What Is Narrative Medicine?

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For people seeking a more satisfying healthcare experience, narrative medicine may be the answer. A growing field in health care, this practice encourages patients to tell the story of their health so that physicians can more thoroughly and effectively treat the condition at hand.

In narrative medicine, physicians strive to gain a deeper understanding of the experiences and emotions likely to have influenced each patient’s health.

By sharing your stories, you create a more complete picture of your illness and its impact on your life. At the same time, narrative medicine offers insight into the treatment approaches and self-care strategies likely to produce the greatest benefit for each individual.

Ultimately, narrative medicine provides a powerful means of “bridging the divides that separate physicians from patients,” according to Rita Charon, MD, PhD, a Columbia University professor who originated the field of narrative medicine. A more holistic way of treating disease, narrative medicine looks beyond symptoms and treatment options to consider the whole patient and their unique needs, beliefs, and values.

The Benefits of Narrative Medicine

One of the core principles of narrative medicine is that receiving patients’ stories helps to build empathy in physicians and, in turn, improves the quality of care. Indeed, a number of recent studies have shown that higher levels of physician empathy may be associated with more positive outcomes in patients.

In a study published in Academic Medicine in 2011, for example, researchers analyzed the effects of physician empathy on 891 people with diabetes. They found that patients of physicians with high empathy scores were significantly more likely to have good control of their blood sugar levels (compared to patients of physicians with low empathy scores).

In addition, a study published in Annals of Indian Academy of Neurology in 2012 determined that people with migraines had better health outcomes and were more likely to stick with their management plans when they felt that their physicians were empathetic to their condition.

Narrative Medicine: Tips for Starting Conversation With Your Doctor

In recent years, medical schools across the country have begun training residents in narrative medicine. Columbia University even offers a narrative medicine master’s program geared toward healthcare professionals and trainees. However, since narrative medicine is a still-emerging field, many physicians may be unfamiliar with the principles of this practice.

If you’re interested in narrative medicine and its potential role in your health care, let your doctor know. Even if your doctor lacks training in narrative medicine, he or she should be open to hearing your health story.

A number of questions may help guide you in starting this conversation with your doctor. For instance, Dr. Charon typically begins her first patient visits by asking, “What would you like me to know about you?” Pondering this question prior to your doctor’s visit may help you to build your narrative.

Here are several other questions that practitioners of narrative medicine often ask their patients during a doctor’s visit:

  • “How do you feel about your condition?”
  • “What do you think is going on with your condition?”
  • “How has your life changed as a result of your condition?”

If you feel intimidated about starting this conversation with your doctor, remember that narrative medicine can reveal important clues about your health and, in the end, aid your doctor in finding the optimal approach to treating your condition.

Narrative Medicine: What to Talk About With Your Doctor

Narrative medicine practitioners often recommend that patients approach this process as a form of storytelling.

To that end, it’s essential to consider the characters (i.e., friends, relatives, and other people in your life) and plot points (i.e., major and minor life events) that stand out to you as you examine your own history with health and illness.

As you’re telling your story, make sure to address any stress and anxiety related to your condition. Keep in mind that your family’s health history may also heavily factor into your fears surrounding your illness. And if you’re apprehensive or shy about divulging intimate details about your life, remember that most doctors are accustomed to discussing personal issues.

More Guidance on Narrative Medicine

Careful preparation can help you make the most of your doctor’s visit, especially if you’re nervous about sharing the more personal elements of your health story. Before your visit, make note of any story points you’d like to bring up with your doctor, then take those notes with you to your appointment.

Keeping a health journal can also help you string together the details of your health narrative. Try taking at least 10 minutes to write freely about your illness experience, which may uncover thoughts and feelings that you’ve been suppressing.

If you need further support, bringing a friend or family member to your doctor’s appointment might also be helpful.

Finally, if your doctor isn’t willing to discuss your health story with you, consider seeking out a doctor with a greater interest in narrative medicine.

Sources:

Attar HS, Chandramani S. Impact of physician empathy on migraine disability and migraineur compliance. Ann Indian Acad Neurol. 2012 Aug;15(Suppl 1):S89-94.

Charon R. The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001 Oct 17;286(15):1897-902.

Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians' empathy and clinical outcomes for diabetic patients. Acad Med. 2011 Mar;86(3):359-64.

Peterkin A, MD. Practical strategies for practicing narrative-based medicine. Can Fam Physician. 2012 Jan; 58(1): 63–64.

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