Physicians as storytellers

Guest:

Megan L. Srinivas, MD, MPH, Infectious Disease Physician, Clinical Instructor, and Translational Health Policy Researcher

Podcast transcript

Transcript is autogenerated. Although edited for clarity, it should not be considered an exact replication of the podcast and may also be updated as needed.

Alex McDonald, MD: Hello everyone. Welcome to today’s PermanenteDocs chat, the first one of 2024. Thank you for joining or listening from wherever you may be. I want to give a shout out to our LinkedIn Live listeners and viewers as well, it’s a new thing we’re doing this year, looking forward to getting some in-person live interaction. Again, I’m your host, Alex McDonald. I practice family and sports medicine here in Fontana, California as part of the Southern California Permanente Medical Group. Today’s podcast is brought to you in collaboration with the American Medical Association, and we have Dr. Srinivas here. Dr. Srinivas, welcome to the podcast. 

Megan Srinivas, MD, MPH: Thank you so much Dr. McDonald. It’s a pleasure to be here with you all. 

AM: Wonderful. Dr. Srinivas is an infectious disease doctor, clinical instructor, and a translational health policy researcher. I want to know what that means exactly. And she’s also an American Medical Association ambassador. We are excited to have her here today to talk about storytelling and physicians as storytellers because that is such a powerful tool that we should all have in our doctor’s bag — virtual of course — in this day and age. It should be a great conversation. We’re going to keep this short and high yield, only about 20 minutes or so. If you have questions either on the webinar or in LinkedIn Live, make sure you drop those in the Q&A. We’ll try to get to as many of those as we can. And we’re going to jump right in. So, Dr. Srinivas, tell us who you are and what you do. 

MS: Well, my name is Megan Srinivas. I live here in Iowa, and I wish I was in California right now with the weather that we’re having. But we’ll do this virtually if you’re going to make me stay in the snow! I’m an infectious disease physician, like you mentioned. And aside from working clinically, I work in health equity, a lot of rural health equity both in the U.S. as well as globally. And I’m also a state legislator. 

AM: Oh, wow. Wonderful. You wear lots of different hats. Tell us a little bit more about your state legislative position. 

MS: So, it’s basic advocacy for our patients. In all honesty, that’s what drove me to run for office. Working within systems that we do we see how much policy actually impacts the care that our patients can receive. So honestly, it was using storytelling to try to create change that then put me on the other side of the table, creating the policy and using those stories to drive change. 

Storytelling in medicine 

AM: That is amazing. Well, great segue. As we mentioned, storytelling is such a powerful tool. Why is it important for physicians to have in our skillset? 

MS: We do a great job of listening to patients, of treating them as a whole person, not just as the individual problem that they present to us. But in order for us to be able to reflect what they’re experiencing and how we can better create systems, how we can better do our job and get the resources we need, we should utilize their stories to make others understand what we see every single day. 

AM: There are a couple different layers here. There are our patient stories that we can help use to advocate for hospital clinic system change, but then there’s also our own personal stories to connect with patients. And how do you use those, I guess both professionally as a physician, as a legislator, and as an individual? 

MS: You’re right. There are so many different ways in which we can use storytelling. At the most basic level when it’s interacting with our patients, it’s enabling them to know that they’re not alone, that we understand the path that led them to wherever they are, whether it’s in a hospital bed, in the office, more than just being something that we read out of a textbook. And it’s that humanistic connection that enables us to truly understand how we can better treat our patients and create that bond. 

AM: Yeah, that makes perfect sense. I remember this experience so clearly when I was, I believe I was an intern actually. And prior to that moment, I felt like I had to be this sort of stoic kind of Norman Rockwell vision of what a physician is. And I had to be the professional in the white coat and I couldn’t smile, and I couldn’t let my personality through. But then once I realized I could just be myself — and for those of you who know me, I’m kind of goofball — I had so much more fun in the exam room, and I was able to connect with patients so much more because I was a person first and foremost, and second a physician. And that’s why I’m not worried that AI is ever going to take over our jobs because that humanistic connection is what I think drives patients to us and keeps patients with us and has patients listen to us, is we share a little bit about us and our own stories when we’re interacting with patients. Tell us about your thoughts on that. 

