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HOUSTON — Effective communication with patients isn't always easy, but Stacy Nigliazzo, RN, a clinical instructor at the Baylor College of Medicine's Humanities Expression & Arts Lab (HEAL), Houston, said that over the course of her career as a caretaker and clinician, she has learned that stories are "gifts."

"Sharing stories makes us better communicators; communicating better makes us better caregivers and better people," she said. "As Margaret Atwood said, in the end, we all become our stories."

To share best practices for patient-centric communication, Nigliazzo, with HEAL colleagues Andrew Childress, PhD, an assistant professor in the Center for Medical Ethics and Health Policy at Baylor College of Medicine, and Burke Nixon, an instructor and core lecturer at Rice University, Houston, conducted a small interactive session workshop at the American Academy of Physician Associates (AAPA) 2024 Conference & Expo in Houston entitled Bringing Storytelling and Reflection into Caretaker Communication. The trio leveraged the age-old power of storytelling to help PAs enhance their communication skills, highlighting best practices from poetry, literature, and film.

"Communication is absolutely fundamental to the caregiving experience — from caregiver to patient and patient to caregiver," said Nigliazzo. "One of the most important things we can do for our patients is to learn how to become better communicators so we can better build trust. And that starts by honoring each other's stories so we can alleviate suffering and promote recovery."

Honor the Protagonist

The workshop began with the instructors asking the attendees to brainstorm the essential elements of a good story.

"It's such a human thing to tell each other stories — we've been doing it for as long as we've been alive," said Childress. "It's one of the most fundamental ways we learn, and so by talking about what makes a good story, we can think about the best ways we can improve the way we talk to patients."

Workshop attendees offered suggestions including "an emotional experience"; "a twist"; "a beginning, middle, and an end"; "emotional connection"; and "escalation." The instructors discussed the traditional literary definitions of plot, conflict, and resolution — and the idea of the protagonist or the character who drives the story's action.

At this point, Nixon emphasized a key insight for the session: The patient is the protagonist of any clinical encounter and should be honored as such.

"When you're the protagonist of the story, your emotions are an essential part of the story," Nixon said. "Certainly, every caregiver can be a protagonist in some stories. Their emotions matter. But in an illness narrative, the person with the illness or injury is the protagonist of that story. You cannot be an effective medical communicator if you are not honoring the fact that the person you are treating is the protagonist of their story."

You Can Learn a Lot in 5 Minutes

In the next part of the workshop, attendees were asked to break off into pairs to share their stories. They had 5 minutes to tell their partner about their background. They would then switch so the storyteller could take a turn as the listener. Once the group reconvened, each person would tell their partner's story to the workshop.

"There's no doubt that there are time constraints with any caregiver and patient communication, but you can feel seen in a very short amount of time, or you can feel ignored in a very long period of time," Nixon said. "Someone can ask you questions for 15 or 20 minutes, and you can still feel like they don't hear you."

At this point, the instructors shared another communication insight: The PACE model of communication.

P(urpose)

A(udience)

C(ontext)

E(motions)

When communicating with a patient, consider your patient's purpose. Why are they here? What are you trying to achieve in the conversation? In terms of your audience, who are you speaking to? How should you adjust your approach to reach them better? Then, context: Where and when are you having this conversation? Are there any circumstances that might make it harder for you to get the information across? And, finally, emotions. What might the person you are speaking with be feeling right now? Have you acknowledged those feelings?

"The caretaker's job is to recognize the patient's story and to communicate in a way that helps them on their journey," said Nigliazzo. "We just saw how much you can learn in a really short amount of time when practicing active listening, and you really honor the patient as the protagonist of the story."

Flipping the Script

Sometimes, better communication comes from learning what not to do. The instructors played a short clip from the film 50/50, a movie about a young man who learns he has terminal cancer. In the diagnosis scene, the physician barely acknowledges the patient. He speaks "medicalese" (mostly into a digital recorder while staring at his computer screen) and fails to answer the patient's basic questions. The doctor also seems excited that the young man has a rare and difficult-to-treat form of cancer.

"This doctor treated the illness like the protagonist," said Nixon. "He didn't even seem to recognize that this 20-year-old kid was going through this. He was not honoring him. He didn't have a sense of who his audience was, what the patient needed to understand, or what his purpose should be in giving him his diagnosis."

Next, the instructors provided the attendees with a script of a real-life scenario of a young Haitian refugee who had been rushed to the emergency room by his basketball coach. The doctor, much like the one in the movie scene, had not communicated well with his young patient, nor the adult who had accompanied him to the hospital that day. They then asked the group to rewrite the scene to include the PACE objectives.

"Every patient encounter is a new opportunity to rewrite the story," said Nigliazzo. "Today is a draft for tomorrow. You may not be able to go back and fix something that was done in the past if it's over, but you can always move forward and repair things."

Embracing the Narrative Arc

At the end of the workshop, attendees appreciated the opportunity not only to learn more about the art of storytelling but to share their own stories with the group. Jahidah Reid, a PA from Valley Stream, New York, said she appreciated the reminder to "honor the protagonist" in her future work as a PA and health coach.

"I think it's important that I continue to center upon my patient stories and their experiences," she said. "It could be very easy for me to do a lot of the telling before I've heard — I need to be mindful that I honor them fully as I help them navigate whatever is ahead."

Mary Springston, a PA from Tully, New York, said that she appreciated the reminder that each patient is a person, first and foremost.

"As an educator in the final years of my career, I really want my students and future PAs to remember that patients are people," she said. You are caring for a person rather than their chart.

Nigliazzo hopes that attendees understand that embracing patient stories will help improve treatment adherence and patient outcomes.

"Stories build trust. Look at all the trust we were able to build in this room. If you can build trust with a patient, they are more likely to be honest with you. They are going to be more likely to follow your recommendations and agree with the plan of care," she said. "And, if they don't, they are going to tell you why and know they will be heard so you can come up with something else. When we listen to these stories, we really are enhancing care."

Kayt Sukel is a healthcare and science writer based outside Houston.