Defining Narrative Medicine
Introduction
From afar, medicine can present as a cold, menacing field in which textbooks and clinical trials derive the future of patients. These individuals can feel isolated in their treatments and wavering illnesses, unaware of what’s to come and lacking comfort in this uncertainty. Though I wish a closer look would reveal this to be far from the truth, the medical system incentivizes physicians to treat as many patients as quickly as possible. This amounts to physician burnout, a lack of meaning in care, and, most significantly, a disconnect between physicians and their patients. Doctors are trained to take patient histories in the same, systematic way in order to expedite the process of diagnosis and medication prescription. This medicalization of individuals who each come with vastly different stories subtracts the uniquely human qualities of medicine, illness, and suffering. It is precisely in the context of this truth that the practice of narrative medicine becomes sharply valuable.
What is narrative medicine?
Narrative-based medicine emphasizes the mindful listening and empathetic presence of physicians, allowing a transition from pure symptom-based treatment to a plan that prioritizes the patient’s core needs and concerns. It was born in Columbia University when a group of writers and health professionals began to recognize its potential and grew their practice into a Masters Program. With hundreds of students who have indulged in the art form since, narrative medicine is evolving each day. Physicians slow down and stop themselves from boxing patients in a list of questions that may hinder delivery of the most appropriate diagnosis. By engaging with the patient’s story through writing about it, doctors are able to find connections and meaning in their work which may have otherwise been brushed over. Understanding between physicians and patients is fortified as doctors demonstrate they will face the uncertainty and unpredictability of illness with their patients, reaffirming that no one stands alone in such a battle. When patients feel heard, they realize that their physician has their best interests in mind, knows their story, and is treating the person instead of the case. Under these circumstances, individuals are much more likely to adhere to their prescriptions and be satisfied with their medical experiences. Meanwhile, physicians experience decreased burnout due to seeing a revitalized sense of meaning in their work. It is also taught to patients with long-term illnesses as a tool to cope with and understand their sickness through language.
What are the different kinds of narrative medicine?
Narrative medicine does not turn away everyone who isn’t a physician however, nor does it stop being beneficial outside of the patient-physician dynamic. The practice can generally be broken down into four main sectors – patient-physician, physician-self, physician-colleagues, and physician-society.
The patient-physician dynamic is the most commonly known - when a patient trustingly reveals intimate details of his or her health to someone who was a stranger just moments ago, a physician must know how to effectively listen to the story and consider all of its dimensions. Narrative medicine also considers the relationship between the physician and him/herself. As the role can be incredibly challenging and heavy, practicing courage, humility, and empathy while navigating the pain of patients requires deep reflection on the part of the physician. Using narrative writing as a tool to heal and understand these challenges can be very powerful. Additionally, both colleague physicians and physicians in a student-teacher dynamic can attest to how important narrative competence is for effective training and teamwork. Not only does science rest on the basis of imagination and creativity in thinking of a hypothesis and then testing it, but also the physician training process deeply connects peers and colleagues through shared growth and experience. Physicians regularly depend on one another for support, intuition, encouragement, and loyalty, allowing for ample reflection. Writing about such connections can produce greater clarity about the relationships and more effective dialogue between those involved. Finally, the physician may consider his or her role in society at large through the medium of writing. The public is especially vulnerable around physicians in a way that is difficult to compare to any other field, making doctors agents of social control. This is also worth reflection and deeper understanding, shaping a branch of narrative medicine.
How is narrative medicine taught and used?
Reading and learning more about the field, I have learned that the principles rooting how Columbia University teaches narrative medicine in their master’s program actually have nothing to do with healthcare at all. Specifically, narrative competence is often developed through the practice of close reading, which typically refers to listening to nuances in a patient’s story such as tone, metaphor, narrative situation, and temporality. Close reading can be exercised through interacting with pieces of writing and art which aren’t connected to healthcare, applying the same analysis to train the muscle later used with patients. Whether one’s goal is to submerge themselves in a lifelong career in healthcare or to try and avoid ever stepping foot inside a hospital, I believe that learning how to closely read a situation and using this skill to navigate conversations can be a healthy skill for all relationships. Gathering all of the resources I have read on this practice, I am writing a series of pieces inspired by narrative medicine which closely analyze and bring light and context to stories of health-related challenges. Additionally, learning that narrative medicine is often used by medical students to reflect on the challenges they face and experiences they overcome in training, I was inspired to apply this framework to my own experiences as a pre-medical student and, through careful reflection, frame my stories in the emotions they originally took place in.