Book review: The Art of Storytelling: from parents to professionals. The Great Courses

East Tennessee State University: Professor Hannah B Harvey

This is the first Great course that I have listened to. Yes, I’m like all of you. I’m proudest of those ‘important books’ on my bookshelf that I read during high school and college, and always aspire to buy and read more, but … there never seems to be enough time to CATCH UP ON THE LAST EPISODE OF BREAKING BAD or THE EXPANSE or THE MARVELOUS MRS. MAISEL (yes guilty as charged, your honor), much less break away to read a book (hello, audible.com for the commute) much less read the CLASSICS (unless of course your high school children start leaving their English lit or Russian lit or Holocaust books around and you pick them up an devour them, just to be annoying to the kids—try it, it’s fun).

So, it was with a mix of apprehension (will this be boring?) and pride (look at me! Taking another class for real! Kind of.) that I bought this and began listening. Thanks, ‘half-off audible.com sale.’ Turns out “on sale” Nudges do actually work (a future book review: I’m sitting here on the plane typing this review on my phone while the book Nudge presses against my knee in the seat-back pocket of this Economy seat).

Yes, yes I know. My wife often says: ‘it must be difficult to be you.’ Yes. Yes it is, honey. Thanks for noticing.

I’m listening to this first course. Professor Harvey has a bit of a southern accent, pleasant, well-spoken. A promising start. She’s explaining principles of good story telling, sure. Then she launches her first story, and I’M RIVETED. And then she dissects what just happened. AND I’M RIVETED. A big part of my job is: presentations, pitches for new ideas, new projects, talks to others about our successful work, speaking to laypersons, to programmers, doctors, students to convince them of something or another. I think I tell a pretty good story: some humor, some funny illustrative quotes, some quick lessons related to the story, and then a quick close.

But the professional storyteller? Watch this…

Wow.

Later in the course, the professor reveals that Little Red Riding Hood has hundreds of local culturally diverse versions. And many were not intended for children. In the version she tells, the wolf is a MAN. A handsome, vaguely dangerous, very attractive man. And darkness and blood and meat and ?string and ?white sheets in the river come into play. It only vaguely resembles the children’s story we all know. And the telling of the story is … transporting.

We learn about point of view, about developing characters and slight variations in voices, using head swivels, facial expressions, tone of voice, stepping around the stage to more clearly represent various characters.

We learn about accelerating time, expanding time to bring attention and create a short story from a longer narrative. We learn about the official role of the narrator, who, different from the heroine, or villain, or bystander, can be unreliable, or unlikeable, or have a complex and different point of view from you playing yourself. Hmm.

We learn about reading your audience, changing the story and presentation, engaging your audience in movements and shout-outs to bring them in.

And we learn about bringing it home. Remembering to tell a story THEY need and want to hear, not just a sorry YOU want to tell.

CMIO’s take? Give it a chance. I’m giving a thumbs up to Great Courses and to this Storytelling series in particular. I’m going to work on being a better storyteller in the service of improving patient lives. I’m also going to work on being a better storyteller to entertain friends and family and myself.

 

Talk to the Hand (11 seconds, seriously?) and 3 tools to FIX THIS PROBLEM.

Yes, talk to the hand.

Our smart colleagues have published in JGIM (Journal of General Internal Medicine) and have updated the classic study: how long does it take for a doctor to interrupt the patient at the beginning of the interview, when patients begin their opening statement about “why I am here today.”

https://www.springer.com/gp/about-springer/media/research-news/all-english-research-news/wait–just-a-second–is-your-doctor-listening-/15963052

In years past, we found that the time it takes for a doctor to interrupt the patient used to be …

18 seconds! Then 23 seconds (hey! we’re getting better!) and now … 11 seconds?!?! That is, IF the doctor asked an open-ended question AT ALL. Yikes.

Seriously disappointing. But, are we surprised? The time pressures on doctors have increased over time. More regulation. More required elements in the documentation. Meaningful Use requirements of Electronic Health Records. Decreasing reimbursement. Not sufficient time or effort dedicated to redesigning the exam room, or to redesigning teamwork so that doctors can be doctors and not clerical workers.

This is what our EHR 2.0 Sprint and our Practice Redesign has been about.

Beyond that, we have an internal clinician retraining program at UCHealth to improve communication in healthcare encounters between patients and physicians, we call Excellence In Communication. Led by our inimitable Patrick Kneeland, executive for Patient and Provider Experience, and a team of a dozen physician coaches (myself included), we are teaching our docs highly effective communication strategies. In a four hour workshop, we can improve clinician experience, patient experience, and reduce physician burnout. Who doesn’t want that?

Of the many techniques and tips, here’s a trio that work particularly well:

  1. Open ended inquiry “How can I help you today?”, and then WAITING UNTIL the patient is done with their opening statement. The published data on this indicated that the vast majority of patients complete their opening statement in far less than a minute, and the exception will go up to maybe 3 minutes, if uninterrupted. The trouble is that docs feel like they’re under so much pressure that every second of listening is excruciating, and the other parts of their brain are already; categorizing, creating a list of possible diagnoses, worrying about completing checklists, wondering about quality metrics, and are too “full” to be present in the moment. We train docs to practice listening for up to 2 full minutes to a colleague’s statement and committing to trying this in an exam room with a patient. Simple, but the behavior change is IMMENSELY challenging and yet IMMENSELY rewarding when done well.
  2. The second technique is “What else?” That’s it. Just keep asking “what else” until the patient runs out of stuff. This, of course is the petrifying fear that docs have: “But that opens Pandora’s box and I’ll never get it shut ever again!” and “But then they’ll bring up stuff that I can’t help them with!” and “OMIGOD this will be 75 things and we’ll be here all day and night!” Yes well, we also know that the FIRST thing that patients bring up with their doctor is only 10% to 50% of the time, the most important thing they want to talk about. So, guess what, if we RUN with the first thing patients say, we’re going to be wrong 50 to 90% of the time. So there.
  3. Finally, and this is the piece-de-resistance, say: “Well, we have discussed quite a few things so far. Which of these topics would you like to cover today in the time that we have? I would like to discuss A, and sounds like B is also important to you. How does that sound?” Negotiating the agenda is a critical skill, and makes items 1 and 2 really useful, creates a win-win agreement between patient and physician, and EVEN SAVES TIME. Imagine: a tool that increases patient and physician satisfaction, and saves time.

Notice that this has NOTHING to do with the EHR being for good or for evil. This works regardless of what you have in the exam room, as long as you have the presence of mind to remember to practice and use the tools.

In this, the winter of our discontent, when everything seems to be going in the wrong direction, when all of our institutions are under attack, and public courtesy and discourse seems to have gone awry, and everyone has a complaint, it seems that so few have ideas to help us climb out of this morass.

These tools could be a glimmer of hope.

CMIO’s take? Use these three tools in the exam room (or the meeting room, the board room, any professional or personal setting where important conversations occur), see what transpires. They are EASY TO understand, but require discipline and hard work to make them work for you. Persist, and they will pay off in large ways for you and for your patients.