PREVIOUS: Educating about illness and story connections
This is a very complex issue, which I have written about in detail elsewhere (links to Somatic illness and the Patient’s Other Story, and Illness Explorer Pathway, and Training Clinicians in Whole Person-Centred Healthcare). Firstly, there are patients who cannot or will not accept that their story might play any role in the illness, even if that illness is chronic and debilitating. Some of this is about the way medicine has constructed illness dualistically; some is about the stigma associated with the psychosomatic concept; some is about fear of what might emerge if the story is approached; some is about the clumsiness of clinicians in dealing with patients who are vulnerable; and some is about timing and waiting.
Our stories are constituted by many things: the most intimate elements of our lives; the hurts, losses and traumas; the qualities of our key relationships; our performance successes and failures; our levels of trust and mistrust; the ways we have been treated by authorities from parents, through teachers, to employers and state institutions; our temperamental tendencies; and many issues related to culture, religion, and gender. Few of us will risk story disclosure to a brisk, matter-of-fact techno-clinician. The clinician earns the right to be told by being genuinely interested, kind, warm and human.
…we proceed at a pace that is governed by the quality of the relationship and trust between clinician and patient.
The truth is that many patients welcome a genuine whole person approach. They really like being treated as a whole person. Once they get past suspicions that you are saying it is ‘all in the head’, they are far more ready to engage with a role for their story than most clinicians give them credit for. Of course they will have all kinds of questions, and will want you to keep doing the ‘physical’ things well. But many are aware at some level that their history does play some role even if they cannot quite define how and why.
All of this means that we proceed at a pace that is governed by the quality of the relationship and trust between clinician and patient. Some will move quickly and some will not. Clinicians who force the pace often stumble. On the other hand, the clinician, who is fearful, unwilling to take risks, and determined to wait until the patient initiates the process, will never help patients integrate their stories into the illness management. There are many cautious clinicians who see ‘things’ that need addressing but will hesitate to raise them for fear of alienating the patient. This website is about helping this problem. Of course I have alienated some patients. I recall a woman in whom I made a connection between her chronic urticaria and some ‘story’ material. She got up and walked out. I didn’t like that. Two years later, she made an appointment to see me, and her first words were ‘you were right’. But being right is not enough. Being ready to hear is needed too.
Brian Broom
