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The patient has the Floor

You’re in a meeting and everyone’s piling in on a new proposal — all at once. You’re only there by chance. Your boss offhandedly told you to come. You don’t have an earned seat at the table.

Then the president stops, waves her hands, and calls for quiet. She turns your way. What do you think, she asks?

It’s a powerful recognition of your authority, your understanding, your agency.

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So why don’t we routinely give patients the floor when talking with them about their own health? Narrative Medicine pioneer Rita Charon routinely begins her visit with a new patient by saying the following:

“I will be your doctor, and so I have to learn a great deal about your body and your health and your life. Please tell me what you think I should know about your situation.”

The first time I read Charon’s words, it stopped me in my tracks. Can you imagine a doctor saying that?

All of a sudden, you — the patient — have the floor. The medical professionals are no longer the experts about your situation.

You are.

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Providers know some things about your situation, perhaps. But you live in your body twenty-four hours a day.

Even when you’re not experiencing the worst of it, it’s with you — like a backpack you can never completely set down. Like a pager, it will go off again. The uncertainty of the next event is its own burden.

I have a long history of kidney stones. Just as predictable as the stones themselves are the well-meaning people who want to diagnose or treat me: I had a friend who got rid of his kidney stones by drinking a teaspoon of fill-in-the-blank. Or, urologists who don’t get kidney stone pain.

I’m the expert on my kidney stones. I should have the floor.

A cardiologist I admire tells his patients: “You don’t have to justify calling me. You know what you’re feeling better than I do.”

When the real expert — the patient — has the floor, everyone wins.

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One more thing: this applies to health care systems and insurance companies, too. Providers need the floor when it comes to their own experience — experience too often silenced by systems that demand we shut down both patient and provider stories. When the person most impacted leads the discussion, we all win.

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🙏 A personal thank-you to Nancy, my boss for many years. She supported my narrative medicine practice, gave me the floor when others were reluctant to — because I was “just a chaplain” — and sent me to the Narrative Medicine workshop at Columbia. One of the best experiences of my career.

This post was reviewed for formatting and minor corrections by Claude.ai by Anthropic. Claude contributed about 5% of the content here.

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