The power of personal storytelling 

MS: No, it’s exactly right. Honestly, it was my intern year where I first really discovered the magic of storytelling. We had a patient who had been facing a lot of challenges when it came to her health care, from both being able to access it from a cost standpoint, from the social determinants of health standpoint, but then also in processing everything that she was going through. She had had a HIV diagnosis for a long time, which had led to renal disease requiring dialysis. And it was this whole cascade of issues. And when I was able just to sit with her and talk to her about her experiences, and then also share my story — she had an immigrant background — sharing how my parents were immigrants, it was that story that enabled her to see some similarities that allowed her to open up to me about what her real issues were so I could help get her the treatment she needed and overcome the challenges that were actually preventing her from being able to succeed. 

AM: That’s such a powerful story. Having something in common, some common point of connection with your patient, suddenly it just changes the whole dynamic of that interaction. When I see patients, especially when I’m meeting patient for the first time, if they’re wearing a Lakers jersey or a Lakers hat, I tell them about how I’m a Clippers fan. And obviously that creates a little bit of humor and breaks the tension, but there’s this commonality of, hey, we’re both basketball fans. And sometimes little comments like that can really just set the tone and change the dynamic for the conversation. What other tips or tricks do you find as individuals in storytelling in the clinical setting help us to better connect with our patients? 

MS: Honestly, it’s the small things that you’re talking about, things that matter to the patient that you notice, and you bring up that are so critical. In the setting of the last several years, we’ve actually faced so many challenges as a medical industry, as a health care industry, with people not necessarily trusting what is being told to them from a scientific perspective. But as physicians, we have a very rare opportunity, if we utilize those links, if we talk about the stories of being in our own communities. For instance, being in rural Iowa where I serve a lot of patients, we had a lot of people who had some hesitancy towards the vaccines. And I didn’t approach it as we need to talk about the vaccines because this is the right thing to do. Instead, I approached it from a time when I was scared about doing something or how I viewed the vaccine being made as akin to making a batch of brownies. I do a lot of food analogies in my storytelling! 

AM: Great, we’ll get along well! 

MS: And it was really those type of conversations that over time, I would say about four out of the five patients that would come to me that initially were vaccine hesitant, eventually ended up getting a vaccine. And it’s really just approaching it from that humanistic standpoint where we can really create that clinical change. 

AM: For me, to use that vaccine example a step farther, I think the number one thing that has convinced my patients to get vaccinated is when I told them that I got my flu and my COVID vaccines this fall, I also got my children their COVID and flu vaccines this fall. And that example in telling my story that I care about my children, and I want them to be protected is more powerful than any number or statistic out there. I always use those examples. 

MS: Exactly. And in all honesty, also, even just telling your story about the 24 hours after I got it, I had horrible fevers. It sucks. I’m not going to lie to you, but I also much more protected now for the future. 

How physicians can use storytelling to build trust, fight medical misinformation 

AM: You mentioned medical misinformation and disinformation, which has run rampant online and in social media. How can physicians help to reclaim that space and reclaim that narrative, or even just help to combat some of that misinformation both individually one at a time, but also on a systems level or on social media? Do you have any recommendations from that perspective? 

MS: Definitely. On a one-on-one basis, it’s the fact that we are in a unique position where people are coming to us because they already have a certain level of trust for the profession, and they’re often seeking help or wanting to be reassured they’re healthy. We’re already in a position where there’s an inherent amount of trust laid upon us. And if we utilize that to build upon it and create those connections, then we really can work to understand why somebody might have misinformation or disinformation that they’re believing, and then work to tell them why that might not be correct. And it’s building upon those relationships that enables us to do that.  

But then, on the grander scheme, we still have doctor in front of our names. And having that title also puts you in a spot in society where people inherently think that you are trying to help. Stats have shown that we’re one of the most trusted professions out there. When we use our social media to magnify stories of people who’ve had good experiences, or own stories, or even just the information in relatable small chunks without jargon, into small words that are things that people want to read in a two-sentence snippet on Twitter or X, then it actually can really impact somebody’s decision making. Don’t highlight the misinformation, don’t reshare the disinformation. If you see something, instead find a way to frame the correct information and put it out there. Because whenever we retweet, re-highlight, quote tweet, whatever it is, we actually are highlighting that for more people to see. 

