Storytelling should be a core part of the medical curriculum
"Narrative Medicine" is the future, even in the age of AI
I invited Rohan to co-write this piece because of his involvement with Roon, where he’s watched hundreds of physicians record video content. We’re both passionate about this topic and have had a few in-depth conversations about it that we figured we’d turn into an op-ed. I’m also writing a book about the topic of storytelling, which will be published in 2025.
As a healthcare industry, we spend a lot of time talking about the power of artificial intelligence and how it will “replace” or “augment” physicians. What we don’t discuss nearly enough is the human stories and relationships that are the core of medicine even in an age of advanced computing.
As Rohan often says, being a great doctor requires more than skills in diagnosis and treatment. To relieve suffering, providers need to connect deeply with patients and their families. But as we contemplate AI in healthcare, what might we lose from the human aspects of medicine? Imagine a Chatbot informing you that you have incurable brain cancer and walking you through your treatment options, in that off-putting ChatGPT conversational style?
Because of AI, the medical process could change. Rote memorization is already a thing of the past and it will only become more clear with time that computers are better at it! We think the best doctors in the future will be master integrators, expertly making sense of endless patient data with the help of AI tools while combining that with established science and their own experience. They’ll also be needed at the bedside. As AI becomes more prevalent, the biggest shift will be that we’ll see more training for doctors to be empathic communicators and storytellers.
This is the thinking that’s already at the heart of “Narrative Medicine,” which should be part of medical training in our opinion. What do we mean by that? It’s a movement that arose at Columbia Medical School in the early 2000s, which promotes a kind of medical education that sits at the intersection of medicine, humanities and the arts. The movement calls for physicians to better understand their patients' perspectives and experiences so they can deliver better health care. Key to this is teaching physicians about active listening and storytelling and its power to effectively communicate ideas and foster healing. This kind of education and training should be taught everywhere, and we believe it will be.
The kind of training that needs to be taught as a core curriculum in medical school, alongside skills that are going to be increasingly important in today’s world like communication and social media. Doctors should be leaning into what makes them human, rather than trying to beat AI at what it does best in ingesting vast amounts of information and spitting out answers. No human will ever be able to mine huge troves of data on par with a computer. But no AI-trained program will ever be able to sit in front of a patient, look them in the eye, and tell them the kind of story that will help them come to terms with an extremely difficult, emotional decision related to their treatment.
We’ll offer up an example from Rohan’s neurosurgery practice at Weill Cornell Medicine in New York.
This patient was dealing with a glioblastoma, an incurable form of brain cancer that typically leads to death within 12 to 18 months.
She had just learned that the tumor had returned a second time.
Her immediate, next question: “Should I take more treatment?”
When she asked this question, Rohan had already explained the range of treatment options to her from the medical side of things. So he realized the thrust of her question was not about the details of treatments, but his opinion on whether she should make that choice. Ultimately, that was her choice to make.
So he decided to tell her a story about his friend with glioblastoma. He, like her, had a young family. He was fed up with appointments and the insane logistics of health care delivery. And he very matter of factly just told his treatment team “You all work for me, not the other way around - I’m not missing any more vacations, or time with my family on account of this disease. From now on, I”ll take my treatments but work my treatments into my life rather than the reverse.”
He told her this story because he knew she needed to feel some agency with her health care choices amidst the uncertainty of this horrible disease. And hearing a story of the other patient, who had so masterfully articulated his own autonomy, gave her the confidence to design her own plan.
The next day, Rohan received a message “Thank you so much for our appointment yesterday. I booked a vacation with my kids and will resume treatment afterwards. See you all in a few wks!”
In that moment a simple story provided her the relief she needed.
Humans have been telling stories for a very long time. Think about those cave paintings in parts of Europe, or any ancient religious texts which teach us morals from a young age. It’s the time tested way to transmit information, communicate ideas, and persuade.
There’s also plenty of evidence from neuroscience research that the brain preferentially processes stories, and not facts and figures. For example, A study from UC Davis shows how the hippocampus functions far better if called upon to remember a coherent narrative rather than disparate facts. Brain-imaging studies from Princeton have shown that listeners literally sync with powerful storytellers at the neuronal level. This shows, at an electrophysiologic basis, the power and influence of master storytellers.
