Free Every Patient Tells a Story by Lisa Sanders

care doctors and a doctor specializing in diseases of the head and neck. That is the power of these little stories.
    Clearly, knowledge is an important part of this. Simms was able to make this diagnosis because he knew this disease. It’s rare, so it’s likely that the patient’s primary care doctor and the ER doctor had never heard of it. But the ENT knew about this disease. When Simms mentioned Lemierre’s, he’d recognized it. But somehow he hadn’t been able to connect the knowledge of the disease with its classic clinical presentation. Somehow he hadn’t created a story or illness script for this entity. Maybe he’d never seen it before either. I doubt he’ll miss it again.
    Doctors are constantly adding to the number and richness of the illness scripts in their heads. Every patient contributes. Lectures can too. Most speakers start off with a classic patient story before presenting their research on a disease or topic. Medical journals often present difficult cases in their pages. Like those presented to Fitzgerald, these cases teach doctors about a particular disease, and about the construction of the story that can help the doctor link the patient to the diagnosis.
    These stripped-down stories, while useful to the diagnostic process, bear little resemblance to the stories a patient tells the doctor. Doctors strip awaythe personal and specific to make their version of the story and in doing so sometimes forget that the reason we do this is to help the person in the bed. That person is more than their disease, but sometimes that seems to get forgotten. When doctors confuse the story they have created about the patient’s disease with the patient himself, this contributes to a sense that medicine is cold and unfeeling and indifferent to the suffering of patients—the opposite of what medicine should be.
    Dr. Nancy Angoff is the dean of students at Yale Medical School. She watches over the one hundred students of each class as they wend their way from student to doctor. She’s concerned that medical education spends too much time on focusing the students’ attention on the disease and not enough time on the patient. She cringes when she overhears a student refer to a patient by his disease and location, or when the discussion of a cool diagnosis overlooks the potentially tragic consequences for the person with the diagnosis. She worries that the doctors they will become will forget how to talk to the patient, to listen to the patient, to feel for the patient. For years she worried that in the excitement of mastering the language and culture of medicine they might lose the empathy that brought them to medical school in the first place.
    When Angoff became the dean of students, she decided to see if she could do something to prevent that transformation. And she wanted to do it right from the start, right from the very first day of school. “Students come here and they are very excited about medicine. They want to help the sick patient, and medicine is the tool that makes that possible. That’s why they are here. But medical schools don’t teach you about the patient, they teach you about the disease. I wanted to emphasize the patient right from the very first day.”
    As part of that effort, Angoff has shaped that first day at Yale Medical School to try to “vaccinate” the students against the focus on the disease and the depersonalization of the patient that is part and parcel of current medical education. To do this, she focuses on the difference between the patient’s story and the story the doctors create from it.
    So on a warm September morning, I returned to the classroom in which I had spent most of my first two years as a medical student to see what a newgeneration of med students is taught about the stories we hear and those we tell as doctors.
    As Angoff, a small and slender woman in her mid-fifties, stepped onto the stage, the nervous chatter of these brand-new students quickly died. She said