Narrative Medicine

I’ve been reading about a concept that’s been around for a while but I’m only now becoming aware of: narrative medicine. It has interesting connections to population health management, and places a premium on building empathy between physicians and patients in this era of hyper-short interactions.

According to an article on the Association of American Medical Colleges’ website, narrative medicine is a discipline taught in a handful of medical schools that helps future doctors better understand how to interact with patients on a human level.

The article connects this approach to population health management in the sense that understanding each patient’s specific life circumstances (i.e. social determinants of health) is at the heart of narrative medicine.

Those stories can illuminate how a person became ill, the tipping point that compelled them to seek help, and, perhaps most importantly, the social challenges they face in getting better. 

AAMC website

Fans of prose fiction and poetry — and creative non-fiction, for that matter — will be aware of narrative’s power to transport readers into the consciousness of characters that may, by outward appearances or circumstances, seem much different than themselves. In this way, the reader comes to strongly identify with someone to whom they might otherwise not have given the time of day. Practitioners of narrative medicine assert that by teaching future doctors to develop this same kind of empathy for their patients, overall patient health can improve.

Interest in learning the craft of writing has taken hold in medical programs like the Columbia University College of Physicians and Surgeons, Brown University’s medical school, and the University of Nevada, Reno School of Medicine. Rita Charon, MD, PhD, executive director of Columbia’s Program in Narrative Medicine and founder of the field, says, “It’s not a stretch to say we need help to look at our own processes or to see and appreciate what patients are telling us. For me, it became a way for patients to feel heard and noticed.”

That last part really gets me: “A way for patients to feel heard and noticed.” Traditionally, doctors were often considered diagnosticians, and still are to some extent. But it feels like things are changing: now, although time is still at a premium and interactions between healthcare providers and patients is too short, there seems to be a growing acknowledgement that the patient should be allowed to exercise some amount of agency over their own course of care.

Interestingly, baked into the concept of narrative medicine is “close reading,” another approach borrowed directly from literary studies. As defined by the writing center at the University of Wisconsin-Madison, close reading is a “deep analysis of how a literary text works; it is both a reading process and something you include in a literary analysis paper, though in a refined form.”

Fiction writers and poets build texts out of many central components, including subject, form, and specific word choices. Literary analysis involves examining these components, which allows us to find in small parts of the text clues to help us understand the whole.

The Writing Center at the University of Wisconsin-Madison

Understanding the constituent parts of a patient’s life can begin to help their care team to hone a care pathway that conforms to their actual life circumstances. Such an outlook goes beyond aspects that can be entered into an electronic health record, such as which zip code they live in, whether or not they have reliable transportation, and how likely they are to adhere to different care regimens. And treating the whole patient in this way can be an antidote to physician burnout as well, giving doctors permission to construct rich stories around those in their care as opposed to seeing them as a collection of data points.

Because of the opportunities it affords physicians to gain a deeper appreciation for those they treat, the discipline of narrative medicine has spread beyond the U.S. Several medical schools in Taiwan, for instance, have incorporated this new mode of understanding into their curricula. In one study of 15 participants engaged in narrative medicine or medical humanity education at various medical schools and hospitals across Taiwan, the authors “performed manual thematic analysis to identify the themes and concepts of narrative competence through a six-step theme generation process” with an eye to “exploring the dimensions and connotations of the clinical narrative competence of medical personnel.”

Unsurprisingly, the study found that “Cultivating narrative competence in medical education can complement traditional biomedical orientation” and that “(p)atients often use metaphors or symbols to explain their conditions.” In other words, treating patients as one-dimensional figures ignores a rich source of information that could help physicians deliver higher quality care and improve the health of entire populations.

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