AM: Right. I do a lot of social media work and try to stay positive and focus on my voice and my story and not trying to directly respond to some of those other things, because you just get stuck in the vicious echo chamber in some respects. I always tell people that if you’re going to use social media, set your framework and stay with your own voice and ignore the trolls. In fact, if you’re not [getting trolled], you’re probably not doing something right. I tell people, getting trolled is a badge of honor when it comes to social media. 

MS: It truly is! And sometimes it’s really good for an evening laugh too, when you’re sitting around the family table. 

Impacting policy and advocacy, one story at a time 

AM: That is very true! You touched a little bit on how physicians are uniquely situated to tell our own stories and tell patient stories to some degree, but I have a good colleague who likes to say that stories lead to outcomes. We, as much as we like to think about it, we don’t legislate based on data and statistics, we really legislate based on anecdote in those stories. So how can we use patient stories and our own stories to really impact advocacy and policy, be it at the clinic, at the hospital, at the state, at the national level? 

MS: Honestly, every single speech that I ever start when I’m talking to my fellow legislators, I relate it back to somebody in my district or a patient I saw in the hospital and how this situation in life impacted them and how if we pass this particular law, it could fix the issue. Putting it into the perspective of this is actually happening in real life, this is how it’s happening, changes the narrative completely. From a cognitive standpoint, humans always want to connect with something that’s real, that’s going on. And theoretical conjecture is really hard and abstract to actually think about how and why we need to do something. Why is this so important? Why is this so critical in the moment? When it comes to whatever issue you’re talking about, bringing in a patient themselves to tell the story — and if the patient can’t come in, then asking them if it’s okay to change their names, their initials, the information, the PHI of course — if you can share the experience that they had to see if you can prevent other people from experiencing that same thing, is so powerful. 

AM: Connecting with an individual, connecting with a patient, obviously with patient permission, I think is so incredibly valuable. I remember the first time I went to the state capitol and met with a legislator I was blown away by how little they knew actually about medicine. They used the term podiatrist and pediatrician interchangeably; they didn’t realize those were two very different medical specialties. And helping them to understand with a story from a patient, particularly from our medical students, they actually listened to them more than the seasoned physicians, I was blown away by that experience. And I try to tell people, look, even though you feel like you’re just one person, your voice is so small, you, again as you mentioned, you have that MD or DO after your name, and that’s incredibly powerful. And then our patient stories are even more powerful to help educate others and help them understand the gravity and the scope of the potentially well-meaning or very flawed legislation they’re looking at. 

MS: That’s exactly right. Honestly, reproductive health is a perfect example of this. We had a huge debate in Iowa this summer, and the vast majority of legislators have no actual understanding of what’s happening in medicine. They have never been in an office that they’re not the patient in. And breaking down these technical terms is really difficult, especially when it’s also put in policy. Talking about it from a patient perspective is so much more effective. People were making assumptions, and the rhetoric out there was not actually what our data shows. They were saying people are just using abortion as birth control. And as we know, the data shows that that’s not true, that abortion is utilized for so many critical medical situations and unfortunate situations when many people don’t want to have an abortion.  

I was able to share the story of one of my patients who had tried to get pregnant for two years, finally got pregnant, but then unfortunately around 78 weeks of pregnancy discovered she had leukemia and we had to use an abortion to be able to give her chemotherapy so she could live. And it was just a complete change of perspective for so many in the room who didn’t realize that that is the same procedure we use in those situations. 

Physician authors and storytelling resources 

AM: Right. It’s scary and there’s so much hype and rhetoric around some of these very emotionally charged issues, abortion being a great example. But again, realizing that the person at the end of that conversation is a real, living, breathing person and directly impacted.  

We have a question here in the chat, and if there are other questions, please drop them in the Q&A box. In terms of physicians as storytellers, are there authors or speakers who set the bar, so to speak, when it comes to telling stories and sharing stories? Off the top of my head, I think of Atul Gawande, but are there any specific people that are high on your list? 

