You’ve probably heard this conversation starter many times before: “Tell me about yourself.” You
might answer with your name, where you're from, and maybe a fun fact. Whether you’ve
thought about these details deeply or not, they lay the foundation of a story that reflects you.
The building of this story plays a critical role in narrative medicine.
Narrative medicine is the practice of mindfully contextualizing a patient’s lived experiences
to better care for and treat them. It’s an approach to healthcare that considers
not only the physical, but also the mental and emotional aspects of a person’s health.
By seeking out a patient’s story, clinicians can gain an in-depth perspective of their patient,
and ultimately see a whole person, not just a diagnosis.
Narrative medicine requires a vast array of skills— clinicians must be able to listen to,
comprehend, and act upon a patient’s story. Sometimes, a patient’s story isn’t clean-cut,
so clinicians also need to be able to navigate its nuances. This set of skills is called narrative
competence, and clinicians can improve their narrative competence through creative expression.
Narrative medicine provides a solution to common challenges faced by clinicians and patients. A
clinician cannot rely on their medical knowledge alone to prevent, diagnose, and treat illnesses.
If they cannot communicate and connect with their patient, the patient may feel neglected,
invalidated, or even hesitate to return for another visit. In some cases, a clinician may
miss the correct diagnosis, or the prescribed treatment may be ineffective. If a patient is
from a marginalized population that has suffered historical, racial or other categorical trauma,
the disconnect can be even larger. The most common sources of disconnect between a clinician and a
patient are known as the “four divides.” These are obstacles that hamper the development of a strong,
patient-clinician connection. The first divide is differing views on mortality.
While clinicians primarily encounter illness and death through their work,
patients often react more strongly based on their personal experiences. The second divide is the
context of illness. Most clinicians see illness as a phenomenon requiring medical intervention,
while a patient may see illness as the effect it has on their life and on others. The third divide
is differing beliefs about the causes of disease. Not only do clinicians have extensive medical
training, but their knowledge is also valued more than their patient’s, creating an unequal balance.
The final divide is vulnerability. Patients may be hesitant to share personal details about their
lives, and a clinician may be hesitant to inquire, making the process of diagnosis and treatment
more difficult and stressful. Through conversations,
narrative medicine can result in more personalized care with improved health outcomes. Researchers at
The University of New England found that veterans who were asked to share their personal stories
experienced less chronic pain than those who were not. Additionally,
clinicians who listened to the stories of veterans experienced less emotional burnout.
While there are many accounts of the healing benefits of narrative medicine,
there are constraints to the approach. First, there is a limited amount of empirical evidence
on the effectiveness of narrative medicine, the training needed to practice it, and how
it relates to disease and illness outcomes. Narrative medicine also takes time, and how
to manage that time efficiently is a concern for incorporating it into modern medical practices.
Additionally, narrative medicine is a tool, not a cure. Clinicians need to understand
that using narrative medicine does not guarantee a smooth patient-provider relationship. Finally,
narrative medicine cannot fully capture someone’s entire story.
This stance is known as narrative humility. Although the field of narrative medicine
is relatively new, the use of stories within patient-clinician care is not.
In fact, storytelling has a long history in medical practices outside of Western medicine.
Ngoma is just one example of this. By combining stories with rhythms and dance, the ceremony has
been a source of traditional healing in central and southern Africa for countless generations.
Narrative medicine continues to be introduced on both national and global scales: initiatives
that utilize the approach have sprouted in the United States, England, France,
Taiwan, and Pakistan. Medical schools and other healthcare institutions have incorporated
narrative medicine courses and workshops into their curriculum and community education,
and narrative medicine is gradually becoming part of the Western medical norm. Narrative
medicine helps bridge the gap of misunderstanding between clinicians and patients, and by doing so,
connects individuals with themselves, others, and the diverse landscapes in which we all live.
Everyone has a unique story, and narrative medicine seeks to
honor these stories to build a healthier, and more connected world.