Host Dr. Lee Sharma welcomes Dr. Allan Detsky, to explore how storytelling transforms medical practice. From his journey as a clinician-scientist to teaching narrative medicine at the University of Toronto, Dr. Detsky shares powerful stories, including connecting with a dying patient through hockey, and discusses fostering vulnerability and observation in clinicians.
How can storytelling bridge the gap between clinicians and patients in modern medicine?
In this episode of Scalpel and Sword, host Dr. Lee Sharma sits down with Dr. Allan Detsky, as he shares his journey from economics and clinical practice to teaching narrative medicine. He discusses the inspiration behind his narrative medicine course, sparked by his JAMA op-eds and stories like “The Hockey Stick,” where he connected with a terminally ill patient by arranging a special hockey experience. Dr. Detsky explains how narrative competence—using techniques like weaving stories or shocking patients with unexpected gestures—enhances patient care and clinician empathy. He also highlights his innovative “music video” teaching method, using songs like Hotel California to sharpen observation skills and foster mindfulness among residents. With insights from his career, including his time as physician-in-chief at Mount Sinai Hospital, this episode is essential for healthcare providers seeking to deepen patient connections through storytelling.
Three Actionable Takeaways:
About the Show:
Behind every procedure, every patient encounter, lies an untold story of conflict and negotiation. Scalpel and Sword, hosted by Dr. Lee Sharma—physician, mediator, and guide—invites listeners into the unseen battles and breakthroughs of modern medicine. With real conversations, human stories, and practical tools, this podcast empowers physicians to reclaim their voices, sharpen their skills, and wield their healing power with both precision and purpose.
About the Guest
Dr. Allan Detsky is a professor and clinical investigator at the University of Toronto's Department of Health Policy, Management, and Evaluation, with cross-appointments in General Internal Medicine. Trained in economics (PhD from Harvard-MIT) and medicine (Harvard Medical School), he served as Physician-in-Chief at Mount Sinai Hospital in Toronto and has published extensively on health policy and economics. A prolific writer for JAMA, he teaches narrative medicine, drawing from personal stories like "The Hockey Stick" and "My Father's Voice." Twice nominated as a Tony Award producer for musicals like Jesus Christ Superstar and Come From Away, Dr. Detsky emphasizes storytelling's role in medicine, humility, and conflict resolution.
Email: Allan.Detsky@sinaihealthsystem.ca
About the Host:
Dr. Lee Sharma is a gynecologist based in Auburn, AL, with over 30 years of clinical experience. She holds a Master’s in Conflict Resolution and is passionate about helping colleagues navigate workplace challenges and thrive through open conversations and practical tools.
Connect with Dr. Lee Sharma:
📧 Email: scalpelandsword@gmail.com
🌐 Website: East Alabama Health - Dr. Sharma
[00:00:00] Hello, my peaceful warriors. Welcome to the Scalpel and Sword Podcast. I'm your host, Dr. Lee Sharma, physician and conflict analyst, and I am so excited to have on the podcast today, Dr. Allen Dsky. Dr. Dsky is a physician and also an expert in health policy. His initial training was in economics. He graduated from Harvard Medical School and he got a PhD at the Harvard MIT program in Health Sciences and technology.
He has been the physician in chief at the Mount Sinai Hospital in Toronto, and he's currently professor and clinical investigator at the University of Toronto Department of Health Policy Management and Evaluation. In addition to this, he also teaches a class in Narrative medicine at the University of Toronto, and in addition to all of these amazing accomplishments, he has also been nominated twice as a producer for a Tony Award of two musicals.
Jesus Christ's superstar and come from away. Dr. Jetski, it is an honor and a [00:01:00] pleasure to have you on the podcast today. Thanks for having me. So we were talking before we jumped on the recording, that the reason I had reached out to you was because there was an op-ed piece in the Journal of the American Medical Association a couple of weeks ago.
It was written by one of your students that had taken the narrative medicine class that you teach at the University of Toronto. She had written so beautifully about how this class had positively impacted her. And narrative is one of those things that I think we all assume we know how to do. We think we all know how to tell stories, but I think in the context, especially of the practice of medicine, but also in terms of conflict resolution, it's a vital skill.
What got you into being interested in narrative medicine? I started out in my career as a clinician scientist. I have a PhD in economics and I'm a general internist, and so I was hired into two departments at the University of Toronto. One was originally called Health Administration and then went on to become [00:02:00] health policy management and evaluation, and that's where I have my tenured track position, and that's where I do a lot of my research through my course and the courses that I teach.
