SKIN September 2019 Volume 3 Issue 5 Copyright 2019 The National Society for Cutaneous Medicine 366 COMPELLING COMMENTS Storytelling in Dermatology Robert T. Brodell, MD1, David W. Brodell, MD2 1Professor and Chair, Department of Dermatology, Professor and Interim Chair, Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi 2Department of Dermatology, University of Rochester School of Medicine, Rochester, New York At a recent conference, John D. Trybus, PhD, a social strategist from the Georgetown University Center for Social Impact Communication, promoted storytelling as a way to influence legislators for the benefit of physicians and their patients. In fact, there is evidence that politicians and voters are more likely to be swayed by an emotional story than by scientific facts. 1, 2, 3 Effective stories help us make sense of complexity. 4, 5 A brief case emphasizes the importance of social strategy to motivate patients and promote treatment adherence. Report of a Case: A 17 year-old male with severe nodulocystic acne presented with his mom after failing to improve on a variety of topicals and systemic antibiotics. Oral 13-cis retinoic acid was recommended. Benefits and risks were discussed including the one in a thousand risk of developing depression, and vanishingly rare risk of colitis that is identical to the risk using oral antibiotics. The mother listened intently to my scientific arguments, but refused to let her son take the medication. The dermatologist then told a story about his five children, three of whom had taken 13-cis retinoic acid for their severe acne. The physician dryly noted that he did not like his children, paused…and, then admitted to loving his children. Each child had cleared rapidly and remained clear, and none experienced any significant side effects beyond predictable dryness. The patient’s mother felt emotionally persuaded, and her son began a trial of 13 cis retinoic acid clearing completely in 5 months. What are the components of a good story?6 First, it must be short and have a finely honed plot sometimes referred to as trajectory.6 In fact, a patient’s attention span is often less than 10 seconds.7,8,9 Second, storytelling must be strategic.6, 10 Our story was designed to motivate a mother who loves her children, just like the dermatologist. Thirdly, the story was perfectly honest, authentic, and personal.11 It would be ethically inexcusable to lie to a patient. Fourthly, good stories are relatable. In our case, humor was used to engage the patient with a strong emotion- love for their children!1 Fifth, there was a call to action with a “hook” that was immediately persuasive. 1, 12,13 A physician gave the same medication to the children he loves! Finally, the effectiveness of the story is measurable. In this case the patient and his SKIN September 2019 Volume 3 Issue 5 Copyright 2019 The National Society for Cutaneous Medicine 367 mother accepted the recommended medication. If a story repeatedly fails to achieve the desired outcome, it is time to develop an alternate approach! In fact, stories do not always work because they are subject to interpretation. It is worthwhile to ask an open-ended question that might explain why the desired action was not achieved. The physician might ask: Did I offend you with my failed attempt at humor? They might just blurt out an explanation. In addition, the mother and son have their own stories that may relate to side effect experienced by a friend. Physicians must be good listeners as well as storytellers to identify the issues that could explain the family’s fears. It may be an effective strategy to highlight the similarities between the physician and patient stories or adopt the patient’s story with a twist. In summary, dermatologists should never minimize the importance of a good story and continue to motivate their patients with time- tested tales. Skillful storytelling in the context of evidence may serve to maximize adherence. Though story telling in American politics is sometimes based on half-truths and deception, dermatologic anecdotes must be grounded in fact. Conflict of Interest Disclosures: Robert T. Brodell, M.D., discloses the following potential conflicts of interest: Advisory Board: Novartis. Clinical trials have been performed for Genentech, Novartis, and Janssen Biotech, Inc. David Brodell has no conflicts of interest to disclose. Funding: None Corresponding Author: Robert T. Brodell, M.D. Professor and Chair, Department of Dermatology Professor of Pathology University of Mississippi Medical Center Instructor in Dermatology University of Rochester School of Medicine and Dentistry 601-815-8000 rbrodell@umc.edu References: 1. Berger J. Contagious: Why Things Catch On. New York, NY. Simon and Schuster; 2009. 2. Cron L. Wired for Story: The Writer's Guide to Using Brain Science to Hook Readers from the Very First Sentence. Emeryville, CA Ten Speed Press; 2012. 3. Rodriguez F, RE Rhodes, KF Miller & P Shah. Examining the influence of anecdotal stories and the interplay of individual differences on reasoning Thinking & Reasoning . 2016; 22(3); 274-296. 4. McKee R. Story: Substance, Structure, Style and Principles of Screenwriting. It Books; 1997. 5. Gottshall J. Stories change minds and key to their effectiveness: The Story Telling Animal. Life Sciences; 2013. 6. Stories Worth Telling: A guide to Strategic and Sustainable Nonprofit Storytelling. Georgetown University Center for Social Impact Communication. Meyer Foundation. meyerfoundation.org 1-62. 7. Cornish D, D Dukette. The Essential 20: Twenty components of an excellent health care team. Pittsburgh PA: RoseDog Books, 2009: 72-73. 8. McSpadden K. You Now Have a Sorter Attention Span than a Goldfish. Time. May 14, 2015. 9. Ruff HA KR Lawson. Development of sustained, focused attention in young children during free play. Developmental Psychology. 1990. 26(1):85-93. 10. Horsey, D. Tell Your Story...Well & Truly. Monthly Developments Magazine, 2012. 30(4), 8- 10. 11. Storytelling: The five building blocks your stories need. Center for Social Impact Communication, Georgetown University 2014. (www.gcn.org/articles/Effective-Storytelling-The- five-building) 12. McCabe A, C Peterson. Good story emotional leads to motive for action. What Makes a Good Story. Journal of Psycholinguistic Research. 1984; 13(6): 457. 13. Heath, C. & Heath, D. Made to Stick: Why some ideas survive and others die. New York, NY: Random House. 2007 mailto:rbrodell@umc.edu http://www.tandfonline.com/author/Rodriguez%2C+Fernando http://www.tandfonline.com/author/Rhodes%2C+Rebecca+E http://www.tandfonline.com/author/Miller%2C+Kevin+F http://www.tandfonline.com/author/Shah%2C+Priti http://www.tandfonline.com/toc/ptar20/current http://www.gcn.org/articles/Effective-Storytelling-The-five-building http://www.gcn.org/articles/Effective-Storytelling-The-five-building