Last updated on March 15, 2019
When I first turned to writing as a method to cope with the stresses of my practice, I had no knowledge of the field of narrative medicine. In fact, I had been through 4 years of medical school, 3 years of residency, 3 years of subspecialty fellowship, and over a decade in the practice of hematology/oncology before I learned of it. (that’s 20-plus years for those who are counting).
Throughout these long years of training and practice, I’ve struggled to hold fast to my core belief that the best way to take care of one’s patients was to let them tell their stories, and to listen to the stories underlying the disease.
I developed for myself my own way to start every visit with a new patient like so: “I’ve studied your chart, I’ve done my homework, but in order to know best where to start, I want to hear the story in your words.” Because I find if I don’t start this way, there are parts of the story that are of integral importance to the patient, that I will never learn, and if I do not, I cannot determine how to provide the care that person really needs.
Turns out, this is what narrative medicine is all about.
What is narrative medicine? As stated on the Columbia University Narrative Medicine website,
The care of the sick unfolds in stories. The effective practice of healthcare requires the ability to recognize, absorb, interpret, and act on the stories and plights of others. 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 my picks for the top six resources and publications 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
From medium.com: “Lance Weiler, Founding Director of the Columbia University School of the Arts’ Digital Storytelling Lab sat down with Dr. Rita Charon, Professor of Medicine at Columbia University Medical Center and the originator of the field of Narrative Medicine for a discussion on the role of storytelling in providing care that is truly patient-centered.”
…there ought to be millions of those chances going forward–for persons on both sides of this divide, if you will, the patient and clinician, to really not just believe but to see evidence of our sharing of these very deep desires. That nobody on either side is particularly happy or satisfied with how things have turned out. I know the figures on things like physician suicides, and doctors kill themselves at four times the rate — actually the women physicians are even worse than the men at the rate in which they kill themselves. So, it’s not as if the current model is assisting anyone. I could go on if you want to hear my condemnation of the corporatization of health care. And, indeed, there are people who are benefitting from the current state of affairs, but they tend to be the investors in pharmaceutical companies and health insurance companies and things like that. But 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
by Linda Carroll, Reuters Health
…narrative medicine, which 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. published on KevinMD.com
Narrative medicine as a literary form that engages care providers including physicians to share their witnessed stories of humanity can be an instrumental tool to repeatedly resuscitate the physician. 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, or have already…
4. From Doctors’ Stories to Doctors’ Stories, and Back Again
by Marcia Day Childress, PhD, in the AMA Journal of Ethics
The author explains how we can all accomplish and benefit from writing a “55-word story,” as follows:
…the 55-word story is a powerful tool for busy clinicians’ reflective writing… As a literary form, it is simple. As an assignment, it may or may not be written to a prompt. As a task, it is blessedly brief—also game-like, distractingly, even addictively, so. Here is the trick: the story must be 55 words exactly, no more and no fewer (not counting an optional title). There are no other rules…The story may be written fast (in under ten minutes) or slow (take a week); it need not use complete sentences; it may be arranged on the page any which way; its word count may be edited down or built up to the magic 55; in topic and tone it may be dark or droll, silly, sweet, or stunning…
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)
I love this idea so much, I might have to devote an entire post to the 55-word story, look for it soon! (Perhaps even a fun contest?) In the meantime, I encourage you to consider this tool as a short writing exercise to help process your emotions after a difficult patient encounter or a difficult day. 55 words, we can all do that!
(I also especially love the first student story, as I can remember doing the same thing as a third-year medical student on my first day of a clerkship, so terrified of not knowing my role that I followed my resident everywhere, until she kindly turned back to me to explain that she was going into the bathroom and I didn’t have to follow her there…)
5. Narrative Medicine
A Model for Empathy, Reflection, Profession, and Trust
This is a bit older essay, from 2001, by founder of the narrative medicine field, Dr. Rita Charon (see #1), but still every bit as applicable today. I highly recommend the essay in full, but this is my favorite quotation:
Only sophisticated narrative powers will lead to the conversations that society needs to have about its medical system. 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…With the narrative competence necessary for serious and consequential discourse, patients and physicians together can describe and work toward a medical system undivided in effectiveness, compassion, and care.
6. To See the Suffering.
One more essay from Dr. Charon, as published in the December 2017 issue of Academic Medicine. If you read only one essay to help understand the field of narrative medicine, this would be the one I would recommend. (I also cited it in my post on physician grief).
Most powerful quotation:
Here is a painful and bifurcated truth: Facing head-on the realities of serious illness in our settings of contemporary Western health care 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.
Training in the humanities lets one see the suffering. This is, I suggest, what the humanities are for…What one gains by the sight of suffering is the knowledge of the cost of this life. If given proper training in the humanities, this knowledge is available to the interns who do not retreat into the instrumental, to the clinicians who can bear to look full in the face at that which stalks their patients. For those who are prepared, the sight of the laden, heavy, dragging reality of illness and dying comes with its antinomous double: 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.