But then I also was a general interest and very much viewed myself as a doctor. I was cross appointed to the division of General Internal Medicine, first at Toronto General Hospital, and for seven years I was a clinician scientist. I did what scientists do, they write grants. They get grants. They don't get grants.
They do the projects, they finish them, they write papers, they get the papers published. They don't get the papers published. I was on the traditional track of doing that and the amount of medicine that I did was three months a year on medical consult service, taking care of medical problems in surgical patients.
Then about seven years into that, the chair of the department, U of T, decided to make me the division chief and he wanted me to develop the division. This was [00:03:00] 1987. General internal medicine in Canada now was really almost dormant in that period. Most people were subspecialists. There were very few general journalists.
It was a thriving specialty in the United States dealing with primary care and war medicine, but in Canada it was mostly subspecialty medicine. There were some excellent general ISTs, but there was no real training program in that. So when I started to take on the job as the division head, both for the university and the hospital.
In Canada, you have no credibility as a administrator in a department of medicine. If you don't have clinical credibility, you have to be a good clinician. And three months on the Med consult service didn't cut it. So I expanded. My clinical view include three months of med consults and three months of team medicine while I was the division head.
So I did six months of attending while I was the division head, both at the university and the hospital. Then in addition, because of [00:04:00] my role in economics, I was like the managing partner of the group. We had a group of about 150 physicians. We had an economics plan, and the chief of medicine seconded me to help run that financially.
Well, at the end of that nine years. A job came open as the physician in chief at Mount Sinai Hospital and I applied for and got that job and we merged our groups together. So we became one Department of Medicine on four sites, four hospital sites. Mm-hmm. And I continued to do five months of teen medicine attending while I was chief of medicine, which is a lot.
And so when you get to do that much medicine and that much administration. That much research. You see a lot of humanity. You see a lot of stories. You see a lot of things happen. I was always surprised that at any given moment, especially when I was chief of medicine, my [00:05:00] door was always open. Somebody could walk in at five 30 in the afternoon on a Friday and lay something on me.
That would take 10 minutes for me to solve, or three years for me to solve. I was always like, didn't see that coming. So most of my writing was research, but in 2007, JAMA hired a group of 11 mid to senior career researchers. To write op-ed pieces as something called contributing writer. So we were on the masted, we were appointed to jama.
We got paid doesn't, not very much, and our task was to write somewhere between four and eight op-ed pieces a year. Kathy DeAngelo started this and here were the rules, which as a researcher I just loved. They said, first of all, you pick the topic. Second, it's an opinion piece, so it doesn't have to be balanced.[00:06:00]
Third, we don't want any new data, so we don't want to be adjudicating veracity or accuracy of data, and it has to be in your voice. So those are the rules. I was like, no new data and doesn't have to be balanced. And I get to write it like shoot me, like good. Perfect. All day long. Yeah. Yep. And so along with that, I started to write it and I had written commentaries before, so because I have a broad range.
Topics were economics. They were clinical epidemiology. They were about patient care, they were about hospital care. There were a lot of different stories that came out. And JAMA has a section called a Piece of My Mind, published narratives. And so I started to write stories because some of these pieces didn't quite fit the viewpoint or commentary view.
One of the first stories I wrote was a story called My Father's Voice. Which was a story about [00:07:00] contrasting what happens to young people and old people when they get really sick. And my father had an expression, he used to always say, young people might die, but old people have to. And that was a punchline of a story of two extremely sick people.
One was young and one was old. The younger one was much sicker than the older one, but the older one died and the younger one didn't. Or I wrote a piece on my own PSA test. How that led to the value of reassurance, even though PSA was controversial at the time, and it didn't change my life at all. And then I started to write other pieces with other authors.
I wrote a story using Kafka's metamorphosis as a uh, metaphor. For what? It's like when physicians get sick, how you get trapped in your own cockroach. Mm-hmm. And you, you become your own cipher, which is the term that he used. And then I started to write stories about miros [00:08:00] triptych, about dots and lines.
Like when you see dots and lines, is there a story here or isn't there? The same thing in medicine? When you see five different clinical findings, your tendency is to link them all together in a unifying diagnosis. But sometimes different findings have nothing to do with each other. COVID added a lot to that.
Wrote a story called Le Petit, which was a takeoff on that book. The Metaphor for COVID, my absolute favorite, is a story called The Hockey Stick, which is the young patient of mine who had sarcoma, a terminal sarcoma, was dying, and I took over his care and he didn't want anything to do with anybody.
Because he was sick of getting care and so on. Had to find a way to connect with him. I knew he had played minor league hockey for the kitchen of the team, about an hour away from Toronto Minor league team, and so instead of medicine, I started to talk about [00:09:00] hockey and I said to him, what's your favorite team?
