From House to Human – a new narrative for medical effectiveness

House – as portrayed by TV actor Hugh Laurie – has a lot to answer for!

If you’ve seen any episode of the classic series, you’ll know he’s the epitome of the medical genius with zero personal skills. And that’s a problem, because with all due respect to technical competence (and his gift for arriving at the correct diagnosis usually at the third attempt), personal skills are rather important.

‘Medical genius’ is a compelling narrative, which means it has real impacts in the world of recruitment of medical students and in the behaviour of House-hold heroes.

Let’s assume that most medical students start with loads of empathy, wanting to be good with people and thinking that they are. We can regret – and perhaps fix -the depersonalising systems and the stories that go with them that drain their good natures all too often as their careers progress.

Fortunately, there’s an upsurge of interest in communications in medical circles. You’ll hear about it under the title of ‘medical improv’, for example. It’s a counter to an epidemic in health services of ‘Empathy Deficit’.

There are plenty of nursing and medical students, all of whom we can presume want to give good care. Then they hit systems of education and health care. In the US, UK and beyond, it can be ironically an uncaring and dehumanised system, devoted more to technology and pharmacology.

Some students get stressed by exams, burn out, or over-rely on short-term coping skills (yelling, alcohol and other tactics for tuning out caring).

Doctors and paramedics are taught to distance themselves from patients, to ration time, to follow formulas for telling people bad news.

But many medical practitioners, not to mention their patients, are resisting such trends. Confidently equipped with information from the internet, they are leading a literate and powerful counter-movement.

Doctors ask ‘What’s wrong with you today?’ as routine.

What can the shift to a more story-based introduction look like?

How about:

Each of these would open up a potentially more productive (and cost-saving) encounter. Professor of Nursing Margaret McAllister calls this approach ‘narrative humility’.The idea is that patients will react differently if the medic takes a stance of narrative humility: not knowing yet, until you (the patient) tell me more. This reduces the feeling of hierarchy and hopelessness, and it helps staff avoid social stereotypes.

Proponents of ‘Medical Improv’, such as nurse Beth Boynton, propose that there’s a value in this more level status. It offers the patient dignity. Likewise, it fits with a solutions-focused (SF) stance of curiosity and trust in people being the experts in their own lives – knowing what they want, if asked respectfully and (no pun) patiently.

If we avoid using old labels and diagnoses, we avoid stigma and confirming biases. Instead, we can pick up potentially important and time-saving history.

Of course, we need the classic medical model abilities – and doctors, nurses and other staff are trained to be very good at this. The point is to re-situate these skills in a more human system. ‘Fix me, but not by making assumptions. Or, if you are making assumptions, check with me, please.’

The new medical narrative evolves from ‘House’ to ‘Human’. When doctors are flexible and adapt to make this extra conversational space, the patient can use their own voice, helping the professionals to reach better conclusions.

Resources:
Margaret McAllister: https://scholar.google.com.au/citations?user=vUMsgmMAAAAJ&hl=en
Beth Boynton: https://bethboynton.com/
The Solutions Focus: www.thesolutionsfocus.co.uk