Narrative medicine

Narrative medicine is a concept in medical practice that emphasizes including the patient’s story in treating his or her medical condition. The physician spends time learning the background of how the patient developed the condition, how the patient feels about the condition and his or her overall health, and how the condition is affecting the patient’s life. The approach views the patient’s condition much like a plot line in a novel or literary work and the people in the person’s life as characters who impact that plot and are therefore important to understanding the patient’s health condition.

Proponents say narrative medicine gives the physician a better overall picture of the patient’s condition and the influence it is having on the patient’s health. They also say it can lead to a better patient/physician relationship that may facilitate better health outcomes. Opponents say that it adds an extra burden on physicians and increases the record keeping requirements.

Background

Physicians have long listened to patients’ stories of how they first experienced their medical conditions and the effects the condition is having on their lives and health. However, treating this as an intentional part of the treatment process began in the early part of the twenty-first century. American-born physician and literary scholar Rita Charon coined the term narrative medicine for the practice.

Charon grew up helping with tasks in her father’s medical office in a small town in Canada. This resulted in her seeing the practice of treating patients as a more personal experience. Later, after receiving her own medical degree, Charon was drawn to the study of literature. As she pursued her doctorate degree in literature and learned how stories were crafted and how all the parts came together to make a whole story experience, she began to apply some of the same concepts to determining how a patient’s story comes together. Others were interested in a similar concept and began pursuing it as a topic of study at Columbia University’s Irving Medical Center where Charon worked. In 2000, when Charon wrote a journal article about the practice, she coined the term narrative medicine to signify the blend of the humanities and medical practices she and her colleagues had adopted.

Overview

Unlike the typical medical history, which does involve listening to the patient’s story of how and when the condition began and how it has progressed, Charon’s concept of narrative medicine involves applying the techniques used by literary scholars and critics. Narrative medicine practitioners do not critique the patient’s story, but they do analyze it to look for important details that can reveal additional levels of meaning. These findings can then help guide the physician in treating the patient.

Physicians who use Charon’s approach keep a parallel chart in addition to the usual medical chart in which a physician records symptoms, treatments, orders for tests and medications, and more. In this second parallel chart, the physician records his or her interactions with the patient. This information is used in conjunction with the more traditional medical chart.

Charon suggests five key concepts in developing a medical narrative. They include temporality, singularity, causality or contingency, inter-subjectivity, and ethicality. Temporality refers to time, meaning the time in which the patient’s condition has unfolded as well as the time the patient and physician spend together during treatment. Singularity addresses the unique situation of that patient instead of seeing the patient as just another of the many patients the physician has treated with the same condition. Causality or contingency means looking at the patient’s condition in the same way one analyzes the plot in a literary work and seeing how the plot is interwoven into all aspects of the patient’s life from day to day and week to week. Inter-subjectivity means being attuned to the meaning the patient’s story has for the patient and resisting the natural urge to see the patient’s experiences in relation to the physician’s own life experiences. Ethicality refers to honoring the patient’s story and the impact it has on the patient while once again putting aside how the physician feels about the situation based on his or her own experiences.

Proponents say the practice of narrative medicine improves the physician’s treatment of the patient. It is said to help physicians do a better job of listening to and understanding key details of the patient’s medical history. It is also promoted as a way to improve the relationship between the physician and the patient, and to help the physician identify treatments that will meet the patient’s needs and approval. The practice of developing empathy that comes from seeing patients as individuals with separate stories, instead of seeing them as just another patient with cancer or heart disease, can make physicians more effective in treating their patients, proponents say. It can also increase the physician’s confidence in treating patients as well as increase patients’ confidence in their physicians.

Opponents say that the practice takes more time than physicians have. They point to parallel charts as time-consuming and unnecessary. They claim that physicians can provide completely effective care without spending this extra time, allowing them to treat more patients.

Not every medical school teaches the concepts involved in narrative medicine. However, several schools have begun offering both medical school classes in literary concepts and narrative medicine techniques. Other schools offer advanced degrees in narrative medicine. Some patients have also begun to seek out physicians who specialize in the practice. They believe that having a physician who takes time to hear their entire story, including past family history and the emotional impact their condition is having on their life, will help provide a better health outcome.

Bibliography

Charon, Rita. “What to Do with Stories: The Sciences of Narrative Medicine.” Canadian Family Physician, vol. 53, no. 8, 2007, pp. 1265–67.

Engle, John D., et al. Narrative in Health Care: Healing Patients, Practitioners, Profession, and Community. CRC Press, 2017.

Kolata, Gina. “Learning to Listen.” New York Times, 29 Dec. 2009, www.nytimes.com/2010/01/03/education/edlife/03narrative.html. Accessed 22 Oct. 2018.

Krisberg, Kim. “Narrative Medicine: Every Patient Has a Story.” Association of American Medical Colleges,28 Mar. 2017, news.aamc.org/medical-education/article/narrative-medicine-every-patient-has-story/. Accessed 22 Oct. 2018.

McFarlane, Anna. “Does Narrative Medicine Have a Place at the Frontline of Medicine?” British Medical Journal, 30 May 2017, blogs.bmj.com/medical-humanities/2017/05/30/does-narrative-medicine-have-a-place-at-the-frontline-of-medicine/. Accessed 22 Oct. 2018.

Peede, Jon Parrish. “Doctor of Narrative Medicine.” National Endowment for the Humanities, 2018, www.neh.gov/article/doctor-narrative-medicine. Accessed 22 Oct. 2018.

“Rita Charon Reflects on a Life of Narrative Medicine.” Columbia University School of Professional Studies,8 Oct. 2018, sps.columbia.edu/narrative-medicine/news/rita-charon-reflects-life-of-narrative-medicine. Accessed 22 Oct. 2018.

Wong, Cathy. “What Is Narrative Medicine?” Very Well Health, 23 June 2017, www.verywellhealth.com/narrative-medicine-benefits-uses-and-tips-4143186. Accessed 22 Oct. 2018.

Zaharias, George. “What Is Narrative Based Medicine?” Canadian Family Physician, vol. 64, no. 3, Mar. 2018, pp. 176–80.