that illuminates the human experience must be central to medical practice. That is certainly been my experience for well over a decade running reading and writing workshops at my hospital, and coaching healthcare workers interested in writing is that it’s not just a sort of like after-work, stress reliever. It really does help us in our work in a very meaningful and tangible way.”

The speaker line-up for dotMD is always an eclectic mix and this year is no different. It includes Booker Prize-winning author Anne Enright, comedian and chat show host Tommy Tiernan, former trauma surgeon, GP, academic and author Prof Roger Kneebone, and novelist and psychiatrist Steven Schlozman.

Prof Kneebone directs the Centre for Engagement and Simulation Science at Imperial College London and the Royal College of Music (RCM) – Imperial College Centre for Performance Science. His book, Expert: Understanding the Path to Mastery, was published in August 2020 and in it he explores proficiency and what it means to become an expert in a particular field.

At dotMD, Prof Kneebone will explore how visual and performance artists can provide unexpected insights into clinical practice. Building on his work with experts from unconnected domains, Prof Kneebone highlights parallels that are frequently overlooked.

Speaking to The Irish Times, Prof Kneebone explained that clinicians can learn a lot from experts and performers outside the world of medicine. For example, he draws insightful parallels between the work of a bespoke tailor and a doctor in the manner in which the tailor consults with a client to create the perfect outfit, adjusting it here and there much like a doctor consults with a patient to come up with a diagnosis, and prescribes individualised or bespoke treatments that may also need to be adjusted.

In his work at the RCM - Imperial College Centre for Performance Science (CPS), Prof Kneebone and his colleagues explore the challenges of performance across domains, from the arts, education and business to medicine, science, and sport. The CPS Performers in Residence programme brings together experts in magic, puppetry, embroidery, cooking, chemistry, illustration, percussion and combat flying.

Prof Kneebone sees a common thread between performers and doctors and views the doctor-patient consultation as a performance. For example, he explained that a doctor must be skilled at establishing a relationship with the patient who they may be meeting for the very first time. The doctor must also make the patient feel comfortable enough so they can explain what is wrong and decide what to do next. And all of this must be expertly performed in 10-15 minutes.

While clinicians don’t necessarily see themselves as performers, Prof Kneebone said “all those things are aspects of being an expert performer”.

Prof Kneebone – who has a podcast entitled Countercurrent in which he has conversations with experts from all aspects of life – said the patient-doctor consultation was another form of conversation and as they perfect their expertise, doctors realise that the consultation with patients involves talking less and listening more.

He said it involved being “less anxious to chase after a diagnosis” and spending more time “listening attentively” and trying to understand the issue that is concerning your patient. “A lot of that involves listening and watching and just being there for a while without looping in and saying and doing . . . it’s quite difficult to do but really skilful people you see do it without even noticing it,” he said.

The two days of dotMD this year includes live music by Iarla Ó Lionáird and Ryan Molloy.

Dr Ronan Kavanagh said that live music has become a really integral part of the meeting. “I think it softens up the edges of the battle-weary medics who go to the conference and perhaps makes them a little bit more open to some of the ideas that are shared.”