Stories as case knowledge: case knowledge as stories

Introduction Every case contains a human story of illness and a medical sto ry of disease, which together cover person management, case management, hea lth system management and self-management. Much of that management can be l earned via a thorough set of stories of typical and atypical core cases com piled by clinical teachers. Stories provide a highly flexible framework for illustrating the lessons of experience, the tips and traps for young playe rs, and the dilemmas requiring careful judgement in the trade-offs between benefits and risks. Listening to real stories unfold is much more fun than being lectured (and better remembered). Discussion Stories illustrate 'what can happen' in a case as a guide to 'wh at to do'. A story begins with a real world situation with some predicament and a (causal) sequence of events or plot in which things are resolved one way or another. Patients tell their illness story; their clinician transla tes that into a disease story. Stories sort out what is important in such a predicament, consider the strategy and tactics of what to do, and speak ab out the outcomes. Each local situation provides relevance, context and circ umstantial detail. Stories about case management can encapsulate practical knowledge, logical deduction, judgement and decision making, sharing with the student all the ingredients that develop expertise. Sometimes it is the plot that is import ant, sometimes the detail, sometimes it is the underlying message, the para ble that resonates with the listener's experiences and feelings.' Stories c an also accommodate the complexity of multiple variables and the influence of other stakeholders, the uncertainties and dilemmas within the trade-offs , and the niceties of 'informed judgement'. Conclusion This paper makes four points. First, clinical stories recount po inted examples of 'what happened' that expand our expertise in handling 'a case like that'. Second, cases are the unit of clinical work. Case stories expand the dimensions and details of case knowledge, case-based reasoning a nd case management. Carefully collated case stories can comprise the 'real life' clinical curriculum. Third, stories provide a framework for 'web' or 'net' thinking that links all the objective and subjective details within t he multifaceted complexity of case management. Fourth, personal stories exp lain how both numerical and non-linear influences determined what decision was actually made in that case.