Why Modern Medicine Can’t Work Without Stories

Polly Morland in The Guardian: Most of us over the age of 30 can remember the family doctor we had when we were kids. They met us as babies and watched us grow up. They knew our stories, those of our siblings, our parents and often our grandparents, too. These stories were fundamental to the bond of trust between doctors and their patients. We are now learning that this deep, accumulated knowledge was also palpably beneficial in medical terms.

The stories came in fragments, of course. Any GP will tell you this: that alongside the medical history, there are glimpses of the life that accompanies it: a past trauma, a triumph, a family crisis, a morbid fear or a reason to hope. Reducing any patient to their affliction, the tumorous breast or lazy pancreas, is akin to regarding a book as nothing more than paper and ink. This focus on the whole person, while valuable in all medical disciplines, is bread-and-butter work for GPs. Their role as the keeper of patients’ stories is what most of them love about their job, or what they used to. Because the world has turned, and with it the dynamics of primary care. Few of us attending the doctors’ surgery these days expect to see the same GP twice. We don’t know our doctors like we used to, and they don’t know us, a situation only compounded by Covid and the default to remote consultation. Shared stories have, in many cases, given way to medical transactions.

Even before the pandemic, doctor-patient relationships were in serious trouble. A mobile population, a shortage of doctors, overwhelming workloads, the move towards part-time working (for many GPs, the only way to endure the pressures of the job), bigger practices, larger teams: all of this gnawed away at the humanity of primary care. Meanwhile, the rise of evidence-based medicine has seen a shift towards the management of health risk via a playbook of standardized interventions. While this has driven progress in the treatment of many illnesses, it’s had unintended consequences for the relationship between GPs and their patients. Precisely because the value of those relationships is difficult to render in cold, hard figures, performance metrics are skewed towards outcomes that are easier to quantify. The emphasis, and indeed the measure of success, has shifted from the individual patient to the disease. More here.