“The Danger of a Single Story”

There’s a saying that most clinicians-in-training hear at least once, if not hundreds of times, “patients don’t read the textbooks.” This phrase is meant to convey that despite all we learn through formal medical education, most of our encounters with patients don’t reflect exactly what we learned in lectures and textbooks. When transitioning from the books to the bedside, we begin to learn the art of medicine. A large component of the art of clinically excellent practice is learning how to “read” patients to accurately identify and appropriately treat illnesses. Equally important to this art is the ability to empower patients to voice their own stories.

Like a painting, film, or work of literature, each clinical encounter tells a story. That story can be linear or abstract and is subject to interpretation, while comprising different media or characters and evolving over time. In clinical care, the story we’re learning to understand, compose, and tell is what allows us to move beyond textbooks and apply knowledge in a way that allows us to see, hear, and treat patients with compassion and inclusivity.

As a part of the Graduate Medical Education Health Humanities Track at Johns Hopkins, I recently watched and was moved by a TED Talk called “The Danger of a Single Story” by Chimamanda Ngozi Adichie. I found myself coming back to it as I read other narrative medicine assignments. A single story creates biases, reinforces stereotypes, and can prevent people from seeing the full potential of others and themselves. Narrative medicine offers a unique opportunity to share stories and broaden the perspective of both healthcare professionals and patients. By expanding our perspective, narrative medicine makes us aware of our biases, which is often caused by the single story that we can fall back on if we’re not vigilant. Narrative medicine offers a way to enhance our skills of observation, communication, and compassion. If we can become more open and understanding, we can create a space for our patients to be open and comfortable. This, in turn, may allow us to make the most appropriate diagnoses and treatment recommendations. In this manner, we allow the patient to tell their own story from which we can learn, instead of trying to fit their story into what we think we already know.

Just as it exists for clinicians, there’s the danger of a single story for our patients. Especially during the pandemic, our patients’ experiences and social interactions may be limited and they may be less likely to encounter others whose stories may or may not be like theirs. This isolation can allow depression, insecurity, and biases to flourish, while resiliency slowly dwindles away. The pandemic has posed unique barriers for individuals to socialize, while adding new stressors including trauma for some. One way we can help our patients build resilience during this time is through exploring narratives through literature. We can make a conscious effort to find and promote stories of diversity to recommend or to give to patients who are literate, encourage building literacy skills in those who are not, and identify alternative modes of storytelling for those unable to read. Literature offers our patients insight into another world or perspective, and well-selected readings exposes patients to stories that include character(s) with whom they identify and by whom they feel represented.

In a response to this increased need to build resilience and representation in media among our school-age and adolescent population, an individual clinic level-program was developed by Dr. Margaret Hannah and Rosemary Hawkins for the children and families of Baltimore at the Harriet Lane Clinic. This program was started in January of 2021 with a mission to use reading as a means of building resiliency with a focus on presenting characters from diverse backgrounds. The Cooperative Children’s Book Center found in a 2018 study that only 10 percent of books featured Black characters and only five percent Latinx and Asian Pacific Islanders/Asian Pacific American characters. This is in stark contrast to half of all books featuring white characters. The patients served at the Harriet Lane Clinic are diverse and the literature given to them should be as well. In addition to making representation an explicit goal of the program, it was also critical to find likeminded donors. A local book shop, Charm City Books, went above and beyond in the donation. Daven Ralston curated a box filled with hand-selected books that contained current titles and bestsellers and also spanned diversity across its many intersections. The books included main characters of color, characters with disabilities, and characters identified as members of the LGBTQIA+ community. Stories represented characters with varying socioeconomic backgrounds and immigration status and included themes of adverse childhood events.

This program is just one example of how clinicians can help patients increase access to diverse narratives and promote engagement with literature as a means of building resiliency. Another example is The Baltimore County Public Library features a March Anti-Racism Book Discussion with featured and recommended anti-racism book lists. Their website also links to a resource that anyone can access at Diversebookfinder.org. No matter what you do in your clinic to promote engagement with stories and literature, the first step is starting the conversation about stories and their power to build resilience and prevent the single story that poses a danger to us all.

Resources for ages 16 and up:

“Full Disclosure,” by Camryn Garrett, sensitive topics area as it is about a teenager living with HIV.

“This Time Will Be Different,” by Misa Sugiura. “. . . shines a light on the Japanese American experience, self-worth, mother-daughter relationships, friendships, love and feminism.”

“Patron Saints of Nothing,” by Randy Ribay. “. . . portrayal of the struggle to reconcile faith, family, and immigrant identity.”

“The Downstairs Girl,” by Stacey Lee. “. . . a glimpse of the Gilded Age and what is it like to live as an Asian American during that time period.”

“How (Not) to Ask a Boy to Prom,” by S. J. Goslee. “. . . modern gender-bent young adult rom com.”

“There’s Something about Sweetie,” by Sandhya Menon. “. . . follows a young woman with a big voice, a big personality—and to her family’s dismay (though not her own), a big body.”

“I Have No Secrets,” by Penny Joelson. “. . . tells the story of Jemma, an intelligent young teenager, who has severe cerebral palsy, is quadriplegic, for the most part confined to her wheelchair and unable to communicate.”

“The Field Guide to the North American Teenager,” by Ben Philippe. “When Norris, a Black French Canadian, starts his junior year at an Austin, Texas, high school, he views his fellow students as clichés from ‘a bad 90s teen movie.'”

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.