Narrative vs Evidence-Based Medicine--And, Not Or

Experts whose goal it is to disseminate and translate population-based evidence—including those who disseminate guidelines—usually shun personal narratives in the name of science. But the debate should not be whether science or story is better. Both have their places in promoting evidence-based medicine.

Facts and figures, while essential to promote evidence-based practice and policies—often are not persuasive enough to overcome patients’ preconceived beliefs and biases. Scientific reports are by nature characterless and ahistorical, but their translation and disseminations should not be.

Scientists can use narratives in at least two ways. One is to neutralize stories that promote disproven theories. Real people can embody—through characters and actions—evidence of a risky behavior, such as the dangers of off-market use of a drug or what can happen to a child who is not vaccinated. A second way to use narrative is to tell the story about the process that was used to come to a scientific conclusion. Such stories can increase trust and credibility of scientists—and improve the translation of evidence into practice.

Narratives from patients, physicians and scientists have been shown to enhance the believability of health messages when recipients identify with the characters in the stories told.