It’s all too easy to become alienated from our patients. Tapping into the benefits of narrative medicine can help us reconnect.
Some describe the "art of medicine" as the gray area where diagnostic information and plan of care are not clear cut. Yet I'd argue that the art of medicine extends beyond moments of clinical ambiguity. The very fabric of medicine is artistry.
Our patients have stories that we solicit the moment we ask what brings them to clinic or hospital. We learn personal details when we ask questions about our patients' medical, social and family histories. Depending on the rapport we develop, the process by which we collect the information that guides our management can be dynamic and therapeutic. The medical narratives that we present in a formulaic fashion may include terms seldom used outside of medicine like "linea alba" and "borborygmi," but fundamentally these remain stories nonetheless.
Here, I'll explore the intersection of humanities and medicine, including the benefits of narrative medicine.
Restoring the physician-patient relationship
Medicine has changed. Many of these changes are of great benefit, from new tests and therapeutics to new technologies. There is a wealth of medical information secondary to extensive research and development. Some changes have impacted the very culture of medicine. One such change is in the dynamic between between physicians and patients.
New technology and the demands of documentation have diminished the time that a physician, their patient and that patient's family spend together. At the same time, reliance on technology has undercut the need to evaluate patients holistically, even outside of their disease process. In response to this cultural shift, many have called for greater integration of the humanities into premedical and medical training.
This integration could give physicians the tools to truly see their patients. In his book "Attending: Medicine, Mindfulness, and Humanity," Dr. Ronald Epstein describes the humanistic interaction between physician and patient well: "The ability of doctors to see each patient as a complete human being (and vice versa), in my view, is the basis for the trust and understanding that help the patient through the hard times. It is a learned skill, a habit of mind. ... [C]linicians have to prepare for those relationships that place them outside their comfort zone — when there is suffering, conflict, uncertainty, or loss."
The benefits of narrative medicine
One proposed model for deepening patient-provider relationships, narrative medicine is the union of medical humanities, biopsychosocial medicine and patient-centered care. Dr. Rita Charon, a pioneer in this field and executive director of Columbia University's Division of Narrative Medicine, describes the skills of narrative medicine as the ability to recognize, internalize, interpret and be moved by stories of illness. Beautifully she suggests that this practice is "a commitment to understanding patients' lives, caring for the caregivers and giving voice to the suffering."
Built on the practices of reflective writing and close literary analysis, narrative medicine requires radical listening and profound empathy. When we develop these narrative sensibilities and sensitivities, we become more empathetic to the stories shared by our patients and more skilled at homing in on the emotional aspects of the disease process. Narrative medicine helps us see the context of our patients' circumstances more clearly — we become better able to look beyond their laboratory results and their vital signs. It rekindles the intimacy lost when we see patients only as pathology.
The benefits of narrative medicine aren't just limited to the physician-patient dynamic. Physicians who develop narrative competence are able not only to walk alongside their patients as they navigate their disease processes but also to support their colleagues and to reflect upon their own hardships as providers in a career fraught with loss. In fact, narrative medicine can reduce physician burnout, according to Neurology Today.
Writing in Academic Medicine, Dr. Charon has powerfully described the way narrative medicine can help physicians respond to human suffering. "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," she writes. "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."
The field of narrative medicine forces us to move beyond the ideology of "How do I treat this pathology?" to the more holistic response of "What does my patient need?" In many instances, our patients need our enthusiastic support, our time and the space to share their stories. Our engagement in narrative medicine gives us a mechanism by which we can tap into the human side of medicine and strengthen our bond with our patients, our colleagues and ourselves.
Want to learn more about narrative medicine? Read:
- "To See the Suffering" in Academic Medicine
- "Neurologists Find an Antidote to Burnout Through Narrative Medicine" in Neurology Today
- "Claiming the Narrative Wave With Story Theory" in Advances in Nursing Science
- "Narrative Medicine Workshops for Obstetrics and Gynecology Residents and Association With Burnout Measures" in Obstetrics & Gynecology