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Residents and Patients: Telling Stories to Cope With Stress
Jeffrey P. Bishop, MD
JAMA. 1998;280:1960.
All residents have a story about a patient situation that got under their skin. Mine occurred at 4 AM when I was the resident in charge of medicine in the emergency department (ED). I had patients in all three of our cardiac booths, a psychotic patient waiting to have medical causes ruled out, and six of our nine monitor beds occupied by patients with chest pain, congestive heart failure, and drug overdoses. A young woman came into the ED hyperventilating; she was certain she was dying because she had carpal-pedal spasms. I put her in our nonurgent waiting area. After about an hour, her boyfriend, who I learned had induced the hyperventilation during a heated argument, came to me asking why his girlfriend had not yet been seen. I replied that I was taking care of the critically ill patients first. He then informed me that his girlfriend was critically ill and threatened me with battery if I did not see her soon. I had security guards escort him to the door.
When residents and other physicians gather, we share these "war" stories. The stories do not just convey medical information; they help us develop camaraderie and build community because we use stories to relay our feelings. Most people outside the medical profession cannot understand our stories; they lack the context to understand how we must continually balance the work of treating patients with compassion. They do not see the humor that sometimes accompanies the trauma of our work and are frequently shocked by our cavalier attitudes. They cannot fully understand the semidelusional, sleep-deprived state that residency induces. So we share our stories with each other, drawing energy and comfort from the fact that someone else understands their gory details and can empathize with the stress of patient care.
Stories have always revealed the values of a community. Ancient epics such as the Iliad, the Odyssey, and the Aeneid conveyed what their societies held most sacred. Our stories take on the same importance and can serve as therapy cloaked in narrative garments. When a colleague shares a case with you, your colleague is attempting to convey his or her interpretation of a situation. If you listen carefully, you might hear about more than just a medical condition. You will probably glimpse a new understanding of the human condition. Stories can build bridges that link us together in the humanistic endeavor of medicine.
While such informal sharing is therapeutic and reaffirming, storytelling can often take on a negative aspect. The downside is that we have no one to challenge us to look at the other side of the story—the patient's side. Left unexamined, our stories can lead to stereotypes; they can also become empty rhetoric used to maintain an unhealthy distance between patient and physician and create a "them and us" dichotomy. Unexamined stories become little more than urban legends that serve to make us laugh, but scarcely uphold what we ought to hold as sacred.
Stories are powerful and they must be told; it is healthy and therapeutic to hear the community-building stories that convey the values of the medical community. However, we must become literary critics with the ability to discriminate the sacred story from the rhetorical legends. In the short-term, such legends may lighten our loads and provide humor, but in the long-term they do violence to the sacred relationship we share with our patients.
Assistant Professor of Internal Medicine
University of Texas
Southwestern Medical School
Dallas
Edited by Ashish Bajaj, Department of Resident Physician Services, American Medical Association.
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