Editorial Volume 19 Issue 3 – We are all story-tellers

Abstract

Story telling is a human universal1. It is as old as language. Creating and relating narratives form an integral part of how physicians understand and communicate about our patients and their diseases. We ask our patients to help us develop their story (‘tell me about when all of this first started’), and then we tell their story back to them to facilitate our understanding (‘let me just check I understood; this is how things have progressed’). We use individual patients to anchor our learning in medicine; conditions are better recalled when they are attached to a specific people. Thus, we write case vignettes to improve understand when we teach others. When we see an interesting case we advise our medical students to use the opportunity to revise the related conditions, as we know that an individual patient narrative establishes richer meaning and better recall. Case reports in medicine are therefore the perfect medium for learning. We unravel a patient’s story to communicate not only a timeline of events, but to harness the innate human predilection for story-telling as a tool of meaning-making, comprehension, and hopefully, recall. We share patient stories from past experience to improve the stories through better care in the future. We are delighted to present a heterogenous of collection of case reports in this issue that explore pacemakers, proteus, pneumorhachis, pain and POCUS. The clinical variety isaemblematic of the work of the acute physician. Continuing theme of patient stories; when does their healthcare story end? From the perspective of the acute medic, the story of a patient ends when they leave our department; the narrative is picked up by the receiving clinician. But all patients’ Acute Medicine Unit story has a postscript that we usually do not get to see. In this issue Ahmed et al2 outline their findings from following up patients after an admission for a medical or surgical emergency. Their findings are illuminating and disconcerting. Clinical stories are usually co-constructed by the patient and the clinician. Despite this collaborative effort there may still be a disparity between the patient’s and the doctor’s perception of the story, possibly due to inadequate information being supplied or elicited in the history-taking. Renggli et al3 describe a web-based software tool that allows patients (who are able to do so) tell their story: complete their own medical history. Their app provides a richer medical history, but the authors recognise that the art of the medical clerking by a trained physician remains a medical necessity. We have previously reported articles exploring the possibilities of predicting aspects of the patient’s story from the data available at the ‘first chapter’: at the point of admission.4,5 Conway et al6 have developed a risk calculation tool with the ambition of risk-stratifying patients based on their presenting vital signs. But complex systems require complex data analysis, and it seems that prognosticating from only a few small data is too limiting. Moving forward, we may be able to model patient outcomes with greater nuance (the ‘output’) if we get increase the complexity of the initial data (‘the input’).