Narrative Medicine

Western medical care system has mainly relied on a biomedical approach that treated disease/illness through examination of measurable biological variables such as blood work, X-ray, MRI and physical examination. It often ignored psychological, behavioral, and socio-cultural characteristics germane to the individual patient (Engel, 1977). By the late 1990s, physicians like Dr. Remen (2006) and Dr. Charon (2001) have advocated for patient-centered narrative medicine and urged that medical practice should be structured around the narratives of patients. Narrative Medicine, defined as medicine practiced with the narrative competence to recognize, understand, absorb, interpret, and be moved by the stories of illness (Charon, 2001). It addresses the need of patients and caregivers to voice their experience, to be heard and to be valued, and it acknowledges the power of narrative to change the way care is given and received.

The narrative process offers individuals a chance to conceptualize their lives and their identities and to share their stories with medical professionals. The process of personal narrative can have a cathartic effect which helps individual form a new sense of identity following his/her illness (Lorenz, 2010). Patient’s narrative provides clinicians a glimpse into the physical, psychological, social, and economic impact of an illness and how that illness affects the individual, the family, and the community. As such, narratives can guide the clinician in holistic approach and inform clinical decision-making in patient-centered care (Frass, 2015).

There is no doubt that everyone in this world for being a patient would applaud the idea of narrative medicine. However, as every family doctor clinic is busy rushing patient in and out the clinic for less than 10 minutes per visit, the stressed-out, overworked doctors, seeing too many patients in too short a time, couldn’t even collect full patient histories relating to the specific illness, the feasibility of narrative medicine in Canadian medical care system is questionable.

Dr. Rita Charon  –  Professor of Clinical Medicine and Executive Director of the Program in Narrative Medicine at Columbia University and a Cecil H. and Ida Green Visiting Professor at Green College, UBC, who will be presenting at Richmond Hospital Dept of Psychiatry Annual Clinical Day on Friday April 8/2016 in Richmond Hospital. For registration, please go to https://rhp2016clinicalday.eventbrite.ca/?discount=GEN

Relevant readings:

Rita Charon. Narrative Medicine: Honoring the Stories of Illness. New York, Oxford University Press, 2008.

Power Point: https://www.meded.uci.edu/medhum/presentations_mh/Narrative%20Medicine.Grand%20Rounds.rev.pdf   Narrative Medicine in Practice by Johanna Shapiro, Ph.D. Professor, Department of Family Medicine; Director, Program in Medical Humanities & Arts, University of California Irvine, School of Medicine

References

Charon, R (2001). “Narrative medicine: A model for empathy, reflection, profession, and trust”. JAMA: The Journal of the American Medical Association 286 (15): 1897–1902.doi:10.1001/jama.286.15.1897. ISSN 0098-7484.

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136

Fraas, M. R. (2015). Narrative medicine: Suggestions for clinicians to help their clients construct a new identity following acquired brain injury. Topics In Language Disorders, 35(3), 210-218. doi:10.1097/TLD.0000000000000063

Remen, Rachel Naomi (2006). Kitchen Table Wisdom: Stories That Heal. Riverhead Books. ISBN 9781594482090.