Professional Practice
PlainViews Staff
Story Telling Skills Can Improve Health Care:
The Emergence of Narrative Medicine
Not everybody knows how to tell a story—or listen to one--and many people involved in health care may not even think of their patients in terms of a life story. Most physicians are trained to solve medical problems without taking into account the specific psychological and personal history of the patient—including their underlying values and spiritual needs. However, health care chaplains are most interested in these values and spiritual needs and the increasing interest in a new field of study, Narrative Medicine, which aims to treat the whole person, not just the illness, should increase the value of palliative care.
The emergence of this field as a serious medical discipline can be traced to Rita Charon, MD, the author of Narrative Medicine: Honoring the Stories of Illness (Oxford University Press, 2006), who proposed something new to Columbia University: a master of science in narrative medicine. The one-year program at the School of Continuing Education was cited by The New York Times as number one of The New Master’s of the Universe for 2010. (The newspaper selects ten outstanding master’s degree programs each year.)
In addition to her medical degrees, Dr. Charon got a PhD in English when she realized how central is telling and listening to stories to the work of doctors and patients. The program in narrative medicine helps doctors, nurses, social workers, and therapists to improve the effectiveness of care by developing the capacity for attention, reflection, representation, and affiliation with patients and colleagues.
Courses are guided by works of philosophy, film, art, and literature that bring us face to face with death, though in very different ways, such as Plato’s Phaedo (about the death of Socrates), Tolstoy’s The Death of Ivan Ilych, and others. By reading, attending movies, and viewing art, health care workers learn how to increase their reflective practice and observational skills. Courses in fine arts utilize observation and description of art as a means of enhancing visual diagnostic and communication skills. Narrative photography is about seeing the human story through the still image. A life drawing course helps people realize they have never really seen anyone as clearly as when they try to draw them.
In addition to curriculum courses, the Columbia program offers Narrative Medicine Rounds, which are free and open to the public. These are evening lectures or readings presented by scholars, clinicians, poets, novelists, even a jazz pianist. Podcasts are available for some of these.
The emergence of narrative medicine seems in direct response to a health care system that places corporate and bureaucratic concerns over the needs of the patient. With insurance and pharmaceutical companies also part of the profit equation physicians have to keep people moving through the system in order to make a living at reimbursed rates. Time spent listening to Mrs. Garcia’s story about how she emigrated from Cuba doesn’t figure into the equation.
Narrative medicine aims to help health care workers incorporate the life stories of patients, including their own unique value system, into their options for treatment, so that it fits the individual. When information can be shared this way, ethical decisions are made about the patient’s care, particularly at the end of life, when treatment goals can be in harmony with the way the patient has lived their life through the beginning and middle.
The discipline of narrative medicine is getting more attention in medical schools and conferences around the world and in medical blogs such as KevinMD.com, and MedPageToday.com.
The emergence of listening to the patient’s story as an integral part of care isn’t new for professional chaplains and other spiritual care givers. However, it’s integration into medical schools and physician practice is an area of opportunity.
How are – or how can – professional chaplains contribute to the integration of narrative medicine?
PlainViews is seeking articles from readers who have experience in working with physicians in this area:
• How have you educated physicians, other members of the health care team, and/or administrators of the importance of the patient’s story?
• Have you taught a class, inservice, or grand rounds? If so, would you be willing to share how you developed the education, advertised it, and the topics you covered?
• What are the ways you’ve incorporated the practice of incorporating the importance of narrative medicine into efforts to improve patient satisfaction?
• What questions or struggles would you like to have colleagues provide input on?
Send your submissions to plainviews@healthcarechaplaincy.org