When starting this blog, I was asked by many people, “but what exactly is narrative medicine?” I thought that after a month devoted to the concept in medical school, I should be able to answer that question; however all I could ever muster up were some vague musings on telling our stories to help us connect to one another as human beings, especially in the context of the physician-patient relationship.
Thankfully, Dr. Rita Charon and the Division of Narrative Medicine in the Department of Medical Humanities and Ethics at Columbia University have done this work for me. As it turns out, I was mostly right, but there are some further nuances to it. The concept that is central to narrative medicine is narrative competence. Narrative competence is essentially the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Narrative medicine then takes narrative competence and incorporates it into the practice of medicine1.
Narrative medicine requires two participants: a teller of the story (or a writer) and a listener (or a reader). This way, it facilitates a communion between the two involved parties, which in turn forges connection. In the context of a therapeutic relationship, the patient gives account of themselves and the clinician receives it1,2. Though it can be applied to any of the following relationships (and others): physician-patient, physician-self, physician-physician, and physician-society1.
Dr. Charon has detailed how incorporating narrative medicine has improved her clinical practice. She has found that inviting patients to tell her a story about their lives and what is more important to them has strengthened the therapeutic relationship and made them more willing and open to share1,3. Just as we are taught in medical school to begin with open-ended questions to gather the most data about a patient’s illness, doing so also allows us to tease out the patient’s fears, hopes, and worries. In doing so, we are better able to extend empathy to our patients and they are more willing to open up to us, thereby allowing us to gather more information and better focus our differential diagnoses and care1,3.
Not only do our patients benefit, but we as clinicians do as well. Physicians are submerged in pain and suffering on a daily basis and despite the focus several decades ago on detachment, that is less the goal now. In diving into our own emotional responses to patients and their journeys as well as our own, we are better able to weather the tides of illness and maintain our own courage, faith in love in the face of tragedies. Stories are also the way that we learn; clinical education and residency essentially focuses on experiential learning of the stories of disease processes over and over again1. Yes, the data is very important, but it is within the context of the patient’s whole narrative that we are able to help them. A transaminitis can be due to 1000 different circumstances; it is the story that helps us make sense of it.
How do we build narrative competence? Through practice. The Division of Narrative Medicine at Columbia University recommends reading literature, writing about that literature, and reflecting on all of it2. So that is what we will do.
References
- Charon R. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA.2001;286(15):1897–1902. doi:https://doi.org/10.1001/jama.286.15.1897
- (2019). About Narrative Medicine. [online] Columbia Narrative Medicine. Available at: https://www.narrativemedicine.org/about-narrative-medicine/ [Accessed 9 Dec. 2019].
- Charon, R. Dr. Rita Charon: Honoring the stories of illness. Presented at TEDxAtlanta; September 13, 2011; Atlanta, GA. https://www.youtube.com/watch?time_continue=279&v=24kHX2HtU3o&feature=emb_title. Accessed Dec 9, 2019.
Writing for Wellness 