Telling science as a story
Scientific content can be organised as a story, with a character, a goal, obstacles and a resolution, or explained through an analogy to something familiar. The form needs to fit the document's purpose while preserving the science it carries.
Story forms and progression
Medical stories can take the form of case histories; histories of diseases, technologies, people or institutions; anecdotes; analogies; parables; extended figures of speech; and personal accounts. Stories can embody abstract concepts in characters, plots and settings, while analogies and metaphors link unfamiliar ideas to familiar ones.
Three basic elements make a story:
- Sensory details.
- Characters who want something.
- A plot putting obstacles in the way of that desire as it moves towards a climax or resolution.
A narrative's progression combines:
- A compelling character with a defined goal.
- A journey through conflict or complications towards that goal.
- A character changed by dramatic events culminating in a climax or emotionally significant resolution.
Planning narrative nonfiction involves choosing and organising true facts along a narrative path, and leaving out aspects that do not serve its dramatic purpose. The storyline relates the journey to past events and possible future developments; the ending can resolve the conflict or bring a surprising nonresolution.
And/But/Therefore
Randy Olson’s And/But/Therefore structure reduces the classic story to three stages:
- And: introduce the protagonist and setting, describing the normal or ordinary world.
- But: bring in the inciting event and moment of change or transformation; there may be several challenges, each requiring action.
- Therefore: describe the changes, partial resolutions, transformations and final resolution arising from the challenges and conflict.
This structure can be considered for patient materials and may also be used in slide presentations, abstracts, posters and manuscripts following Introduction, Methods, Results and Discussion (IMRAD). Scientific documents should retain a straightforward structure and a clearly defined story, avoiding twists, turns and red herrings that obscure it.
Analogies for mechanisms
An analogy can make a complex technical principle picturable. Neurotransmitters and receptors, for example, can be compared with keys and locks that are highly specific but not exclusive. A story about a 1950s Oldsmobile key opening a camp-door lock illustrates how a neurotransmitter with a sufficiently similar structure can activate a different receptor.
A magnetic resonance imaging (MRI) explanation for patients concerned about invasiveness compared the machine's magnet to a magnetic pin cushion and hydrogen protons to pins, using the familiar image of aligned pin heads and tips to picture alignment of protons for imaging.
A diagnostic mystery
A patient arriving with a problem that needs explanation provides a clinical detective story: a symptom can have many causes, and the investigation seeks a diagnosis. A history and physical (H&P) can follow the same progression as a diagnostic television episode:
| Clinical material | Narrative function |
|---|---|
| Chief complaint | The lead or dramatic cold open. |
| History of the presenting illness | Context: what happened just before the problem. |
| Past medical history and physical examination | The patient's backstory. |
| Blood tests or imaging | The investigation. |
| Diagnosis | The answer to the mystery. |
A selection rule for diagnostic stories is to choose cases doctors would tell each other at the water cooler.
Narrative order and the power of explanation
Storytelling can conflict with scientific exposition: a story builds towards its conclusion, while science often puts the conclusion first. For public communication, storytelling language, tension and plot can be more effective than simply listing findings. The audience should come first when stories are used to make science and medicine understandable and engaging.
Story can be difficult to incorporate into regulatory writing, but approaching the work with caring, warmth and attention to the reader can help make it clearer.
Accessible exposition can also spread a mistaken account. In 1946, Walter C. Alvarez published an account of dementia as accumulated small clots, promoting stroke rather than plaques and tangles as an explanation for Alzheimer's disease. Science communicator Jay Ingram suggested that the popularity of this account delayed Alzheimer's research by two or three decades.