What’s in a Story?

Book Title: What’s in a Story?

Book Author: David Orlans, Rodger Charlton, and Samuel Finnikin

Publication Information: Solihull, UK, Hampton-in-Arden Publishing, 2017, 212 pp., £10.00, paperback

“What’s in a story?” This book is not a treatise on narrative medicine proposing a direct answer to this question; rather this extended collection of narratives leads the reader to find his or her own answer. In 2009, the British Journal of General Practice published a call for “valuable learning points” and clinical “golden rules”¹ to be collated for passing down to the next generation, and a decade later this work now presents the compiled learning points, golden rules, and clinical wisdom that was submitted by individual practicing clinicians.

The breadth of topics covered in the individual submissions have been grouped into topical chapters such as “The Art of General Practice,” “Making a Diagnosis,” “Gut Feelings,” “Death,” and “Looking After Yourself.” Within each chapter is a range of reflections, running from brief one- or two-paragraph observations, to more extended multipage stories; and each narrative is followed by one or several “golden rules” related to the clinical story at hand.

Some of the stories, such as the emotional chaos surrounding the precipitous delivery of an unexpectedly pregnant teen, are powerful reminders that “Life often isn’t ideal… it’s our job to deal with these situations as expertly as possible” (p 32). Others, such as dealing with pain management in the elderly for whom guidelines provide reasons to discourage nearly all analgesics, present the conundrum that “tying to tailor all available medical science and best practice to individuals, as opposed to populations, is the core process of consultation” (p 53). While many stories convey the depth of pathos we often confront in general medicine, most of chapter 5 (“Occupations and Hobbies”) introduces sometimes humorous diagnoses such as “Barber’s Belly” (p 147) and “Sudoku Shoulder” (p 148). Themes that run prominently throughout the book include reminders to listen and be present, to never be easily reassured by the absence of “classic” symptoms for serious conditions, to be careful of the details, and to expect the unexpected.

The collected vignettes appear to have been only lightly edited for clarity, thus the authors’ original voices are preserved. This gives an air of authenticity and reality, as it often seems the reader is peering over the author’s shoulder or sharing the consultation room. However, the variation within each chapter in length and format of contributions sometimes makes for an uneven reading experience; a more systematic approach to organizing material within each chapter might make for a smoother read in future editions.

Since the book presents the collected submissions of general practitioners in the United Kingdom, it relates a style of practice with different terms, phrases, and modi operandi than those to which physicians in the United States are accustomed. Despite this, the more important point comes through that clinical primary care has important common themes no matter where or how it is practiced.

While evidence-based-medicine has long been touted as the application of “current best evidence in making decisions about the care of individual patients,”² debate continues both over the best ways to personalize evidence³ and to apply evidence in the context of the individual patient narrative.⁴ In contrast to works that address this question from broad first principles, this book takes us through the challenges of practicing medicine one patient story at a time. Those new in practice will glean many valuable insights from this book to inform their growth in practice; and experienced clinicians can find both inspiration and solace in reading the reflections of others who have faced the challenges of general practice and been willing to share their wisdom. Nearly all readers will at some point want to reply, respond, or riposte, and while direct reply to the many vignette authors is not possible, the authors have an open call on the book’s website for reflective learning pieces to be shared in a future edition.⁵

What’s in a story? Many things, it turns out—humor, pathos, and the collective wisdom of colleagues who have been willing to share.