Narrative medicine explained

Narrative medicine is the discipline of applying the skills used in analyzing literature to interviewing patients.[1] The premise of narrative medicine is that how a patient speaks about his or her illness or complaint is analogous to how literature offers a plot (an interconnected series of events) with characters (the patient and others) and is filled with metaphors (picturesque, emotional, and symbolic ways of speaking), and that becoming conversant with the elements of literature facilitates understanding the stories that patients bring.[2] Narrative Medicine is a diagnostic and comprehensive approach that utilizes patients' narratives in clinical practice, research, and education to promote healing. Beyond attempts to reach accurate diagnoses,[3] it aims to address the relational and psychological dimensions that occur in tandem with physical illness.[4] Narrative medicine aims not only to validate the experience of the patient, it also encourages creativity and self-reflection in the physician.

History and development

In 1910, the Carnegie Foundation for the Advancement of Teaching created the Flexner Report, which set out to redefine medical educational practices. The report argues that the goal of medicine is "an attempt to fight the battle against disease most advantageously to the patient." Flexner wrote that "the practitioner deals with facts of two categories. Chemistry, physics, biology enable him to apprehend one set; he needs a different apperceptive and appreciative apparatus to deal with other more subtle elements. Specific preparation is in this direction much more difficult; one must rely for the requisite insight and sympathy on a varied and enlarging cultural experience." In the late 20th century, narrative medicine came to emphasize an aspect of wider cultural elements in medicine.

From the 1990s, physicians such as Rachel Naomi Remen[5] and Rita Charon, who also holds a doctorate in English literature, argued that medical practice should be structured around the narratives of patients.[6] In 2000, Rita Charon first used the term 'Narrative Medicine' to describe a method of using what she calls "narrative competence," which is "the capacity to recognize, absorb, metabolize, interpret, and be moved by stories of illness."[7] [8]

Methodology

The teaching of narrative medicine involves close reading of texts, writing assignments of personal reflection about the text, and discussion of the personal reflections.[9] With the development of 'narrative competence' comes greater understanding and empathy that facilitate the patient and clinician working together.

Close reading

Close reading is a technique in teaching literature wherein the formal aspects of a text are studied. Students are directed to the read a text "for its information, ambiguity, complexity, texture, and mood as well as for its plot." These methods can be adapted to film, art, and music in the form of 'slow looking'[10] and 'close listening.'[11]

Creative Writing

Following a close reading of a text, students write about their personal encounter with the text, which "unleashes the curiosity and imagination of the writer."

Discussion

In turn, Narrative Medicine teachers apply "close reading" to the students' reflective writing.[12]

Allied use of narrative

The term 'Narrative Medicine' refers to training in interpreting literature and applying that skill to understanding the accounts of patients. Associated fields also use 'Narrative-based Medicine', a main proponent of which is the English General Practice physician John Launer, who holds a degree in English literature. His approach comes from an orientation of Family therapy, wherein patients are invited to expand on and explore new directions in the accounts of their illnesses.[13]

Narrative in Medicine

A broader field is the use of narrative in general in helping doctors and patients deepen understanding of the ways of relating to illness and healing. In the 1990s and early 21st century, this approach is exemplified by the American physician Lewis Mehl-Madrona[14] and the British physician Trisha Greenhalgh.[15]

Educational programs

A number of schools in the United States offer advanced classes in narrative medicine.

The growing field of narrative medicine extends beyond the United States:

See also

Further reading

editor (1998). Narrative Based Medicine, BMJ books.

External links

Notes and References

  1. News: The Writing Cure. Melanie . Thernstrom. The New York Times Magazine. 18 April 2004. 7 December 2021.
  2. Web site: This doctor is taking aim at our broken medical system, one story at a time. Sigal . Samuel. . 5 March 2020. 10 December 2021.
  3. Role of narrative-based medicine in proper patient assessment. Supportive Care in Cancer. 2017. 5357296. Rosti. G.. 25. Suppl 1. 3–6. 10.1007/s00520-017-3637-4. 28220317.
  4. Web site: Narrative Medicine NYU School of Law. www.law.nyu.edu. 2016-03-01.
  5. Web site: Rachel Naomi Remen — the Difference Between Fixing and Healing.
  6. 10.1001/jama.286.15.1897. 0098-7484. 286. 15. 1897–1902. Charon R. Narrative medicine: A model for empathy, reflection, profession, and trust. JAMA: The Journal of the American Medical Association. 2001-10-17. 11597295. free.
  7. What to Do with Stories. Canadian Family Physician . 2007. 1949238. Charon. R.. 53. 8. 1265–1267. 17872831.
  8. News: Stories in Medicine: Doctors-in-Training Record a Different Type of Patient History. Margot . Adler. National Public Radio. 28 October 2003 . 10 December 2021.
  9. Narrative medicine as a medical education tool: a systematic review. Medical Teacher. 2019. 10.1080/0142159X.2019.1584274. 11 January 2022. Milota. M. M.. Van Thiel. G. J. M. W.. Van Delden. J. J. M.. 41. 7. 802–810. 30983460. 115199182. free.
  10. Web site: A guide to slow looking. Tate. 14 January 2022.
  11. Web site: What is close listening?. The Open University. 14 January 2022.
  12. Close Reading and Creative Writing in Clinical Education: Teaching Attention, Representation, and Affiliation. Academic Medicine. 2016. 4721945. Charon. R.. Hermann. N.. Devlin. M. J.. 91. 3. 345–350. 10.1097/ACM.0000000000000827. 26200577.
  13. What is narrative-based medicine?. Canadian Family Physician. 2018. 5851389. Zaharias. G.. 64. 3. 176–180. 29540381.
  14. Web site: Narrative Medicine Heals Bodies and Souls. UTNE reader. 18 August 2009 . 9 December 2021.
  15. Why study narrative?. British Medical Journal. 1999. 1114541. Greenhalgh. T.. Hurwitz. B.. 318. 7175. 48–50. 10.1136/bmj.318.7175.48. 9872892.
  16. Web site: Columbia University Narrative Medicine. Columbia University . 7 December 2021.
  17. Web site: Lewis Katz School of Medicine Narrative Medicine Program. Lewis Katz School of Medicine. 7 December 2021.
  18. Web site: Narrative Medicine Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine. Montefiore Medical Center/Albert Einstein College of Medicine. 10 December 2021.
  19. Web site: Narrative Medicine. OSE Humanities Collaboratory. 2022-01-10.
  20. Web site: Integrative Medicine Program Department of Family Medicine University of California, Irvine. www.familymed.uci.edu. 2016-03-01.
  21. Web site: Narrative medicine seeks the story behind the illness. ACP Internist. 2022-01-10.
  22. Web site: Stories of Illness and Health - Public Humanities at Western - Western University. www.uwo.ca. 2019-02-12.
  23. Web site: Creative Writing, MFA Program Requirements. IR Creative Writing, MFA Program. 2022-01-10.
  24. Web site: Mind-Body Medicine, Ph.D.. Saybrook University catalog. 2022-01-10.
  25. Web site: Medical and Health Humanities at Misericordia University. www.misericordia.edu/medicalhumanities. 2019-02-12.
  26. Web site: Narrative Medicine. SDU. en. 2020-05-11.
  27. Web site: Master in Medicina Narrativa Applicata. Medicina Narrativa. 2022-01-10.