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23:30  11 november  2019
23:30  11 november  2019 Source:   usnews.com

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Everyone loves a great story. Storytelling really has its roots in the beginning of human existence, a communication system that developed with the first societies. Its purpose has always been critical: to be the oral history of significant events, to transfer knowledge and to ensure the longevity of traditions, values and social norms. We spend hours consuming the tales of other people through all aspects of journalism – magazines, blogs, news broadcasts and conversation. The world has seen an entirely new industry in the genetic and ancestral searches for people to track down their family history – the story of their lives through previous generations. Stories are also for entertainment and society building as a vehicle to understand the complexities of the world as it exists. As an Indian proverb suggests, "Tell me a fact and I'll learn. Tell me a truth and I'll believe. But tell me a story and it will live in my heart forever."

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a woman talking on a cell phone: Mature female doctor talking with her young female patient.© (Getty Images) Mature female doctor talking with her young female patient.

With regard to health care, storytelling has been employed in certain areas with some success. One of the major areas of impact is in the realm of patient safety. Having patients and families tell their stories of preventable-harm events has shone a spotlight on the process issues that exist that may result in injury. Many hospitals have embraced this phenomenon and overall, there is belief that such stories have improved the preventable harm in many care centers. Why? Most likely, it adds the human aspect to the facts of a case, touching the empathy cord inside most human beings. It adds both accountability and urgency to improvement activities. The result has been a national movement to do better.

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Another area where many organizations, both inside and beyond health care, have used storytelling is in an effort to forge a connection to the purpose of their enterprise. While it may seem odd that those who deliver care to people in their time of need can require a reconnection to their purpose, it is indeed very necessary. People can get empathy fatigue and lose sight of the mission at certain points, and a reminder can be uplifting if done well. These "connect to purpose" stories can be about efforts of staff and clinicians providing care and compassion and often involve patient feedback on a job well done.

But are those uses of storytelling optimal? Since storytelling is one of the most impactful ways of learning and connecting, there should be additional ways to use it effectively in engaging with our patients and team in the health care sector. And the idea is catching on through narrative medicine.

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Narrative medicine is a relatively new concept. It's about spending the time to get a patient's story and not just the facts of immediate importance to the acute encounter. It goes beyond getting the symptoms and employing evidence-based practice, and attempts to delineate the entire story of what led the patient to seek care at this juncture. The story starts at the beginning, when we're meeting the patient in the middle. It explores how they became ill, how they feel about the situation, how they are or are not coping, and what might impact their journey to recovery. It can point out to us what is important in their life, their religion or their culture that will define success of treatment.

If one takes a moment to reflect, our "connect to purpose" story should always remind us that in health care, we are in the people business. We need to connect to the whole person, put the human being together with their chart. We can get their medical history from the EMR, to a certain degree – but we need the whole person story to be most effective and work with the patient as a team.

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So how do we wade deeper into narrative medicine? First and foremost, we must recognize that it is discipline and skill that, like all other medical knowledge, gets better with practice and exercise. Medical schools like those at Temple are growing a strong curriculum in this area, with increased engagement with their learners. This can present challenges with such a packed slate of necessary studies, but it should not be looked on as something additional – rather, another critical skill. In addition, other medical schools are reading the lay literature and some of the old masters to hone skills about what stories are really saying with regard to the human condition, to develop skills in getting to a deeper understanding. What used to be attributed to bedside manner could now be considered an entirely new tactic in history taking.

Once we really excel at narrative medicine, the potential advantages far outweigh the disadvantages. First of all, no expensive medications or equipment are required, just time and patience. Of course, encounters could get quite lengthy if stories are unfocused, but part of the training should be on helping the patient work their way through the story at a reasonable pace without taking away from the tale of their journey. In that way, this method could be quite cost effective. In addition, the impact on value for the patient and the provider is potentially astounding by enriching the quality of the interactions for each by providing the entire context for the doctor-patient relationship. We know from satisfaction surveys that patients are frequently disappointed because their provider didn't take time with them or address what they really thought was important. We also know that burnout is rampant in health care providers, often associated with a loss of empathy. Perhaps narrative medicine can reignite the heart to match the head.

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Physicians are in general naturally curious, which is what leads them into a field to investigate diagnoses, look for new cures and understand the human body. All people want to connect to those who are important to them, and in the patient doctor dynamic, that quest should be paramount.

As healers, we have a commitment to improve the human condition. That should go beyond throughput, ordering tests and writing prescriptions. It should be about connecting with humankind, understanding their journeys and developing both cultural awareness and humility. We should lead with our heart. After all, that should be the connect to purpose for all of us.

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a person sitting on a table: “While most people realize that water is essential to their health, very few actually drink enough,” says Eddie Johnson, founder of Anabolic Bodies. “Besides for ensuring that you have the correct electrolyte balances, and being beneficial to your excretory system’s health, water, (or lack of it), can also affect your eating habits. In fact, it is well documented that thirst is often mistaken for hunger, this means that if you’re thirsty, you may be exchanging zero calorie water for unnecessary meals. Over time this will add up to extra pounds that will take their toll on your health, as well as your appearance.”The Remedy Rx: To ensure you’re adequately hydrated, follow experts’ guidelines: Drink 1.7 liters (or 7 cups) of water every 24 hours.

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