Narrative medicine

Narrative medicine is a medical approach that recognizes the value of people's narratives in clinical practice, research and education.

History

Since the 1970s critics have alleged that Western medicine has fallen victim to the professionalism movement. According to this critique, many medical schools and residency programs train physicians to treat medical problems merely as problems to be solved, without taking into account the specific psychological and personal history of the patient. As of late 1990s physicians like Rachel Naomi Remen and Rita Charon have argued that medical practice should be structured around the narrative. Charon stated:

"Sick people need physicians who can understand their diseases, treat their medical problems, and accompany them through their illnesses."[1]

The value of narrative medicine has been summarized as follows:[2]

  • In the diagnostic encounter, narratives:
    • Are the phenomenal form in which patients experience ill health
    • Encourage empathy and promote understanding between clinician and patient
    • Allow for the construction of meaning
    • May supply useful analytical clues and categories
  • In the therapeutic process, narratives:
    • Encourage a holistic approach to management
    • Are intrinsically therapeutic or palliative
    • May suggest or precipitate additional therapeutic options
  • In the education of patients and health professionals, narratives:
    • Are often memorable
    • Are grounded in experience
    • Encourage reflection
  • In research, narratives:
    • Help to set a patient centered agenda
    • May challenge received wisdom
    • May generate new hypotheses

Narrative medicine aims not only to validate the experience of the patient, but also to encourage creativity and self-reflection in the physician.

In 2009, Columbia University created a master's program in Narrative Medicine.[3]

Obstacles

Remen notes,

People who are physicians have been trained to believe, that it is a scientific objectivity that makes them most effective in their efforts to understand and resolve the pain that others bring them, and a mental distance that protects them from becoming wounded from this difficult work. [4]

Objectivity, empathy, and global thinking, are not incompatible with a degree of dissociation, sufficient to protect oneself, from the patient's suffering.

References

  1. ↑ Charon R (2001-10-17). "Narrative medicine: A model for empathy, reflection, profession, and trust". JAMA: The Journal of the American Medical Association 286 (15): 1897–1902. doi:10.1001/jama.286.15.1897. ISSN 0098-7484. Retrieved 2012-11-24.
  2. ↑ Tricia Greenhalgh and Brian Hurwitz. "Narrative based medicine: Why study narrative?" BMJ 1999, 318:48-50.
  3. ↑ "Learning to Listen" New York Times (2009-12-29)
  4. ↑ Remen, Rachel Naomi (2006-08-01). Kitchen Table Wisdom: Stories That Heal. Riverhead Books. ISBN 9781594482090.

Additional sources

Healing Narratives (HSSC 009) undergraduates at the University of Pennsylvania under the guidance of Dr. Mackenzie (Spring 2007). Tricia Greenhalgh and Brian Hurwitz. "Narrative based medicine: Why study narrative?" BMJ 1999, 318:48-50.

External links