Narrative Matters: Writing to Change the Health Care System, 2nd Edition

Book Title: Narrative Matters: Writing to Change the Health Care System, 2nd Edition

Author: Jessica Bylander, editor

Publication Information: Baltimore, MD, John Hopkins University Press, 2020, 301 pp., $27.95, paperback

The essays in this collection offer hope with their new ideas and ways of seeing. Upon finishing each essay, I wanted to rush back to my office to make changes to how I offer care! Abraham Verghese sets the tone for the book in his foreword with idioms like “stories change our lives,” and “narrative moves us.” This is followed by an eloquent introduction by the editor about the power of stories and how narrative can drive advocacy. This book is a collection of previously published essays from the health policy journal Health Affairs. The section of the journal entitled “Narrative Matters” publishes writing that begins with a personal story and ends with a policy message. For those of us who cling to medical humanities to preserve the soul of medicine, the writing in this book reminds us of the power of the lived experience in faceless policy debates and health care administration.

The list of authors in this collection reads like a who’s who of great medical humanities writers: Abraham Verghese, Louise Aronson, Siddharthra Mukherjee, Charlotte Yeh, etc. There are authors from various backgrounds, such as the former president of Planned Parenthood, a former secretary of health and human services, and others less well known but nonetheless writing from the heart about elderly caregiving, end-of-life care, and opioid addiction. The book is smartly divided into eight sections, covering everything from innovation and research to maternity and childbirth with a timely section on disparities and discrimination.

Dr Mukherjee gives us credence to fight back against overtesting and overscreening; he suggests we are creating a continuous state of precancer anxiety with little improved outcome. Dr Yeh takes us through the overprocessed and disengaged care she herself received that lacked quality and highlighted the fact that patient-reported outcomes are seriously lacking. And there is much more commentary on bundled care, informed consent, and how inconsistent doctors can be, so getting a good one feels like winning the lottery. Lest you worry about being lectured to, the stories are heartfelt. With stories of a physician being mentored by a patient, a transgender physician being insulted by a fellow physician, and stories from patients with chronic pain recounting how addiction begins, you won’t be able to put the book down. Trust me, I couldn’t.

Many of the essays question the standardized, impersonal approach of medicine. A health care CEO and other physicians admit their mistakes which were realized when their own loved one had to deal with an illness in our overly-complicated health system. This certainly resonates with me and how my own care evolves every time I face a personal health scare. While many complain about our system, they seldom offer feasible solutions. These authors are different. Take Katy Kozhimannil’s essay, for example, on reversing the rise of maternal mortality in the United States; after talking about her grandmother, she lays out a detailed five-point plan that includes evidence-based tool kits, expansion of health insurance pre- and postpregancy, and a national maternity mortality review board. Dr Leana Wen’s essay demonstrates how to directly confront a colleague about mistreatment of a patient with a disability. Dr Wen outlines how we could all be better clinicians with patients living with disabilities if six core principles were part of required training for students and residents: Amen!

This is a book for learners, faculty, and practicing doctors alike. I plan to use certain essays with residents and students to teach them empathy. The plight of immigrant physicians and Black doctors not being accepted is highlighted; the authors’ voices will inspire the reader to want to do more and make changes. The global lesson of using stories as evidence is also a lesson that can be taught using this book. Lastly, essays like the one written by family physician Maureen Mavrinac will challenge and inform readers on how to rethink our traditional visits and seize back our agency through innovations like group visits and creating buddy systems for patients. Her enthusiasm will reenergize the reader and help us all avoid burnout. Each of these lessons are relevant and essential. While I don’t agree with the suggestions of every writer, I admire the writing and the way the ideas challenge us to be better. This book will invigorate and also offer you hope!