Jay Baruch is an Emergency Room Physician, Professor of Emergency Medicine, and Director of the Medical Humanities and Bioethics Academic Concentration at Brown University’s Alpert School of Medicine.
Below, Jay shares five key insights from his new book. Tornado of Life: A Doctor’s Journey Through Constraints and Creativity in ER. Listen to the audio version read by Jay himself in the Next Big Idea app.
1. People are stories, not facial data.
In the ER Story Disaster Zone, my main focus is making sure the stories my patients are telling are the ones I am hearing. In a fast-paced environment, providers face unprecedented challenges and are plagued with increasing constraints. But all patients deserve to be heard.
Patients are challenged to construct a highly personal story and confide in a healthcare provider who until that moment was a stranger. You can’t care for your patients if you don’t care about their unique stories.
Storyteller Kathryn Montgomery articulated this challenge brilliantly. “While clinicians work to complete the disease map, each patient, each case of disease, is uncharted territory.” In medicine, evidence from rigorous research studies guides clinical decisions. However, getting to the heart of a patient’s problems and needs means listening to their symptoms while also paying attention to less obvious social and psychological burdens. This is made easier when you focus on the anatomy of a great story centered around compelling characters with desires and expectations. Patients are the authors and characters of their profound stories. live lifeBody issues are often complicated by many other issues such as relationships, money, mental health, substance abuse and loneliness.
Cognitive psychologist Jerome Bruner writes that the story is “an invitation to problem-finding, not a lesson in problem-solving. It speaks more to the plight of the road than the inn to which it ends.” May take me to the area, but the provider must be willing and ready to go there. The linguistic pedigree of the word “urgent” goes back to the Latin word for “bring to light.” Patients come to the ER for myriad reasons, but every patient has a story to tell.
2. Uncertainty is on our side.
Uncertainty is everywhere in healthcare, from diagnosis and prognosis to communication. However, uncertainty doesn’t always feel good. Reach out to more data to ease these feelings. This usually means more diagnostic tests. But I learned from my patient, Jill L., that more data doesn’t necessarily mean more certainty.
“Unwelcome uncertainty can narrow the types of issues to consider, limit what you listen to, or evaluate only the details that support your preconceived notions.”
Jill L. was complaining of vague symptoms such as chest pain and shortness of breath one Saturday night, so I looked for problems such as a heart attack or a blood clot in her lungs. I was a young doctor, diligent, courteous, and unimaginative. Unfortunately, I was too focused on the “what” to ask “why?” Eventually she told me why she came to the ER. She was a victim of interpersonal violence. The night she came in she finally had enough and she didn’t know where else to go.
Studies have shown that physicians who are uncomfortable with uncertainty are more likely to overdo diagnostic tests and are less likely to include uncertainty in their conversations with patients. Eliminating uncertainty in conversation can cause psychological distress. Poet Mark Doughty said:
Getting used to uncertainty requires changing your relationship with it. We shouldn’t ignore it, pretend it doesn’t exist, or align problem solving with questions that have answers. If we don’t welcome uncertainty, we may narrow down the types of issues we consider, limit what we listen to, or only evaluate details that support our preconceived notions. Allowing for uncertainty is not enough. We must learn to exploit and use uncertainty as a marker for further investigation.
3. The remedy for uncertainty is ignorance.
Accepting the importance of the unknown can help you get used to uncertainty. This concept of ‘not knowing’ was borrowed from author Donald in his Barthelme essay of the same name. Barselm describes the act of writing, and the creative arts in general, as a process of coping with ignorance. The problem is crucial to ignorance. Without problems, there are no inventions.
It is difficult to feel comfortable with uncertainty and ignorance when doctors are motivated to seek answers rather than admit ignorance. Not knowing is a muscle that can grow stronger and more stable through training and interrogation of our thought processes, starting with the decisions we make before we think we are making them.
We must never forget that we seek information.For example, why do I choose specific details to focus on in my patient story (or other stories), such as chest pain or difficulty breathing in Jill L’s case? What are my other details? No focused? I felt stuck in Jill El. Getting stuck in medicine can mean failure, but through the lens of ignorance, we welcome getting stuck. It might help you slow down and think differently.
“When doctors are motivated to seek answers rather than admit what they don’t know, it is difficult to feel comfortable with uncertainty and ignorance. ”
How do you recognize when something is wrong and you need to change gears and look at the situation with different eyes? It starts with that feeling, the pressure. I found myself pushing it forward. Force that. Since then I have learned to back off. The “What’s Next?” Solution Start with a deep breath and a question. how did you get here? where’s the tension? What do I not know? The invitation to question our thought processes is likely in organizational cultures that value the willingness to tackle problems.
4. The best medicine doesn’t work for false talk.
As an emergency physician, I am a professional storyteller who cares for storytellers under pressure in stressful situations. is an entity. Instead, it often feels like a first draft. It is not uncommon for suboptimal results and misunderstandings to occur simply because intelligent people have spoken incorrectly.
Making a story is hard. Even under ideal circumstances, it is not easy to verbalize and share with strangers a tender, complex and embarrassing experience. Imagine you are the patient. Anxious, tired, trying to be understood and afraid of what it means.
When you write, you build a different relationship with language. Not only are you aware of what has been said and how it has been expressed, but also critical silences and evasions that may contain what is left unsaid: the very things you are saying. start to notice. need to hear But I have nothing to say. Anna Deavere Smith writes:
Our brains crave narrative coherence. Experts from Daniel Kahneman to Jonathan Gottschall write about how we’re all set to take cognitive shortcuts. We subconsciously weave random, imperfect data into our stories. You should be careful. Our minds tend to create a different story than what the patient is trying to tell us.
Modern medicine, fascinated by technology, often ignores the power of storytelling. It does not tell us when our questions and thoughts are irrelevant. The best medicine doesn’t work on false talk.
5. How we respond to constraints says a lot about us.
Years ago, a respected medical professor made the following statement after I gave a lecture at his medical school. You don’t have story time. ’ And he is right. There are many constraints, amplified by the pressures of an unprecedented pandemic.
Obvious constraints include lack of time, constant interruptions, forced decisions based on imperfect information, and congestion. Other less obvious constraints include emotional fatigue, limited compassion, and dealing with a healthcare system that seems to forget that the patient comes first.
“Stories act as portals of social interaction that draw us emotionally into the experiences of others.”
These restrictions, I told the professor, do not stop patients from bringing their stories to the ER. In fact, these constraints serve as arguments for bringing as many tools as possible into these pressured spaces. Widespread in the medical field.
The stories reveal how people deal with life’s obstacles, give in, overcome, and make their way in the world we all share. Stories act as portals of social interaction that emotionally guide us into the experiences of others. The pandemic has made it clear that everyone in healthcare and society needs to be adaptable, flexible and creative in order to be prepared. It begins with a willingness to understand the unknown experiences of others. It cannot happen unless we recognize the limitations of our own thinking. We must let our guard down, be brave, and invite people into our lives, even if it’s just a few steps. When others slowly creak open that door, we have to find the courage to take that step ourselves.
How we respond to constraints reveals something about us.
If there’s one thing I’ve learned in my 30 years on ER and Page as a professional listener and storyteller, it’s the importance of humility. Understanding other humans is not always easy, but it is possible and necessary. We’re not going to be perfect, but it’s important to try.
To hear the audio version read by author Jay Baruch, download the Next Big Idea app today.
