We Can Be Heroes: On the Craft of Medical Storytelling
In April 1912, a large steamship carrying over 2000 people departed Southampton, England, intending to arrive in New York. After 4 days of travel, the ship collided with an iceberg near Newfoundland, Canada, opening a 300-foot gash in the hull that eventually caused the ship to sink, with more than 1500 people losing their lives.
Sound familiar? Those are all true facts, but not very compelling, right? Let’s throw in a rebellious artist, a woman trapped by her own privilege, an unlikely romance, a square-jawed villain, and a palpable thread of tension between rich and poor—now that’s a multi-billion-dollar story.
Sure, it works for the movie Titanic, but you can’t create a hero who navigates through overwhelming obstacles with hope and unwavering determination when presenting a new oncology therapy…or can you? Let’s dig into the craft behind medical storytelling and how to go from a few scientific data points to a truly engaging narrative that moves audiences.
First, Understand Your
Before you put a word down on the page, you need to know your audience. Who are they? What motivates them? What are they hopeful for? What are they afraid of? What obstacles do they face? Understanding the answers to those questions is critical—because everyone in your audience should be able to see themselves as the hero of your story. Imagine we’re trying to tell a story about a new prostate cancer drug called Newdrugimab made by XYZBio, Inc. Neither XYZBio, Inc, nor Newdrugimab, should be the hero of the story. What they can be, though, is the hero’s guide—that is, the Yoda to your audience of Luke Skywalkers. More on that in a bit.
You can begin to assess the best story for your intended audience in several ways; you can use data from published literature or databases and conduct online surveys, interviews, and customer advisory boards to learn who your audience is as people. Then, through utilities like persona research and analytics firms that specialize in audience segmentation, you need to observe your audience. You need to understand: what are their specific needs? What is their context? For example, if your hero is a rural oncologist, her journey—or story—is going to be different than if your hero is practicing in a large urban academic institution. They have different needs and obstacles in caring for their patients.
Then, Find the Story Elements
What is the product and the data telling you? You can certainly tell audiences about the disease indication, the mechanism of action, and the gene targets, but, like I said earlier, the product isn’t really the story, it’s merely an element, a guide. Drugs and therapies don’t just treat diseases, they are therapies given by doctors to patients to change their lives. The people are the story.
Still, we need to ask technical questions in relation to the people at the heart of the story. How does the mechanism of action of Newdrugimab affect the life of the patient being treated by the rural or urban oncologist? Does it work better than the other available options? Does it treat unique tumor types that other drugs don’t treat? Is it a more efficient therapy and therefore less burdensome to administer, allowing the patient to go about their daily life more easily? What is the job not currently being done that needs to be done? The answers to these questions constitute the context of your story. With your audience identified and elements in hand, you can start putting the story together.
“And, But, Therefore” and “What Is/What Could Be”
There are many ways to think about story structure: begin-middle-end or plot-twist-ending or inciting incident—rising action—climax—falling action—resolution. However, I like to keep it simple, and formulate stories using “And, But, Therefore” (ABT)1 and “What Is/What Could Be”. These story frameworks help us more clearly draw connections between the different elements of our story. Example:
An oncologist has a patient named Joe who is a married father of two daughters and was recently diagnosed with prostate cancer. Joe is getting rapidly sicker and not responding to the first-line targeted therapies the oncologist has prescribed.
But Joe needs to keep his job to stay on health insurance to pay for the expensive oncology treatments. He needs a therapy without too many side effects so he can limit the amount of time he has to take off. Fortunately, Joe’s oncologist has recently learned that XYZBio, Inc received FDA approval for Newdrugimab, a targeted therapy with a unique mechanism of action for prostate cancer with fewer side effects than the leading first-line therapies. Joe’s oncologist prescribes Newdrugimab to Joe and he quickly improves.
Therefore, Joe can keep his job, spend more quality time with his family, and get the treatment he needs to live a happy, healthy life.
Now let’s use another simple but compelling narrative structure: Nancy Duarte’s “What Is/What Could Be”2. In her Ted Talk, now viewed almost 3 million times, Nancy describes her discovery of this structure by meticulously analyzing speeches from some of history’s greatest presenters like Abraham Lincoln, Dr. Martin Luther King, Jr., and Steve Jobs.
What is: Joe has prostate cancer
What could be: Joe could be in remission
What is: Joe’s oncologist only has first-line options with horrible side effects
What could be: Joe’s oncologist has the option of Newdrugimab with noninferior efficacy but a cleaner safety profile
Simple, but effective. These storytelling devices force you to think about the most important questions for your audience: “what is the point?” and “what’s in it for me?” You’ll notice that I didn’t shy away from making product claims like “Newdrugimab has fewer side effects” and “Newdrugimab has a unique mechanism of action,” but those are merely the context for the story of our hero, Joe’s oncologist, who is using Newdrugimab to improve Joe’s treatment outcomes and quality of life. Telling humanizing stories is common in direct-to-consumer advertising, but I think it’s just as important in medical education for physicians who, after all, are human beings too.
The story of one patient’s experience with Newdrugimab is but one of thousands of stories one could tell, but I think there’s tremendous power in focusing on individual stories. If you’ve ever seen a good documentary film, Civil War by Ken Burns, for example, you’ll notice the filmmaker goes beyond referring to the historical context (America in the mid-18th century, slavery, Confederacy, Mason-Dixon line) and tells the story of individual people living in that context and how the events the documentary is concerned with affected their lives. Filmmakers like Ken Burns know their audience. They know that the story they are telling is not merely a bunch of facts they’re putting “out there,” but a bunch of facts that need to be organized in an intelligible way to make an impact upon a receiver. The facts, or the elements of the story, are part of a larger relationship between storyteller and audience.
Finally, Obey the Golden Rule of Storytelling: Keep Things Simple
Now that we’ve defined the audience, gathered the elements, and explored the construction of a story, I want to leave you with one guiding principle: keep it simple. If you give your audience too many messages, they’ll walk away with nothing. Find your key message and stick to it. This doesn’t mean being simplistic or condescending—your audience is smart and need to be treated as such. Rather, keep reemphasizing the most important message (or 3, at most), and allow other sub-messages to reinforce the main ones.
We can look to literature for a good example of this. The Lord of the Rings by J.R.R. Tolkien is perhaps the greatest fantasy series ever written. In the series, Tolkien built a whole world, created new languages, and fleshed out dozens of characters throughout the course of over a thousand pages. Yet the story is simple: a young hobbit named Frodo Baggins inherits a magic ring which needs to be destroyed in the fires of Mount Doom to defeat Sauron once and for all and save Middle Earth. Tolkien never loses sight of this throughout the entire narrative.
Going back to Newdrugimab, we can create a similar story: Oncologists looking for a safe, effective treatment option to help their patients with prostate cancer live healthy, productive lives should consider Newdrugimab, a unique targeted therapy with less side effects than the leading first-line options. That’s it! If we can remain focused on our ultimate storyline, the simplest explanation as to why what we’re talking about matters, then we can begin doing medical storytelling in a way that is truly meaningful for our audience and will move and engage them.