“Anecdotal Evidence”: Why Narratives Matter to Medical Practice

I want to tell you a story. After a lecture I gave recently at a well-known medical school on the possible utility of narrative to clinical practice, from the back of the auditorium came the fi rst question of the traditional question and answer portion of the program: " Don't you feel, Dr. Campo, that what you seem to regard as the arrogant biomedical science model of medicine is already suffi ciently under attack these days? " As the lights came up, I could make out a tall, bearded man in a long white coat, standing as if at attention near the end of one of the aisles. " We have creationists trying to teach 'intelligent design' in our children's science classes, and even closer to home, nurses and optometrists being given the right to prescribe medications. " Their applause having ceased, my audience now grew hushed as he went on, his voice steadily rising. " Do you really expect physicians to accept the notion that what any ignorant patient tells us about his disease should carry a weight equal to what our years of training and expertise reveals to us about complex pathophysiology? " Then came what was clearly meant to be his coup de grace, delivered in an almost derisive tone. " Really, sir, do you have anything more than the anecdotal evidence you shared to support your thesis? " Our Skepticism about Anecdotes Of course, like any physician trained in the past several decades, I too had learned to view the anecdote with the greatest amount of skepticism, if not outright disdain. The anecdote, though beguiling in its familiar engagement of our human sensibilities, is, we are all taught, the enemy of objective, dispassionate observation. The anecdote is rife with such diffi culties as openness to interpretation, and the biases of faulty memory and foolish optimism; it is just as likely to be explained by fi ckle chance as by anything truly under the clinician's control. It is colored by the infl ections in our voices and shaped by our gestures and facial expressions. The case report counts not for academic promotion, while the randomized controlled trial of thousands of anonymous subjects has become the lingua franca of our profession, and for good reason, as rigorous epidemiologic studies have replaced mere conjecture with sound, evidence-based understanding of the causes of countless diseases and effective treatments for them. …