Dr. Rita Charon, M.D., Ph.D., founder and director of the pioneering
Program in Narrative Medicine at Columbia University‘s College
of Physicians and Surgeons, “invented the term ‘Narrative
Medicine’ [in 2001] to connote a medicine practiced with narrative
competence and marked with an understanding of the highly complex narrative
situations among doctors, patients, colleagues, and the public”
(Dr. Charon, Narrative Medicine). While narrative medicine is still
a burgeoning, relatively new field of study - with only several medical
schools in the nation that require “narrative competence”
- narrative medicine has deep academic roots in biopsychosocial medicine,
primary care, medical humanities, and patient-centered medicine. It
is designed to teach healthcare professionals “to listen very
expertly and attentively to extraordinarily complicated narratives --
told in words, gestures, silences, tracings, images, and physical findings
-- and to cohere all these stories into something that makes at least
provisional sense, enough sense, that is, to be acted on” (Charon,
Narrative Medicine). Narrative medicine works to create the conceptual
framework through which to better understand the often incredibly complex
relationships in the realm of healthcare - doctor-patient, doctor-family,
doctor-colleague, doctor-public, etc. As Dr. Charon explains, narrative
medicine “gives us [the] theoretical means to understand why acts
of doctoring are not unlike acts of reading, interpreting, and writing
and how such things as reading fiction and writing ordinary narrative
prose about our patients help to make us better doctors” (Narrative
Medicine). At Columbia, every second-year medical student is required
to take a seminar in narrative medicine and all medical students are
encouraged to take additional classes, such as figure-drawing classes
at the Met and poetry and fiction-writing workshops; Dr. Charon is confident
that these experiences “will create more imaginative, empathetic
doctors.” In rapidly increasing numbers, physicians across the
nation are becoming convinced that “narrative competence”
makes for better doctors - doctors who not only make diagnoses with
a stethoscope and blood-work, but who listen to their patients, who
read their stories and who pay close attention to how their patients
communicate “illness narratives.” “Narrative medicine
brings a useful set of skills, tools and perspectives to all doctors.
Not only does it propose an ideal of medical care -- attentive, attuned,
reflective, altruistic, loyal, able to witness others’ suffering
and honor their narratives -- that can inspire us all to better medicine,
it also donates the methods by which to grow toward those ideals. Any
doctor and any medical student can improve his or her capacity for empathy,
reflection, and professionalism through serious narrative training …
Ultimately, narrative medicine may offer promise as a means to bridge
the current divides between doctors and patients, between doctors and
doctors, between doctors and themselves, illuminating the common journeys
upon which we all are embarked” (Dr. Rita Charon).
"The effective practice of medicine requires narrative competence, that
is, the ability to acknowledge, absorb, interpret, and act on the
stories and plights of others. Medicine practiced with narrative
competence, called narrative medicine, is proposed as a model for humane
and effective medical practice. Adopting methods such as close reading
of literature and reflective writing allows narrative medicine to
examine and illuminate 4 of medicine's central narrative situations:
physician and patient, physician and self, physician and colleagues, and
physicians and society. With narrative competence, physicians can reach
and join their patients in illness, recognize their own personal
journeys through medicine, acknowledge kinship with and duties toward
other health care professionals, and inaugurate consequential discourse
with the public about health care. By bridging the divides that separate
physicians from patients, themselves, colleagues, and society, narrative
medicine offers fresh opportunities for respectful, empathic, and
nourishing medical care."
(Abstract from "Narrative Medicine: A Model for Empathy, Reflection,
Profession, and Trust" by Rita Charon, 2001)
"Physicians who are able to appreciate the nuances of their patients'
stories will enjoy their patient encounters more, will understand the
patient's illness more confidently (not to mention more economically)
and, in relating back to the patient what's going on, will more
effectively treat the problem. For his part, the patient will feel that
he's been heard and will believe he is known and understood and is more
likely to accept the story the doctor tells him back even if diagnosis
does not involve tests, and treatment is reassurance and/or watchful
waiting."
(from "The Role of Narrative in Medical Education and Practice," by David
Svahn, M.D., director of the Humanities and Medicine Program at Bassett
Healthcare in Cooperstown, N.Y.)