Are you astronomy police fan? He said, no, I'm a Tampa Bay Lightning fan. I said, you're from Kitchener. Why are you Tampa Bay? Oh, my favorite player is Steve Stamkos, who at the time was the captain, and then out of my mouth came words that I didn't expect, and he certainly didn't expect them. I said to him, would you like to meet Steven Stamkos?
Wow. And like, yes, I would. And so I got him tickets to when the Lightning came next and the staff at the, the stadium treated him like royalty with his family. It turned out that Staco was injured and didn't make the trip up to Toronto, so he didn't get to meet him. He did get to meet him later on a Zoom call, but his agent sent up a hockey stick, and it was a story about how when you can't cure somebody's sarcoma, sometimes you can still do something that's fulfilling.
Them and you. And so that's, of all the stories I've ever written, that one is my favorite. And then [00:10:00] about a year ago, my chair said, would you like to teach another course? I teach a course in health economics. I teach a course on how to write a paper that'll get published research. She said, we'd like you to teach something else.
Would you like to teach? And she gave me some, some stuff. And I said, what I really would like to do is teach a course in narrative medicine, which is how to tell stories. Because you can tell from listening to me, I am a very good storyteller, even if I say so. I love to tell stories. And she said, oh, that'd be great.
And we launched a course. I had three junior faculty who said they would help me, but really only one of them was able to because the others got too busy. So there was me and a woman who was a urologist. Who had taken Rita Sheron's narrative medicine program at Columbia? Rita was a classmate of mine in medical school, so I knew, and we launched a course in last October that was gonna last.
It was a one semester course, but it lasted [00:11:00] over the whole year. So we met about once a month and 10 women signed up and me and was the teacher and Sarah. So there I was, me and 11 women. We. Talked about what narrative medicine is. How do you tell stories? We read stories. We gave examples of ones that I thought worked really well.
I gave them some of the structures that I loved. One of my favorites is to take two separate stories and weave them together and have them come together at the end. That's a dramatic trip. I like to have something where you start at the beginning and then it's the last words. Basic tricks that I use in my writing.
And Sarah had her own experiences as well. And we involved Emily Silverman, who runs the Nocturnists, and she did a session for us over Zoom. And the students really got into it. It was like it was, they didn't know each other to begin with. [00:12:00] Like it said in that article that the three women wrote, Priya, Fiona, and Anu didn't know each other and they were very nervous and.
Some of them thought this is gonna be easy because there's no facts that I have to know. And some of them thought, this is gonna be hard because I'm gonna have to talk about my feelings. And also Canada's bilingual country, so some, there was the French Canadians who sat in one corner and talked to each other in French.
Mm-hmm. And one was a veterinarian. They were all different fields in medicine. One was a nutritionist, and we just started to read the stories, talk about. What they evoked. And the other technique that I use is something that I developed during COVID called the Music Video. And I take, for my clinical team, I would take three to five minutes a day to play a music video.
Usually something from musical theater 'cause I have a background and [00:13:00] a side gig in musical theater, as you pointed out before. So I will pick a Tony presentation that's particularly good, or a vocalist who's very good, or an actor who's very good, and show a video. Or I'll take a pop song, uh, or I'll take an indie song and show them videos.
And I use those as teaching them the powers of observation in my clinical teaching. One of my sessions always was, let's look at the patient and tell me what you can discern about this patient from looking at them and everything that's around them. What does their hair look like? What's in the IV bag?
Are there shoes next to the bed? Do they have a gt? Is there oxygen next to them? Is there a bar above them for mobility? Does the chair look like it's ever been sat in before? Are there cards and flowers from family members? Like you can tell a lot about [00:14:00] people from observing them. So I use that technique in the music video, and I would ask them questions like, how do we know that the young girl in this video and the old girl, the same person just at two different points in time, the answer is they were wearing the same red dress.
What's the theme? And I have some favorites. For example, my favorite rock song is Hotel California, and I think people usually say it's the sixth Best Rock song. For me, it's the best and like the lyrics are just so interesting to try. What does this mean's? Not a hotel. And when at some point, after two or three times when it became clear that being the only man in the room.
Was making the dynamic interesting. I said, I often give people a nickname and maybe it was the second or third session, I said, you women are the ladies of the canyon. And they of course had no idea what that man. One of the next [00:15:00] music videos we used was Joni Mitchell. My favorite albums vocalists from I was, I was born in 1951, so I started college in 1969.
