When Syl Jones was a child, his doctor would carefully explain that if he didn’t take his medicine, he wouldn’t be able to go to school.
That was the worst kind of punishment for Syl, who loved school. His doctor knew that about him and thus explained his prescribed care in terms the schoolboy could grasp.
Jones, a longtime Twin Cities medical and creative writer, uses the anecdote to explain why he’s spending the coming months and all of 2016 helping doctors at Hennepin County Medical Center in downtown Minneapolis, the state’s largest safety-net and training hospital, learn to use narrative medicine. The work, the focus of Jones’ Bush Fellowship, began in June.
“It’s a little bit new and old,” he said of narrative medicine. “It’s not exactly cutting-edge stuff. … It’s about combining the arts and sciences.”
Columbia University in New York leads the field, offering a master’s degree in narrative medicine that explores the patient-doctor connection. Jones is doing the same at HCMC.
The idea behind narrative medicine is that better understanding leads to better care. Raw transcripts of doctor-patient interactions show that providers routinely interrupt patients within the first 13 seconds, Jones said. “The patient doesn’t get to tell the complete story,” he said. “Patients tell you things that don’t appear to have anything to do with their original complaint.” Patients’ fears compound the communication break, he said, adding “doctors don’t learn to unravel complex conversations.”
HCMC CEO Jon Pryor said Jones is working “to help us effectively partner with patients to improve the lives of those living with congestive heart failure. He specifically is telling our patients’ stories to help us all improve care. He is also training … tomorrow’s physicians.”
Jones has led training sessions with psychiatry, family medicine and first-year residents, helping learners appreciate the value and importance of narrative medicine.
Jones believes the explosion of technology in medicine at the cost of touch has widened the provider-patient gap. He encourages doctors to write narratives on their patients. “You need some quiet reflective time to think about what the person has said,” he said.
He used the example of a patient with a headache who hasn’t slept, and how deeper questioning could reveal stress resulting from working multiple jobs, caring for children and an elderly parent. Often what people really need is reassurance from a caring authority figure, Jones said.
To illustrate how patients conceal their real concerns, Jones and the caregivers read books, especially those with unreliable narrators. He cited Ford Madox Ford’s “The Good Soldier,” where the narrator appears to be telling one story that unravels into something else that flips the reader’s perspective.
Jones encourages caregivers to “ask themselves about the reliability of the narrators, listening to find out if the patient is really telling them everything they need to know.”
In narrative medicine, the doctor and patient “coproduce” a care plan to ensure it fits — something increasingly important as medicine moves into more specified care through genomics.
Pryor said Jones also thinks about diversity and inclusion in medicine. “These are important concepts from many perspectives: Do we have a workplace that is accepting and inclusive and therefore a great place to work? How can we improve our diversity in our leadership and workforce to be reflective of the patients we see? What are some mechanisms to approach the disparity in health care that exists in Minnesota?” Pryor said.
Finally, Pryor noted that Jones is working with HCMC’s research group to acquire more grants. “Syl will learn a lot during his fellowship, and we will definitely learn from him,” Pryor said.