Storytelling in Healthcare for Social Change
Today’s Progress Notes is a wrap-up of the 2012 PCP’s Gregg Stracks Leadership Summit, where health professions students learned the power of storytelling for transforming healthcare.
As the editor of Progress Notes, I’m always reading stories submitted by primary care leaders and advocates and I’m inspired from afar. This past September, I had the opportunity to meet some of those leaders in person. Primary Care Progress brought 60 primary care-track students – from medical schools, nursing, pharmacy, and PA schools across the country – together at the Harvard Science Center for the Gregg Stracks Leadership Summit. Here they found common ground not as fellow med students or fellow health professionals students, but as a group of marginalized people ready to take action.
The phrase “marginalized people ready to take action” doesn’t typically conjure up images of bright-eyed, young, 20-somethings pursuing advanced degrees in medicine. Typically, it conjures images of Cesar Chavez’s United Farm Workers; women fighting for the right to vote; African Americans in Montgomery, Alabama, launching a bus boycott.
And it conjures images of some of the people these students hope one day to serve, those who lack access to primary care because they are uninsured, undocumented, or simply because they live in areas across both urban and rural America where nobody wants to practice.
But as each summit participant shared his or her story, a common storyline emerged: The story of arriving at medical school, expressing an interest in primary care, and facing judgment and discouragement. Whether by faculty or peers who openly express disappointment in their choice to pursue primary care or by curricula that seem designed to steer trainees into subspecialties, nearly all summit participants had a story to tell about being shamed for their interest in the field. Nearly all felt marginalized.
Learning storytelling for social change in healthcare
Led by Marshall Ganz, former director of organizing for the United Farm Workers, participants spent two days learning to mobilize to change the culture and curricula on their campuses in hopes of encouraging more students to choose primary care. Ganz showed them that one of the most powerful tools they possessed to mobilize and engage others for their cause was their own personal story, “The Story of Self.”
Through examples provided in speeches from Gandhi’s speech to the Indians of South Africa, calling them to refuse to be fingerprinted by the white government, to then-Senator Barack Obama’s 2004 speech to the Democratic National Convention, Ganz showed how successful activists use storytelling to call people to action. That call to action, Ganz pointed out, “lies at the intersection between urgency and hope.”
“Before Martin Luther King, Jr., described his dream,” Ganz reminded the audience, “he painted a picture of a nightmare.”
Summit participants learned to tell their own stories of why they chose primary care as a means to call others to take up the fight to transform the field. What seemed to unite so many of the stories was a narrator who had a heart for the marginalized.
Chris from Duke described fixing a clogged toilet for an elderly African-American man because he couldn’t pay a plumber. The vivid image of teenage Chris lying on the floor under the toilet tank during his summer break will stay with listeners longer than any platitudes like “I just always wanted to help people.”
Amy from Baylor talked about her mother who tutored children with special needs in their home when Amy was growing up. Amy got to know the children and recognized how their disabilities had unfairly marginalized them and their families.
Julie from East Carolina University recalled waiting tables in the wealthy resort town where she grew up. Where other American teenagers might never have considered forging relationships with the Mexican workers at the restaurant, Julie was struck by the fact that she’d never had a chance to get to know the people who made up such a significant part of North Carolina’s population. She wanted to tell her family and friends everything she had learned about them in hopes of giving them a voice.
With the guidance of Ganz and a team of coaches, the participants learned to weave their stories of self into the larger “Story of Us,” a story with which sympathizers for their cause would identify.
In one story, Joe from Baylor described the disappointed looks he got from faculty and peers when he revealed his intention to pursue primary care. Avik, a primary care resident at Yale, painted a picture of a primary care program housed in the windowless hospital basement and stocked in part with broken examination instruments. Each story described a culture or a setting that seemed designed to shame any student who dared pursue a career in primary care.
After learning to use storytelling to grow their campus-based movements, summit participants homed in on exactly what they would like a movement to accomplish at their school and whom they would need to target.
Students at the University of Medicine and Dentistry of New Jersey, fearing that two open faculty positions in family medicine may never be filled, devised a plan to mobilize students to make sure the positions are filled and by high quality candidates. Students from Tulane plan to pair first- and second-year med students interested in primary care with primary care resident mentors in order to cultivate and maintain the students’ interest in the field over the span of med school.
The change that these campaigns are meant to inspire, Ganz highlighted repeatedly, is born out of hope, and hope comes from seeing the world as a place of possibilities, not probabilities. This theme was personified in the summit’s keynote address by Dr. Jeff Brenner, of whom Atul Gawande said in his 2011 article in The New Yorker, “Few people shared his sense of possibility.”
Brenner is known for applying the theory of “hot-spot policing” – focusing police efforts on areas that yield the most crime – to patient care (hotspotting). He wanted to invest the most time and resources in the patients who were costing the health care system the most, and like the characters in so many of the stories shared at the summit, these patients were the most marginalized, the most voiceless of us all.
Underscoring the need for strong leaders to share their personal stories, Brenner shared his. Like others’ stories, his featured some of the most marginalized people in our society. Brenner’s vantage point, however, was unexpected. His grandfather was a Ku Klux Klan leader. Raised in a Philadelphia suburb by an impoverished single mother, Brenner came from a poor, uneducated family, yet he not only broke those chains by getting an education, but he also used that training to serve the most powerless among us. He has dedicated his career to treating those who can’t pay for medical care but need it most.
Brenner was unapologetic about revealing such personal details of his life to this audience. “If you are not vulnerable,” he said, “you are a crummy leader.”
Brenner helped arm summit participants with the courage to tell their stories, and PCP’s media team introduced them to some of the tools. Emphasizing a summit theme, “If you don’t tell your story, someone else will,” the media team encouraged participants to Tweet, Facebook, blog, film and photograph the true story of primary care – that it is a viable career option where exciting innovation is happening.
PCP’s co-founder and president Dr. Andrew Morris-Singer had opened the summit with his own Story of Self. He equated the urgency and hope that motivate him to fight for primary care transformation with the same passion that pushed him to fight for gay rights as a college student. To close the summit, he invited everyone to weigh in on how the leadership strategies presented could be used going forward in local and national efforts. What ensued was a lively 45-minute, student-led discussion on ideas for a national campaign to transform primary care.
A week later, my inbox is already showing the signs of a once voiceless group now eager to tell their stories and grow the ranks of the primary care workforce. We’ll share some of them on this blog. I hope they’ll inspire you to share yours.