My favorite musical artists were, and I'm Canadian, were Joni Mitchell. Mm-hmm. Gordon Lightfoot. Yep. Jane Taylor and Simon and Gar. Mm-hmm. I'm a folk walk kind of guy, and Joni and Gordon are at the top of that list. They had never even heard of Joni Mitchell, which was also funny, but they got really into it.
Yeah. And as I point out in that article. They started to learn a lot about each other. They talk to each other a lot in between the sessions. And one of the most important things that I teach all of my residents is. Call people by their names when they answer. This is cardiology. Say, what is your name?
And the reason you wanna call people by their name is, first of all, it personalizes it. [00:16:00] Secondly, if you wanna find that person after, you need to know who they are. Like just today, I had a medical student that I arranged a consult for with a surgeon. He told me what happened and I said, who was the surgeon?
He said, I don't, don't, I don't remember his name. I was like, how could you not know his name? How are you gonna come back to him? So calling people by their name and they really picked that up. At least one of the students in the class had been my resident before. Anyway, that's how I got into narrative medicine.
Wow. There is so much that just in what you've talked about in terms of your journey. Into developing this class and what led you to develop your wonderful storytelling ability. There's so much. I want to, even just what you just said I wanna talk about, but one of the things I kind of wanna start with in terms of the story of the hockey stick that you had a patient with whom you were having difficulty communicating and clinically reaching, and rather than just pounding or even creating a power dynamic or saying, [00:17:00] I'm the physician, I know what to do, whatever.
You found a way to use a story, to use narrative, and in using that narrative, you created an atmosphere where that patient felt comfortable and was able to work with you and be your partner in their care. One of the things that you talk about in terms of this class, and also I think in your writings with narrative medicine, is the concept of narrative competence, and I think that's one of the things that's so beautiful about this class that you taught.
Is, like you said, you are a storyteller. You love telling stories, but I think there's so many parts to the way that you tell stories that really do help people understand that it's a skill that even if you're good at telling stories, that we can get better. One of the things you also mentioned when you talked about the story with your PSA that you wrote for jam.
Is the concept of transparency. There is a vulnerability that goes with being a storyteller. And I think part of what we do as physicians and also using narrative [00:18:00] to reach and develop, and I think that's one of the things in the JAMA article that really came through to me is that you were able to communicate that to them.
And there's even a part in that jam article where the veterinarian, I think is writing a story and she's talking about having to deal with family members and the other people in the room were tearing up, even though she's talking about cats and dogs. There's a resonance that occurs there. As you've taught your residents and medical students about narrative and narrative medicine, do you see them becoming more transparent and vulnerable as clinicians?
Yes. The music video experiment was really one that taught me a lot about how they handle this because. First of all, I always liked to work. I was never a one, two, or two weeker until the very last, mm-hmm. Week I attended last year I attended was 2023, in which I agreed to do three weeks instead of four.
But I always wanted to do four weeks so that you could develop relationships. The [00:19:00] idea that you can work with somebody for one week and actually get to know them is ridiculous. I said, I have standards. I don't care if you like me, I want you to like me, but I want you to learn something. And you know what?
If you're not buying what I'm selling, that's, I would teach them, this is how you do an oral presentation. And because these are the key pieces of information that you want to communicate to the other listener. And things like, who takes care of this patient when they're not in the hospital, who's their ongoing primary care doctor or their ongoing specialist residents had no idea why that was important, and I would have to explain to that.
I'm gonna talk to them and tell them that their patient's here to find out information. Mm-hmm. And after they leave, they're going back to that person. And I wanna know who that is. That kind of discontinuity of care that our trainees were exposed [00:20:00] to, really bugged me. So I always like to work with them for a month.
Mm-hmm. And during COVID when there was a lot of crazy shit going on, I said, why don't we just try and break. The tension. I'm now only learning about meditation and mindfulness, but this was my version of mindfulness as if I invented it myself, which I didn't, and I said, we're gonna just watch something.
It's going to not be about anything about medicine. I want you to put your phone down. I want you to take your to-do list and put it on the table. I'm gonna turn the lights out and all we're gonna do is watch the screen and you have to let go. Do you know how hard that is to do? Yes, to routine at in the middle of the day?
At the beginning of the day or the end of the day? Sometimes I would do it in the morning and sometimes I would do it in the afternoon. And when I first started to do this, the tension in the room was palpable. It was like, what do you mean we've got stuff to do? We're busy. [00:21:00] We have to be out by 10. We have stuff to do.
And I'm like, I don't care. Let it go. And then I would watch them and. Over time, like the first day it was like, what is this crazy shit going on here? And then over time, I would say 80% of them, I could see them. Their eyes were going to the screen and their hands were down by their side and their phone and everything was, they weren't touching it, and they were just looking at it.