We often forget how complicated medicine is outside of biology. Remember, physicians uniquely sit at the crossroads of illness, wellness, finance, law, politics, society, family and more. We’ve seen that the great physician educators lean into this complicated milieu and adapt their storytelling accordingly, because they know that health and illness are inextricably linked to socioeconomic and cultural factors. And so in medicine, it’s clear that listening to patients and storytelling can and must be a form of treatment, and not just a “nice to have” communication skill.
There are two core ideas here that we’re talking about, both of which we are suggesting are worthy of intensive study and practice:
“Active listening” to the patient to better understand the whole picture;
Powerful stories to communicate complex ideas, persuade and give the patient agency to make informed decisions.
Putting this into practice though won’t be easy.
The realities of modern medicine discourage this powerful form of healing.
In a world where documentation, billing and RVUs are the coin of the realm, the healing power of storytelling has been marginalized. If there’s no (CPT)code, there’s no dice. Not to mention patient visits have been often reduced to 8-minute encounters, where the physician is often glued to a tablet or computer rather than engaged in any real conversation or deep listening (hopefully AI and venture-backed companies like Abridge will change that).
Thankfully, many clinicians in both of our networks are pushing back against this widgetization of medicine and striving to be the healers they idealized when they first went to medical school (the oath of Maimonides, anyone?). One of the great hopes for AI is that it can swoop in to reduce or even eliminate administrative, billing, documentation, and compliance tasks and thereby leave physicians open to do more face time with the patient.
One last point that we’ll mention: Storytelling can be used for good or for evil. And in recent years, we’ve seen much more of the latter. The online world has facilitated and amplified medical mis- and disinformation leading to disastrous results. A recent example: in the post Covid vaccine era, Republicans were 43% more likely to die from Covid infections compared to Democrats. Online forums are replete with scams and active disinformation that serve only to prey upon people looking for help.
Doctors are not to blame for the rise of medical misinformation (unless they are the ones perpetuating it). But in this new reality, all healers do have a responsibility to combat medical misinformation and narrative medicine is the unlikely hero in this battle. The problem? Doctors have not been historically trained in communicating at scale. And many of the leading clinical experts are understandably reluctant to debase themselves amidst the swirl of shady influencers.
But step into this breach we must! The good news is that there is an emerging class of expert physicians who are leaning into their roles as educators. We’ve observed this special class of medical creation closely and distilled some of the distinct qualities that seems to resonate most with patients and caregivers.
Let’s call it the 5 “C’s”:
Compassion - So much of medical time is rushed. Giving space to the emotional context around a medical decision reinforces the connection between doctor and patient.
Confidence - Patients are looking for answers. Confidence borne from expertise and experience must shine. This generates trust.
Candor - Breaking the glass and letting people into your world of medicine, with all its messiness helps humanize the provider on the other side.
Curiosity - Doctors who share examples from their lives, or examples from other patients (obviously without breaching confidentiality) can tap into the power of storytelling to help persuade. But before doing so, they must ask questions of the patient to gauge what they need.
Concision - No one wants to watch a long medical webinar. Providing a brief, insightful, specific answer is an art that must be practiced.
These attributes aren’t just good for being effective on social media. They’re essential for being a great doctor and for delivering a quality patient experience. And in this time of seemingly infinite yet unreliable information, They’re part of what it means to practice good medicine.
To leave you with a final thought: We think we need a Facebook community/support group for medical creators to share tips, ideas and opportunities with each other. There’s oftentimes a strange professional envy that occurs when physicians speak out in public forums (“so and so doesn’t have the right credentials,” or “they’re too self promotional”). We’ve both noticed it. But it doesn’t need to be this way. We could all be supporting each other instead, recognizing that this kind of communication couldn’t be more important in an era of rampant misinformation. If you’d like to join, add your name here. You don’t need to be a physician, btw! Anyone who describes their role as being a healer or medical communicator is welcome.
Rohan Ramakrishna is a professor of neurosurgery at Weill Cornell Medicine and New York Presbyterian hospitals and the Co-Founder of Roon. He attended medical school at the University of Pennsylvania.