The power of narrative medicine

When I first turned to writing, I had no knowledge of the field of Narrative Medicine.

It took 4 years of medical school, 3 years of residency, 3 years of subspecialty fellowship, and over a decade in practice before I learned of it. (that’s 20-plus years for those counting).

Throughout, I’ve struggled to hold fast to my core belief that the key to patient care is to allow the telling of, and make the space to listen to, the stories underlying the disease.

Turns out, that’s what narrative medicine is all about.

As stated on the Columbia University Narrative Medicine website,

“The care of the sick unfolds in stories…Medicine practiced with narrative competence is a model for humane and effective medical practice. It addresses the need of patients and caregivers to voice their experience, to be heard and to be valued, and it acknowledges the power of narrative to change the way care is given and received.”

Here are six resources on the power of narrative medicine.

I hope they will help you as well.

1. “Creating a Clearing” — Dr. Rita Charon on the power of Narrative Medicine

Dr. Charon says:

“…the current state of affairs is really not benefitting the armies of clinicians and the numbers of patients, so let us prevail. And maybe if we’re left alone in our clearings, just the clinicians and the patients. Forget all the others. Forget the hospital executives and the American Medical Association. If we’re just left in a room together, maybe we can come to some pretty fine ideas of how to make things better for the patients which will in turn lead to fulfillment for that clinician. That’s what I’m hoping for.”

Me too, Dr. Charon, me too!

2. ‘Narrative medicine’ may help stem doctor burnout

From Reuters Health News

“[narrative medicine] teaches doctors to focus on patients’ stories rather than a cut-and-dried checklist of symptoms, can help improve care for patients because their whole story is being heard. It can also help doctors work through their emotions while at the same time enhancing their feelings of empathy.”

Double benefits of narrative medicine: better care for patients, better self-care for doctors!

3. Narrative medicine for social and physician wellness

by Jean Robey, MD

“Relationship centered medicine has been considered a way to help doctors stay in love with doctoring and that premise is supported by narrative medicine to help refocus the efforts of medicine around relationships.”

Well said, Dr. Robey! Too many of us are at risk of falling out of love with doctoring.

4. From Doctors’ Stories to Doctors’ Stories, and Back Again

by Marcia Day Childress, PhD

“…the 55-word story is a powerful tool for busy clinicians’…the story must be 55 words exactly, no more and no fewer (not counting an optional title). There are no other rules…

The 55-word story has long had a place in my literature and medicine course, where senior medical students write to remember significant moments from their clerkships and then share their narratives with classmates…Here are two, by two of the story project’s leaders.

Don’t Forget

The resident you (almost) followed into the bathroom.

All the times you felt completely clueless about where you were supposed to go or what to do.

The physics equation you couldn’t remember.

The residents who made you feel like part of the team.

All the incredible patients you had the opportunity to take care of.

(© 2017 Claire Montaigne, class of 2016)

An Avocado Tree in Monterrey

In his CCU bed with a failing heart, he told me about when that now sickly organ had driven a farm boy from Virginia to Monterrey, where he sat beneath an avocado tree with Elena. I plied him for more each day, treating his heart as he treated mine, unsure who was the greater beneficiary.

(© 2017 Lee Eschenroeder, class of 2017)”

Consider this tool after a difficult patient encounter or day. 55 words — we can all do that!

5. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust

An essay from 2001 by Dr. Rita Charon, but still applicable today.

“Physicians have to find ways to talk simply, honestly, and deeply with patients, families, other health care professionals, and citizens. Together, they must make responsible choices about pain, suffering, justice, and mercy. Not scientific or rational debates, these are grave and daring conversations about meaning, values, and courage…patients and physicians together can describe and work toward a medical system undivided in effectiveness, compassion, and care.”

6. To See the Suffering.

Also by Dr. Charon.

If you read only one essay to understand the field of Narrative Medicine, this would be the one I recommend.

“Facing head-on the realities of serious illness…takes the savage imagination to recognize and then countenance the facts of suffering: unfair, unwarranted, vengeful, impersonal, neutral, demolishing of those whom it visits, without consolation, without the silver linings so often fabricated by those it fingers. There are only two paths open to those who must witness suffering: (1) pretend it is something else — predictable, resectable, eventually curable, spiritually enhancing, the thing that happens to others — or (2) see it fully and endure the sequelae of having seen.

…What one gains by the sight of suffering is the knowledge of the cost of this life. …to the clinicians who can bear to look full in the face at that which stalks their patients… a view of that floating bridge between here and there, that fragile passage between the knowable and the unknowable, that ground each one of us stands on in each lived moment (now, here, as you read my words; now, here, as I write them) with no guardrails, no signposts, no map, no territory; a clear-eyed discernment of this thing, this life, its worth.”

How has narrative medicine helped you? How do you use narrative medicine in your practice? Are there any great resources that I missed, that you think I should add to this list? Please comment!

First published at The Hopeful Cancer Doc



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