What Can Doctors Learn from Narrative Medicine?

June 4, 2014

By Damiana Andonova

Much like how the Stanford Medicine 25 is an initiative to revive the culture of bedside medicine, narrative medicine is a defense for the practice of medicine with narrative competence…

Patient-centered care is an important aspect of the National Strategy for Quality Improvement on Health Care. As such, healthcare institutions are strongly focusing on the patient-physician relationship and the patient experience.

In light of this focus and to better prepare medical students, educational bodies have begun to restructure their curricula to reflect the truly interdisciplinary work of clinicians—to not only diagnose and treat disease, but also care for the patient as a person rather than a body. This, many argue, requires narrative competence: to listen to the stories of patients and promote a healing partnership that is invested the patient’s experience of illness and recovery.

Despite the demanding academic trajectory of clinicians, many feel that gaps in narrative competence linger, as medical students are taught to be great diagnosticians and are fairly ill advised as to how to actually care for patients at the bedside. These gaps, educational initiatives and research studies have demonstrated, could be aptly addressed by the inclusion of medical humanities, and namely, narrative medicine to address the narrative aspects of medical practice.

Rita Charon, the pioneer of narrative medicine, claims that having such narrative competencies could facilitate patient engagement, as narrative medicine is a powerful and effective method for achieving empathic and effective patient-physician relationships. This is because literature not only provides provide a rich source of insight into the human condition and the role of those who provide treatment and care, but can also paint evocative images of illness and the path to recovery from a patient’s and physician’s perspective.

But what is narrative medicine exactly?
It is both a field of study and a literary genre. It is written text by clinicians, patients, and patients’ relatives that comments on some aspect of a medical journey. It includes patient narratives, physician narratives, and more recently, paintings and photographs; any text that can be used for analysis, interpretation, and observation—skills that are critical for a clinician.

What Narrative Medicine Can Offer to Clinicians:
• Empathic engagement
• Prevent burnout and natural jadedness
• Support and nurture compassionate instincts of clinicians
• Self-reflection
• Observation and interpretation skills
• Provide insight into the patient perspective

To further explore narrative medicine, you can read the many published short stories of William Carlos Williams, Richard Selzer, Rita Charon, and Chris Adrian. Of course, Dr. Verghese’s memoirs are also strong examples of the genre. For more recommendations, feel free to contact us.

For those who would be interested in exploring how narrative medicine can assist in self-reflection and prevent burnout, attempt to free-write some reflections of difficult experiences during a physical exam. Shy away from the “medicalized narrative”, which is often inaccessible, and rather ineffective for this purpose.

Sources:

2012 Annual Progress Report to Congress. National Strategy for Quality Improvement on Health Care. http://www.ahrq.gov/workingforquality/nqs/nqs2012annlrpt.pdf
Charon, R. (2001). Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA, 286(15), 1897. doi:10.1001/jama.286.15.1897
Chen, Pauline W. (October 23, 2008). Stories in the Service of Making a Better Doctor, New York Times. (about the importance of Narrative Medicine in medical education) http://www.nytimes.com/2008/10/24/health/chen10-23.html?pagewanted=1
Holloway, Marguerite. When Medicine Meets Literature. Scientific American, May 2005. http://www.scientificamerican.com/article.cfm?id=when-medicine-meets-liter
Last, J. (2008, April). Medicine and Literature: Passion, compassion, confusion and other emotions in stories of sickness and healers. Hektoen Internationa, A Journal of Medical Humanities. http://www.hektoeninternational.org/MedicineLiterature.htm

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