And then there would be 20% of them who just couldn't do that. They just couldn't let go. They would be clutching and they would be, sometimes it was the fly in person who was just there for the night, but after four weeks, really after 10 days, a whole group of them would go. What's the music video gonna be today?
Like how are we gonna let go? Yeah. What? Oh, this is enjoyable. [00:22:00] Especially we in Canada have, we have internal medicine residents and we have what are called off service residents who are from other specialties who aren't really, they're just there for a whole lot of reasons. A lot of it is work, just getting the work done.
And a lot of them were like, this is the best part of the day, because it's not medicine and it's something letting go. And I had one experience. That really taught me how sometimes you just don't know what's going on in the room. I had what was called a junior attending, who was the attending between me and them, and then I rounded with him.
But I had several session where I would teach with them alone because if I was always in the room with the junior attending, then they would defer to me and I, and I wanted him to have that experience or him over. So I did one, it was with a man, and I said, what do they want me to teach? And they said, why don't we try the music video?
So I brought in Hotel California. I played it for them. I [00:23:00] played them with the lyrics and I said, there's a story here. What is this story? What does this mean? And of course, people have been debating what Hotel California means for years. And even the people who wrote it, Don Henley, they've never told us what it means, which is like the Talmud.
The room, we stopped and I said, what does it mean? The room was completely silent and no one was willing to volunteer what it meant because they had never been asked a question like this Since nursery school. These were all medical student types. They were so uptight. Finally, one of the women. She was a family medicine resident.
She started to translate it line by line. She said, this line means this, and this line means that she wasn't getting at the whole story, but at least she was at a try. And I was like, okay. I [00:24:00] was trying to encourage, the other thing that I did, which my wife said is impossible, is I didn't say anything. I just said, what does this mean?
And I sat there and the room was silent for quite a while before this woman spoke up. I didn't try to prod them. And at the end she did that. And then none of the others had anything to say and the 45 minutes were up and I said, and then I told them what I thought the song meant. I walked outta the room and I said, that didn't work.
That was a plus. I was trying to figure out what did the work about it and I thought the reason was that I didn't really know this group. The junior attending knew them. I only knew them peripherally 'cause I had only done some sessions with them. They had met me, but I wasn't really their preceptor. The junior attending was, I'm gonna have to do that with a group that I know well.
And then the next day, the junior attending comes to my office and sits down, plunks himself down and says. My wife and I played a hotel, [00:25:00] California on our phone last night, and we spent about 35 minutes trying to figure out what it meant. And I was like, oh, okay. At least you were provoked into doing that.
And then he said, and the senior resident said to me this morning that the residents and students that missed the session because they were post-call or in some other session, heard about it. Said to her, can you get him to do it again? So I called her up and I said, really? They want me to do it again?
And she said, oh, yes. I was all night long. I was thinking about it, what did it mean? And this morning when we came in, we weren't talking about the patients. We were talking about what does O California mean? I said, wow, you never can tell what's really working and. So you can get people, everybody has stories.
You just have to bring them out of [00:26:00] them. The person who taught me the value of storytelling in her writing was Louise Aronson, who. Geriatrician at UCSF writes for, she was a temporarily an associate editor at Jam Internal Medicine in charge of a section called The Inside Story. And she once wrote a story in JAMA called The Power of Storytelling.
And it was an anecdote about, uh, radio show. Where there was a very smart clinician talking about women and breast cancer screening and how screening too early leads to lots of false positives and mutilating surgery, and how the science shows that you shouldn't start until some age. Everything was going really well until some women phoned in and.
You killed. My sister had breast cancer and it was found by mammography at the age of 38, and it saved her life. You are a monster for telling people not to do it until whatever age she said. [00:27:00] And from then on, every caller who called in attacked the scientist and didn't let her talk, and Louise said what she should have done.
Was told her own story about a 38-year-old woman who had mutilating surgery for her breasts because she had a false positive as the counter narrative how stories. It was a very powerful story, which I've used a lot, and I also want to give credit for the idea that I got for the hockey stick. I didn't make that up.
There was an article written in New England Journal of Medicine called The Psycho Catalytic Effect of Shocking People. And it was about, mm-hmm. How when you get through to your patients, talking about what you want to talk about, say something that's completely outrageous that they're not expecting, and it'll shock them and they'll suddenly talk.
So, I knew this, this kid had his, like the sheet was over his hand. He wouldn't even show me his face. I knew if I said, would you like to meet Steven Stamkos? [00:28:00] That was the psycho. So I've used that technique many times when you can't get through to somebody on what your agenda is, just find out what their agenda is and go for that.