Stories give wings to science: Evidence of the power of story in healthcare

I have never met Natoma Canfield, but I am unlikely to forget her story. Natoma is a woman with cancer who had dutifully paid her health insurance premiums over the years she was healthy but then could no longer afford them when she became sick, and they increased. Ultimately, she lost coverage. Natoma’s story was the one U.S. President Barack Obama relayed on the historic day that the Patient Protection and Affordable Care Act was upheld by the Supreme Court. Her experience encapsulated the health care debate at a time when all the facts—the pros, the cons—were questioned by the other side. But we couldn’t argue with the truth of her story. Stories are powerful. A single story can also be an early sign of a problem and a catalyst toward better science and policy. Compared to studies that are summations of large numbers of events—or many stories made bland by their blending—stories, with sample sizes of only one, penetrate and resonate. They can lodge in memory in ways that cannot be easily erased. The potency of the use of story in the health care debate is breathtaking. Meisel and Karlawish in 2011 spoke of the need for both evidence and narrative, rather than having to choose between them. They asserted that both forms of dissemination have unique strengths and weaknesses that can be complementary, and that the sum of the two can be more effective than either alone. Evidence and narrative are not necessarily equal, however. In contrast to narrative, scientific evidence is held to standards of rigor. Stories are sometimes held up as if to balance, even outweigh, the evidence. When weighed against the stories of real people, with names and faces, science often finds itself cowering in the corner, rendered meaningless and insensitive. There are many examples of stories that need to be told, however, that say something better or more meaningfully than data alone. Such stories, like Natoma’s, might convey a message that is endorsed by evidence but is better communicated at an individual level. Or there might be tales that describe the nuances of an event, thereby pointing perfectly and poignantly to a problem that needs to be addressed, for which evidence may not yet be gathered or recognized. In the most effective stories—the ones that stay with us—the protagonist shows the strengths and talents of the hero but also, and more notably, humility and vulnerability, and thus an ability to be affected by the interactions and circumstances of the story. Indeed, it is that very uncovering the reader most relates to and identifies with. Then the reader is there, part of the story—hooked, engaged, even moved. In health care, the important stories are often the sad ones, those without much of a chance for happy endings. They depict seemingly small glitches in systems and behaviors that end up meaning something. Or they are about something that goes wrong, something that accelerates the life of the hero toward his or her inevitable outcome, thus reminding us of our own mortality, whether near or far. But tragedies can also be redeemed, and perhaps—especially in health care—they need to be. Perhaps the only way to save those who weren’t saved but could have been—should have been—is to tell their stories. Although the human instinct for stories has been well discussed over the ages and by scholars in every field, it is a good yarn. One worth telling again.