Narrative medicine

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Narrative Medicine is the discipline of applying the skills used in analyzing literature to interviewing patients. [1] The premise of narrative medicine is that how a patient speaks about his or her illness or complaint is analogous to how literature offers a plot (an interconnected series of events) with characters (the patient and others) and is filled with metaphors (picturesque, emotional, and symbolic ways of speaking), and that becoming conversant with the elements of literature facilitates understanding the stories that patients bring. [2] Narrative Medicine is a diagnostic and comprehensive approach that utilizes patients' narratives in clinical practice, research, and education to promote healing. Beyond attempts to reach accurate diagnoses, [3] it aims to address the relational and psychological dimensions that occur in tandem with physical illness. [4] Narrative medicine aims not only to validate the experience of the patient, it also encourages creativity and self-reflection in the physician.

Contents

Two first year medical students at Lewis Katz School of Medicine writing/journaling about their experiences in the hospital. Medical Students Writing @ Lewis Katz School of Medicine.jpg
Two first year medical students at Lewis Katz School of Medicine writing/journaling about their experiences in the hospital.

History of the Development of Narrative Medicine

In 1910, the Carnegie Foundation for the Advancement of Teaching created the Flexner Report , which set out to redefine medical educational practices. The report argues that the goal of medicine is "an attempt to fight the battle against disease most advantageously to the patient." Flexner wrote that "the practitioner deals with facts of two categories. Chemistry, physics, biology enable him to apprehend one set; he needs a different apperceptive and appreciative apparatus to deal with other more subtle elements. Specific preparation is in this direction much more difficult; one must rely for the requisite insight and sympathy on a varied and enlarging cultural experience." [5] In the late 20th century, narrative medicine came to emphasize an aspect of wider cultural elements in medicine.

From the 1990s, physicians such as Rachel Naomi Remen [6] and Rita Charon, who also holds a doctorate in English literature, argued that medical practice should be structured around the narratives of patients. [7] In 2000, Rita Charon first used the term 'Narrative Medicine' to describe a method of using what she calls "narrative competence," which is "the capacity to recognize, absorb, metabolize, interpret, and be moved by stories of illness." [8] [9]

Method of Narrative Medicine

The teaching of narrative medicine involves close reading of texts, writing assignments of personal reflection about the text, and discussion of the personal reflections. [10] With the development of 'narrative competence' comes greater understanding and empathy that facilitate the patient and clinician working together.

Close reading

Close reading is a technique in teaching literature wherein the formal aspects of a text are studied. Students are directed to the read a text "for its information, ambiguity, complexity, texture, and mood as well as for its plot." These methods can be adapted to film, art, and music in the form of 'slow looking' [11] and 'close listening.' [12]

Creative Writing

Following a close reading of a text, students write about their personal encounter with the text, which "unleashes the curiosity and imagination of the writer."

Discussion

In turn, Narrative Medicine teachers apply "close reading" to the students' reflective writing. [13]

Allied Use of Narrative in Medicine

The term 'Narrative Medicine' refers to training in interpreting literature and applying that skill to understanding the accounts of patients. Associated fields also use 'Narrative-based Medicine', a main proponent of which is the English General Practice physician John Launer, who holds a degree in English literature. His approach comes from an orientation of Family therapy, wherein patients are invited to expand on and explore new directions in the accounts of their illnesses. [14]

Narrative in Medicine

A broader field is the use of narrative in general in helping doctors and patients deepen understanding of the ways of relating to illness and healing. In the 1990s and early 21st century, this approach is exemplified by the American physician Lewis Mehl-Madrona [15] and the British physician Trisha Greenhalgh. [16]

Educational Programs

A number of schools in the United States offer advanced classes in narrative medicine.

The growing field of narrative medicine extends beyond the United States:

See also

Related Research Articles

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<span class="mw-page-title-main">Physician</span> Professional who practices medicine

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<span class="mw-page-title-main">Emergency medicine</span> Medical specialty concerned with care for patients who require immediate medical attention

Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians specialize in providing care for unscheduled and undifferentiated patients of all ages. As first-line providers, in coordination with emergency medical services, they are primarily responsible for initiating resuscitation and stabilization and performing the initial investigations and interventions necessary to diagnose and treat illnesses or injuries in the acute phase. Emergency medical physicians generally practice in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units. Still, they may also work in primary care settings such as urgent care clinics.

<i>Flexner Report</i> 1910 report on medical education

The Flexner Report is a book-length landmark report of medical education in the United States and Canada, written by Abraham Flexner and published in 1910 under the aegis of the Carnegie Foundation. Many aspects of the present-day American medical profession stem from the Flexner Report and its aftermath. The Flexner report has been criticized for introducing policies that encouraged systemic racism.

Medical humanities is an interdisciplinary field of medicine which includes the humanities, social science and the arts and their application to medical education and practice.

<span class="mw-page-title-main">Family medicine</span> Medical specialty

Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is named a family physician. It is often referred to as general practice and a practitioner as a general practitioner. Historically, their role was once performed by any doctor with qualifications from a medical school and who works in the community. However, since the 1950s, family medicine / general practice has become a specialty in its own right, with specific training requirements tailored to each country. The names of the specialty emphasize its holistic nature and/or its roots in the family. It is based on knowledge of the patient in the context of the family and the community, focusing on disease prevention and health promotion. According to the World Organization of Family Doctors (WONCA), the aim of family medicine is "promoting personal, comprehensive and continuing care for the individual in the context of the family and the community". The issues of values underlying this practice are usually known as primary care ethics.

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<span class="mw-page-title-main">Medical education</span> Education related to the practice of being a medical practitioner

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<span class="mw-page-title-main">University of Pittsburgh School of Medicine</span> Medical school in Pittsburgh, Pennsylvania, US

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<span class="mw-page-title-main">Temple University School of Medicine</span> Public medical school in Philadelphia, Pennsylvania, US

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<span class="mw-page-title-main">Rita Charon</span> American physician

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Further reading