Why doctors need stories.

In a recent NY Times Week In Review there was a wonderful article about the importance of doctors listening to patients’ stories.

There is so much controversy in the medical field about the usefulness of patient stories or, as a field which likes to use fancy words for things call them, “case vignettes”. Why, you ask? Well, medicine  has become increasingly focused on “evidence based medicine”. Essentially, what that means, is that unless a condition, cure or protocol has been “proved” through a verifiable study, we do not put any credence in it and usually do not treat without the numbers behind us. And that makes a certain amount of sense. No one wants a doctor who just throws medicines or treatments at you “just because.” Most of us want “proven” medicine.

There are problem with that approach however. First of all, many alternative treatments don’t ever really get studied, mainly because there is little money to be made in studying them. Really, who would want to throw money into a study to see if a regular schedule of yoga and exercise could manage depression as well as drug? Certainly not the drug companies. Also, there are medical problems which are either rare or not debilitating but aggravating to the person and there often just isn’t a critical mass of people for whom controlled studies would be relevant. For these types of problems, ones maybe we are just starting to recognize, it can be very helpful for doctors in a specific area to share stories and anecdotes about things that have worked. PGAS (Persistent Genital Arousal Syndrome) would we one of those areas. The sexual health field is seeing more cases of this and is trying to treat this condition. So what happens when there is no “evidence based medicine” on a particular problem or syndrome, like PGAS? We could, as many doctors do, either suggest that it’s all in the patient’s head and not treat. Or, as we do at our Center, scour journals and conferences for the most recent treatments, try a number of remedies that have worked for other patients (ours and other physicians’) and try to tailor possible solutions to the problem. As there is no “cure” for this syndrome, we usually don’t solve the problem entirely but we do make things better.

There is one more use of patient stories that is even more profound. It is by listening to patient stories that we often help find the causes and concerns that may have been overlooked. When we do an intake with a patient we spend 45 minutes getting a full sexual history. More than one patient has asked me why. It is not always clear why reviewing what happened 20 years ago will be helpful. And my answer, in every case, is “I don’t know yet. But let’s see.” What I have learned by taking narratives of the whole picture and the whole patient, rather than just looking at the smaller current problems, is that the history often gives me clues. It allows me to understand this person and her problem within the context of her life, not just by itself under a microscope. And that has been a tremendous help, both in solving the current problems, but often also solving secondary problems which may have been overlooked or which over time may have contributed to the current problem, or possibly could help avoid future problems. At the Center we don’t want to just look at your vagina or just at your hormones. We want to look at you as a whole woman with a history and with a story as well as with your body parts.

So come in to see us. We are ready to hear your story

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