MS: He is great. I always loved reading Dr. Paul Farmer’s books and hearing him speak. He was such a magnetic personality, but then having him share his stories of things he saw in real life, people had no idea that situations like the ones he described have existed, and somehow, he was able to utilize storytelling to create this massive movement that has changed health care throughout the world. 

AM: Yeah, that’s a great example. Do you have any recommendations for individuals who want to find their voice, who want to share more than one-on-one with individual patients, who want to try to get out there? Do you have any recommendations or advice for those individuals who want to better share their own stories and their patient stories? 

MS: The American Medical Association actually has free resources available on their websites surrounding storytelling. We know the more physicians are able to reflect their stories, the better it is for our patients, both in clinical care and also in creating the systemic change that we need to advocate for our patients.  

There’s also the American Public Health Association has some tools for it, also a lot of individual organizations. For myself as an infectious disease doctor, the Infectious Diseases Society of America has free resources. There are other places that give great tips on [storytelling] too. The Mullan Institute of George Washington University, they do a lot in the health equity space and they have a lot of storytelling tools. The Rockwood Institute. And there are also tools out there specifically for different niches in medicine. If you’re in HIV medicine, LGBTQ medicine, probably even sports medicine actually, there are really good tools out there that talk about how you can relate to [patients] at every single age spectrum and utilize your stories to be able to better connect. There’s a lot out there on these different organizations’ websites and honestly, most of it is all free. 

AM: Yeah, that’s a really a great example of how there are so many resources. One thing that I share on my online bio, on my Kaiser Permanente page, is about my experience as a professional athlete and then getting injured. I was hit by a truck and was a patient for a number of months, years actually. And sometimes patients will seek me out because I shared my story and my experience which led me to medicine and sports medicine. They’ll say, hey, I know you got injured and I’m injured, and I want a doctor who understands where I’m coming from. That’s one quick, easy way that I always encourage my fellow colleagues to share a little bit about themselves in a print bio, wherever your organization may have those. 

MS: That’s awesome. And in all honesty, just humanizing ourselves too, in the sense of if you’re out and about and taking your dog on a walk, taking just even a picture of your dog and saying, hey, we’re going on a walk around the lake. Or doing a quick video where you can say, hey, it’s a beautiful day outside, I love going on a walk around the lake with my pup. Patients see that on Instagram, they see it on TikTok, on Facebook, and they think, okay, this is somebody who has a normal life who’s more like me than I think. And they start to really connect with you on a different level that make them willing to trust you more. 

AM: Yeah, that’s such a great example of just sharing a little about who we are in our regular day-to-day lives. It doesn’t have to be anything fancy or special. Okay. Well, again, stories lead to outcomes. And I think that’s a theme that I hear you saying over and over again is if we really want to make change, we need to start with stories because stats and data doesn’t really move the needle, even though that’s helpful for us in our physician scientist brains. Okay. Last question. What makes you most proud to be a physician? 

MS: It’s really the interactions I have with my patients. I still remember one patient when I was beginning my fellowship down in North Carolina in ID, and I walk into his room, and he just looked up at me and stared at me for a second with a huge smile on his face. I introduced myself and I sat down and his exact words to me were, you look like me. And I didn’t think somebody who looks like me could be a doctor at a place like this. And just having that grasp that my patients can connect with me on a different level, that because of that I want to use my identity to be able to help them and be able to connect with them and make them feel like they can get over whatever struggle it is that they’re facing. That’s what makes me grateful to be a doctor. It makes it worth it every single day because there is a niche that I can fill that sometimes people feel like they haven’t seen filled before. 

AM: Amazing. All right, we’re going to end on that high note. Thank you so much, Dr. Srinivas, for joining us today for sharing your expertise. I’ve really enjoyed our conversation. 

MS: Likewise. Thank you so much, Dr. McDonald for having me on. 

AM: And thanks to all of you out there who are watching or listening, be sure to check out our PermanenteDocs Chat page, Instagram, social media, YouTube, whatever your streaming platform of choice is for more chats coming up in February.