Narrative medicine is a medical approach that utilizes people's narratives in clinical practice, research, and education as a way to promote healing. It aims to address the relational and psychological dimensions that occur in tandem with physical illness, with the attempt to treat patients as humans with individual stories, rather than purely based on symptoms. In doing this, narrative medicine aims not only to validate the experience of the patient, but also to encourage creativity and self-reflection in the physician. The value of narrative medicine has been summarized as follows:
Contents
History
In 1910, the Carnegie Foundation for the Advancement of Teaching created Flexner's report, which set out to redefine medical educational practices. In this report, it argued that the proper goal of medicine is "to attempt to fight the battle against disease."
Towards the late 20th century, critics alleged that Western medicine had fallen victim to the professionalism movement. They argued that many medical schools and residency programs train physicians to treat medical problems purely on their symptoms without taking into account the specific psychological and personal history of the patient. The emergence of narrative medicine came as a contemporary effort to rehumanize medicine.
One prominent medical school that first began a program on narrative medicine was Columbia University Medical Center with their opening of the first Program in Narrative Medicine. Built within their College of Physicians and Surgeons, they believe that narrative medicine can make profound changes to the way medical treatment is administered:
“Narrative Medicine fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness. Through narrative training, the Program in Narrative Medicine helps physicians, nurses, social workers, mental health professionals, chaplains, social workers, academics, and all those interested in the intersection between narrative and medicine improve the effectiveness of care by developing these skills with patients and colleagues. Our research and outreach missions are conceptualizing, evaluating, and spear-heading these ideas and practices nationally and internationally."
Rita Charon is the executive director of this program and has published and lectured on the benefits of doctors receiving narrative training as a way to increase empathy and reflection in the medical professional field.
As of the late 1990s, physicians like Rachel Naomi Remen and Rita Charon have argued that medical practice should be structured around the narratives of patients. Charon stated:
"Sick people need physicians who can understand their diseases, treat their medical problems, and accompany them through their illnesses."
Educational Programs
The number of schools in the United States that offer advanced classes in narrative medicine has been growing.
This growing field of narrative medicine extends beyond the United States: The British Medical Journal have begun adding their own writing seminars to promote this type of narrative in its emerging physicians.
Obstacles
Rachel Remen asserts,
People who are physicians have been trained to believe, that it is a scientific objectivity that makes them most effective in their efforts to understand and resolve the pain that others bring them, and a mental distance that protects them from becoming wounded from this difficult work.
Objectivity, empathy, and global thinking are stated to not be incompatible with a degree of dissociation from the patient's suffering that is sufficient to protect oneself.