HCP: The Health-Care Professional’s Guide to Narrative Medicine

Patient talking to doctor in a medical clinic
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If you are a health-care professional looking to better serve your patients, a practice known as narrative medicine may have a powerful impact. In narrative medicine, patients share the stories behind their health conditions, with an emphasis on their personal and emotional experience of illness, enabling clinicians to provide compassionate care.

According to a report published in The Permanente Journal, the stories shared may act as a “useful resource for understanding the individual, patient-specific meaning of an illness.” It’s thought that this understanding may provide clinicians with a unique and invaluable insight into how best to treat the condition at hand.

Narrative medicine is often perceived as a means of adding a more human element to health care, by treating the whole person (and not just the illness) in a comfortable, supportive environment and strengthening the therapeutic alliance between clinician and patient.

As the Association of American Medical Colleges explains, this movement involves a profound change in mindset, prompting health-care professionals to ask themselves “How can I help my patient?” rather than “How can I treat this disease?”

The Benefits of Narrative Medicine for Health-Care Professionals

In a health-care system where providers are so often pressed for time, the notion of taking time out to hear each patient’s health story may seem daunting. However, many practitioners of narrative medicine have found that the benefits of this practice supersede any concerns about time management.

Along with a deeper understanding of the connections between patients behaviors and symptoms and the struggles that patients face in controlling their conditions, the benefits of narrative medicine include a stronger insight into possible coping strategies.

It’s also thought that building a health narrative may help patients to feel more engaged and empowered when it comes to managing their condition.

What’s more, a number of studies have shown that patients may experience improvement in symptoms and health outcomes when encouraged to express their emotions about their illness.

If you’re worried about time constraints, it’s important to note that a study published in The BMJ determined that just two minutes is enough for most patients to recount their concerns. The physicians in this study were trained in active listening, and many of the study members had complex medical histories.

Where to Get Training in Narrative Medicine

Because narrative medicine is still a burgeoning field, training in this discipline is not yet widely available. However, Columbia University has a master’s of science (M.S.) program in narrative medicine, geared toward health-care professionals and trainees in clinical disciplines like medicine, nursing, dentistry, social work, physical therapy, and occupational therapy. (A degree or certificate in narrative medicine, on it's own, doesn't qualify the graduate to provide clinical care.)

In recent years, a growing number of medical schools across the country have also begun offering courses, seminars, conferences, workshops, summer programs, and symposiums on narrative medicine.

UCSF, for instance, offers a course in narrative medicine, Columbia University has a certificate program, and NYU has a one-month elective in medical humanities.

While the curricula differ from program to program, many focus on strengthening skills of clinical attention to patients' stories, capturing those stories in writing, listening to patients, practicing self-reflection, and understanding individual context and the patient-centered perspective in illness.

 

How to Incorporate Narrative Medicine Into Your Practice

If you’re new to narrative medicine, asking open-ended questions may help ease your patients into the practice. To that end, practitioners of narrative medicine often begin by asking “What would you like me to know about you?”, according to Rita Charon, M.D., Ph.D., the Columbia University professor of clinical medicine who originated the field of narrative medicine.

As patients tell their stories, take care not to interrupt them. To guide them along as they share their narrative, consider asking such questions as “What do you think is going on with your condition?” and “How do you feel about your illness?”

Asking your patients to write about their illness may also be helpful in getting them to open up and explore any suppressed thoughts, feelings, and fears.

Keep in mind that some patients may be reluctant to share their story, and make sure not to pressure those who are resistant to discussing more personal matters.

Promoting Your Practice

Once you’ve incorporated narrative medicine into your practice, getting the word out can help you reach the wider community and draw patients who are seeking this approach to health care.

Along with updating your website (and making sure that the site is mobile-friendly), you can expand your reach with social media platforms (including Facebook, Twitter, and Instagram). Weekly newsletters are also great for keeping your patients engaged.

As you more fully integrate narrative medicine into your practice, using social media content and blog posts to share your experiences can pique the interest of patients.

Since many patients may be unfamiliar with narrative medicine, your content can go a long way in spreading the word about the many benefits of this practice. Even if you don't write about "narrative medicine", the way you write and communicate will convey your approach.

Sources:

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

Hatem D, Rider EA. Sharing stories: narrative medicine in an evidence-based world. Patient Educ Couns. 2004 Sep;54(3):251-3.

Pennebaker JW. Telling stories: the health benefits of narrative. Lit Med. 2000 Spring;19(1):3-18.

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

Sakalys JA. Restoring the patient's voice. The therapeutics of illness narratives. J Holist Nurs. 2003 Sep;21(3):228-41. 

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