Introduction

EVERY PATIENT HAS an important story to tell. Rita Charon, in her landmark New England Journal of Medicine paper published in 2004, defined narrative competence as the ability to absorb, interpret, and respond to stories. This competence enables providers to practice with empathy, reflection, professionalism, and trustworthiness. Meaning is derived collaboratively, by the teller and listener, reader and writer, observer and observed, patient and physician. When a patient and clinician share a story, they experience it and derive meaning from it in their own ways. Each story becomes part of their lived experience and refines their worldview. Clinicians also have powerful stories to tell about their work, their families, mentors, hopes, dreams, and fears. This book sheds light on the interface between clinicians’ stories and the stories of their patients.

As I considered how to structure this book, I initially envisioned asking contributors to focus on specific conversational challenges that commonly arise in their care of seriously ill patients. However, I soon realized that such a prescriptive approach would inhibit contributors from sharing the stories that are most meaningful to them and potentially most interesting and educational for readers. I therefore decided to take a more open approach by eliciting stories in much the same way as I elicit medical and psychosocial histories from patients. I gathered raw material for each chapter by interviewing each prospective contributor, asking them to “Tell me about a memorable encounter from your clinical work that illustrates your empathic practice.” I allowed them to share their own stories, interrupting only rarely with the occasional brief question or comment to clarify and expand key points. My only other predetermined interview prompt was “Are there one or more people in your life, perhaps a family member, mentor, or colleague, who have informed your approach to empathic practice?” I then distilled the resulting raw transcripts from interviews into conceptual blocks, discarded extra material that did not propel the story forward, and assembled the resulting blocks into story structures that I thought would engage and inform busy clinicians. All stories were anonymized to protect the privacy of patients, families, and all clinicians other than the lead author and mentors whom they honor. Stories contain no personal health information or identifying data. All names used to refer to patients or their family members are not their real names. I remained true to each contributor’s voice by including as much of their original language from interview transcripts as possible and incorporating their suggested modifications in final versions. The resulting collection of stories therefore represents the authentic voices of clinicians from a wide variety of cultural backgrounds and clinical disciplines and applies to a broad audience of clinicians at all stages of career development, from student to seasoned veteran.

The stories in this collection depict many common challenges, such as when patients and families harbor unrealistic prognostic expectations and are therefore considered to be “in denial” or when patients display nonmedical opiate use. However, not all chapters focus on challenging scenarios. Instead, some chapters focus primarily on how clinicians connect with patients by weaving empathy into the fabric of every encounter, not just difficult ones. Although this book offers readers extensive examples of empathic words and phrases with which to respond to emotional encounters, as intended, some chapters describe how actions can often be more empathic than even the most empathic words. Some stories describe the challenges that arise when clinicians face serious illness themselves or get stuck between the roles of clinician and family member as they care for an ill relative. Two chapters focus primarily on the role of spirituality and religion in enhancing empathic practice and addressing existential concerns. One story touches on a question commonly posed by patients’ families, “What would you do if he were your father (or mother or other family member)?” A few chapters focus primarily on the unique challenges that arise when clinicians care for sick children or children of sick parents. Several stories highlight the outsize influence of mentors, parents, and grandparents on shaping clinicians’ careers and development of their craft. Two chapters touch to varying degrees on the role of pets and other animals in strengthening connection between patients and their providers. Several chapters describe strategies for maintaining composure under duress, for instance when clinicians care for patients from chaotic or dysfunctional families or for those who suffer from mental illness. One story depicts a patient who remained distrustful of her medical team despite the fact that they went to great lengths to build trust, and the importance of focusing on process rather than on outcomes when defining success. I started writing this book at the beginning of the COVID-19 pandemic, so the pandemic is mentioned in almost every story. First and foremost, this book presents timeless stories from busy clinicians who face real-world challenges.

Besides compelling stories, this book also includes extensive practice points at the end of each chapter to solidify key teaching points. I included a brief clinician’s guide to empathic expression as the last chapter to offer yet more examples of empathic language for addressing common clinical challenges, a few of which were not included in other chapters. This book can be read all in one sitting or one chapter at a time in any order, since each chapter stands on its own. Readers should learn from this book in the manner they see fit. The lessons presented here are timeless.