Narrative medicine

Narrative medicine is a wholesome medical approach that recognizes the value of people's narratives in clinical practice, research, and education as a way to promote healing. It aims to address the relational and psychological dimensions that occur in tandem with physical illness, with the perspective to treat patients as humans with individual stories, rather than simply the symptoms displayed on their medical chart.^[1] In doing this, narrative medicine aims not only to validate the experience of the patient, but also to encourage creativity and self-reflection in the physician. 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

History

In 1910, the Carnegie Foundation for the Advancement of Teaching created Flexner's report, which set out to redefine medical educational practices. In this report, it argued that the proper goal of medicine is quite simply, "to attempt to fight the battle against disease."^[3] Medical schools adapted their educational setting to depend purely upon the natural sciences, ignoring the human aspects of the disease.^[4]

Towards the late 20th century, critics alleged that Western medicine had fallen victim to the professionalism movement. They argued that many medical schools and residency programs train physicians to treat medical problems purely on their symptoms without taking into account the specific psychological and personal history of the patient. The emergence of narrative medicine came as a contemporary effort to rehumanize medicine.

One pronounced medical school that first began focusing on narrative medicine is Columbia University Medical Center with their opening of the first Program in Narrative Medicine. Built within their College of Physicians and Surgeons, they believe that narrative medicine can make profound changes to the way medical treatment is administered:

“Narrative Medicine fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness. Through narrative training, the Program in Narrative Medicine helps physicians, nurses, social workers, mental health professionals, chaplains, social workers, academics, and all those interested in the intersection between narrative and medicine improve the effectiveness of care by developing these skills with patients and colleagues. Our research and outreach missions are conceptualizing, evaluating, and spear-heading these ideas and practices nationally and internationally."^[5]

Rita Charon, M.D., Ph.D.^[6] is the executive director of this program and has published and lectured on the benefits of doctors receiving narrative training as a way to increase empathy and reflection in the medical professional field. Her work has been recognized by several national organizations, including:

• Association of American Medical Colleges
• American College of Physicians
• Society for Health and Human Values
• American Academy on Healthcare Communication
• Society of General Internal Medicine

As of the late 1990s, physicians like Rachel Naomi Remen and Rita Charon have argued that medical practice should be structured around the narratives of patients. Charon stated:

"Sick people need physicians who can understand their diseases, treat their medical problems, and accompany them through their illnesses."^[7]

Educational Programs

The number of schools in the United States that offer advanced classes in narrative medicine has been growing.

• The Columbia University Medical Center has been the leading pioneer of developing educational programs for the field of narrative medicine. In addition to lectures and seminars given throughout the year, Columbia University created the Master of Science in Narrative Medicine program for graduate students in 2009, making it one of the first graduate programs devoted strictly to narrative medicine.^[8]
• Montefiore Medical Center is the academic medical center and University Hospital for Albert Einsten College of Medicine, and is nationally recognized for its innovative, patient-centered care. This medical center created a program in Narrative Medicine as a subset of the Department of Family and Social Medicine. Residents at this school attend programs where they learn how to use personal narrative to enhance empathy, as well as topics including stress, loss, and balance.
• The Ohio State University Humanities Institute is also supporting the multidisciplinary initiative of narrative medicine. This program runs concurrent with their other undergraduate and graduate programs, where students "strive to develop narrative competence that enables them to deliver care that is not only more empathetic and compassionate, but also more effective."
• The University of California Irvine College of Medicine has created an Integrative Medicine Program within the Department of Family Medicine. This program "strives to change the focus of healthcare and medical education for our residents, medical students and faculty to include a multidisciplinary, patient-centered approach that emphasizes wellness, prevention, and self-care skills, and the adoption of the principles for creating optimal healing environments."^[9]

• In 2011, Western University created the Narrative Medicine Initiative (NMI) and has incorporated narrative medicine into the undergraduate, postgraduate, and continuing medical education departments. They work to answer questions such as "How does the art of storytelling improve health care education and the experience of patient care?"
• Lenoir-Rhyne University has established the Thomas Wolfe Center for Narrative, with the slogan "Heeding the call for narrative in a fragmented world." This program offers graduate-level and certification courses in several narrative training disciplines, one of which is narrative medicine.
• Saybrook University takes a broad approach to narrative medicine through their mind-body medicine program. This seeks to approve the mind-body approach to health and wellness as a way to improve quality of life for patients.

This growing field of Narrative Medicine extends beyond America; The British Medical Journal and other professional publications have begun adding their own writing seminars to promote this type of narrative in its emerging physicians.

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.^[10]

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

References

1. "Narrative Medicine | NYU School of Law". www.law.nyu.edu. Retrieved 2016-03-01.
2. Tricia Greenhalgh and Brian Hurwitz. "Narrative based medicine: Why study narrative?" BMJ 1999, 318:48-50.
3. Flexner (1910). "Medical Education in the United States and Canada". Carnegie Foundation for the Advancement of Teaching.
4. Johna, Samir; Rahman, Simi (2011-01-01). "Humanity before Science: Narrative Medicine, Clinical Practice, and Medical Education". The Permanente Journal. 15 (4): 92–94. ISSN 1552-5767. PMC 3267572. PMID 22319427.
5. "Columbia University Medical Center | Program in Narrative Medicine". www.narrativemedicine.org. Retrieved 2016-03-01.
6. "Columbia University Medical Center | Program in Narrative Medicine". www.narrativemedicine.org. Retrieved 2016-03-01.
7. 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.
8. "Learning to Listen" New York Times (2009-12-29)
9. "Integrative Medicine Program | Department of Family Medicine | University of California, Irvine". www.familymed.uci.edu. Retrieved 2016-03-01.
10. Remen, Rachel Naomi (2006-08-01). Kitchen Table Wisdom: Stories That Heal. Riverhead Books. ISBN 9781594482090.

Additional sources

• Coyote Healing: Miracles in Native Medicine. Lewis Mehl-Madrona M.D. Ph.D. Bear & Company (2003) ISBN 1-59143-010-0 ISBN 978-1591430100

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

• http://www.utne.com/Spirituality/Narrative-Medicine-Heals-Bodies-and-Souls.aspx
• http://www.npr.org/templates/story/story.php?storyId=1480863