The power of stories

Published 19 November 2009, doi:10.1136/bmj.b4887Cite this as: BMJ 2009;339:b4887
Editor's Choice
Trish Groves, deputy editor, BMJ
tgroves@bmj.com

"The brains of human beings seem built to process stories better than other forms of input . . . they seem to offer a solution—a way to extract some meaning and redemption from tragedy by preventing its reoccurrence." So said Thomas B Newman, professor of epidemiology and biostatistics at the University of San Francisco, in the Christmas BMJ six years ago, in a plea for a broad perspective when making public health decisions (BMJ 2003;327:1424-7, doi:10.1136/bmj.327.7429.1424).
Introducing a new BMJ series this week, called Safety Alerts, Tara Lamont and colleagues from the National Patient Safety Agency (NPSA) quote Newman and explain how "the agency’s process tries to combine the ‘power of stories’ in the individual incident with evidence from the wider database. . . . Without numbers, stories are just anecdotes, but without stories, numbers are just dry statistics" (doi:10.1136/bmj.b4489). But how many doctors see the many rapid response reports sent out by the NPSA to NHS organisations or visit its website and database of nearly four million incidents? Too few, we suspect. Hence this series.
The first cautionary tale is about an intravenous drug widely used for conscious sedation of patients for endoscopy, minor surgery, and dentistry. Between 2004 and 2008 nearly 500 NHS staff in England and Wales reported midazolam overdoses to the online reporting system of the NPSA, and in three cases the patient died (doi:10.1136/bmj.b4459). Last December, prompted by these stories and formal evidence, the agency told all hospitals and primary care organisations to make only the lower strength formulation available in all but a few clinical settings. Since then 74% of trusts have complied, NHS purchasing data have confirmed a widespread switch from high to low strength midazolam, and no further midazolam related deaths have occurred.
Angela Harden and colleagues show how they merged stories and statistics to explore better ways to reduce teenage pregnancy rates, rather than simply offering sex education and sexual health services (doi:10.1136/bmj.b4254). Intervention studies, say the authors, should now tackle the more subtle risk factors identified in qualitative studies: teenagers’ dislike of school, unhappiness, and low expectations for the future. They reached these conclusions by integrating themes derived from a meta-analysis of trials and a review of qualitative studies.
There’s another story running in the BMJ at the moment, of a 29 year old woman with recurrent acute myelopathy in pregnancy. The patient is real, and she has allowed her doctors to tell her story so that readers can learn from it. Join the debate by sending rapid responses on bmj.com to the questions raised in parts one (BMJ 2009;339:b3862, doi:10.1136/bmj.b3862) and two (doi:10.1136/bmj.b4025) of this interactive case report, and step into her doctors’ shoes: what advice would you give to Mrs G about her current and any future pregnancy? We will publish the conclusion, commentaries, and a summary of readers’ responses in three weeks, so there’s still plenty of time for you to get involved in this intriguing and difficult story.
Cite this as: BMJ 2009;339:b4887