Start worrying about verbs, doctor

“Don’t call my experience a patient ‘story’”, suggests Dawn Richards. Apparently, The word devalues a person’s experience. I want to comment on this bold claim.

Richards’ article is yet another to consider language in or of medicine. As the mantra ‘language matters’ is repeated and re-tweeted daily, it’s hardly any wonder that people involved in healthcare are seeking new ways to re-language medicine. So much effort is given to suggestions that ‘we’ should speak differently that I sometimes have a feeling that medicine (especially that ‘patient-centred’ and ‘full of empathy’ – do note the inverted commas, please) will soon be a sub-discipline of linguistics. You really do start wondering whether there is any clinical reality behind ‘myocardial infarction’ or is it just a label and the stents that are put into people are there only for fun. Someone simply wants to start the ‘stented’ on the way to become ‘synthetics’.

As much as I am delighted to see such keen interest in language, I would also like to see some sense and reason in the medical-linguistic debates. The postulate to stop using the word ‘story’ is one such postulate where good intentions (of which I have no doubt) do not have much foundation. Basically, some people dislike the word ‘story’ (after all, language matters!), so we must immediately re-consider the use of the word and, ideally, replace it with something that will matter in a way that will make meadows bloom in January. Stop using the word ‘story’ and Brexit will not happen.

So, let’s first consider the negative bit: the author’s bid to not to use the word ‘story’. As ever, the postulate concerns a noun. It never ceases to amaze me that medics and their healthcare friends seem to see the world only in terms of things. There seem to be no processes in medicine, people don’t engage in doing, there are only things. So, if I speak, somehow, medicine is incapable of assuming that I just talk, tell you about what happened, no, medicine must necessarily see such action as product. I can’t just talk, I produce ‘a story’.

There is no doubt that my experience cannot be extrapolated onto experience of others, however, over the 30 years I have used the NHS, I would imagine, I would hear the word ‘story’ at least once. And I must admit that I haven’t. Nobody (neither a doctor, a nurse, nor any other healthcare person) has ever asked me to tell them a story or my story. Those who don’t know any better would ask me about my symptoms, those who do, would ask me about what happened or some such.

I also don’t believe that people will often use the word ‘story’ in reference to what I said. Rather, I would imagine, they would use verbs. A positive scenario would include verbs such as ‘tell’, ‘say’, ‘recount’ or similar, in a negative one, verbs such as ‘claim’. The latter suggest that I’m not believed, of course.

And I would suggest that instead of worrying about the word ‘story’, it’s much more useful to worry about such verbs of speaking (i.e. verbs which report talk, if you interested, I recommend the book by Anna Wierzbicka about them). How do you report what the patient said?  I would suggest that medics familiarise themselves with research on the issue. My favourite example of such research is Hugh Mehan’s article on ‘oracular reasoning’ in reports of what patients in psychiatric care say.

And so, I doubt very much that the issue of ‘story’ is an acute problem. And if it is, it’s because medicine worries about things, not about what people do. The problem of ‘story’ is an irrelevant story.

But let’s now  have a look at what the author suggests be used in lieu of ‘story’. Richards proposes ‘experience’ or ‘perspective’ and in my view she had not given it enough thought. This is because, if I understand it correctly, the author proposes to do away with the verbal part of interaction and suggests that the story-part is transparent giving her (and others) immediate and, presumably, accurate access to patients’ experience. Such an assumption really (like – really really) makes no sense at all. I would in fact venture a guess that more has been written/assumed/researched on impossibility of narrative transparency than on anything else in discourse/narrative analysis (possibly on anything else put together).

In fact, it’s probably only parts of medicine (thankfully, only parts) that still think that what I say gives the doctor immediate access to my mind and to reality behind the story. Alas, such assumptions are utter nonsense. Here are a few reasons why.

First, I really like reminding medics that patients can and do lie to them. Research by Michael Burgoon shows that people lie in order to ‘cheat’ their insurance (medics often play along). Kristian Pollock shows that people lie in order not to be nuisance. Moreover, people have fallible memories (as Elisabeth Loftus teaches us), people even believe that they see ghosts.

In addition to all that, people have very different goals when they talk. One of my favourite stories is one which was told by my mother (you can read it here) about my father. The story was patently untrue, but every time it was told, my entire family were very happy to hear and accept it. For the purpose of the story was not to tell the truth, it was to praise my father. The moment you understand it, you understand that its truthfulness doesn’t matter. When you hear such stories, I would like to ask Dr Richards which experience exactly they give you access to?

The word ‘perspective’ is not explained by the author. In discourse analysis it is reserved for the point of view in stories, it is very much a linguistic term (there is plenty of research on this as well).

What the article suggests is actually very problematic. It is precisely the word ‘story’ that offers the flexibility of understanding that what a medic hears is precisely that: a story. And it is this story that they have to work with, ideally with respect and acceptance of the world it creates. So, when the author writes “Words matter here and for me there is a need to move beyond stories”, I’d say, no, there really isn’t (and I do reject this sleight of hand of introducing the objectiveness of the need in the sentence. No, there is no such need, you propose that there is). It is precisely ‘story’, ‘narrative’, ‘account’ that construe the situation in the most helpful way. And instead of yet another ban on a word, I would suggest explaining this to people who don’t understand it.

But I would like to end with one other point about stories. Understanding that a patient tells a story means understanding that the patient has a voice. They occupy the position of tellability. It is through a story they allow you into their world, into their relevancies, values, beliefs. When you start talking about experience, it’s like you walk into my soul in you muddied boots. You take away my agency in our encounter. I sit in front of you as if I were an open book for you read. I keep being irritated by the assumption that, somehow, the Superman’s vision of the medic allows them to see my ‘experience’, as if there were nothing complex about it. This is way beyond my ability to tolerate such arrogance.

I would really prefer if you let me tell you what I want, if necessary tell you about my life. And if you really must call it something, yes, call it a story. And I would really prefer if you started to listen then rather than observe my experience.

 

 

 

1 Comment
  1. Thank you for putting into words so well what I have been thinking since reading Dawn Richards’s piece. My goodness, I had the effrontery to write a book about narrative (story-based) practice and have taught it for 25 years – how could I now compound the sin by defending the idea of a story?
    But in my book I wrote: “Practitioners need to be able to adjust their own belief that their favoured approach to professional conversations will suit everyone. Every skill and technique..can be applied with thoughtfulness or in a mechanical or dominating way.” I would say the same about insisting that one must or must not use any particular word, which is basically a fetish either way.

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