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Kimberly Rodriguez
Professor Giacoppe
Studies in Arts and Humanity
18 June 2021
Narrative medicine is the utilization of narrative ideas like Storytelling in medical practices, which is implemented to fulfill the shortcoming of biomedical procedures. Narrative medicine is the conglomerate of ideas that encompasses different schools of thought and understanding, running from medical humanities, biopsychosocial medicine, psychoanalysis, patient-centered care, among others. Medical humanities itself covers philosophy, literature, the arts, history, ethics, culture, among others. In a simple term, Narrative medicine can be described as listening to the patient’s story. But the real-world scenario is much more different as it requires a wide range of skills and has competency in particular skills too. This is the primary reason which is why Narrative medicine is not extensively practiced despite its immense benefits. There is a huge challenge for health and medical professionals to find methods of implementing narrative medicine for improving the patients’ experience and practice. But, the effective implementation of making the interaction between the patients and the medical professionals can be done with certain strategies and guidelines.
Narrative-based medicine comprises Storytelling, where the patients, as well as the physician, tells their stories where they get knitted to get new understandings about the illness and possible way of cure (Hurwitz, 2000). It is not limited to this. It also encompassed the acknowledgment of each patient’s story and empathizing their story with concern and interest. Similarly, narrative-based medicine recognizes the detachment which exists between the medical practitioner and patients to take the proper course of action to narrow or bridge the gap by strengthening connections. This is very important for the caretakers to understand and listen to the patients closely, which helps in the better understanding of the patients apart from the illness experience. In medical practice, Narratives play a key role. From the very start of the medical practice, the experience of health workers who are treating a patient, the stories of the patients, and their story of recovery are shared among medical professionals, patients, and the patient’s relatives. These practice has been increasingly shadowed with the advent of new and modern medical technologies as the latter was considered as objective and scientific than the former. Surprisingly, the medical narrative is in change and is gaining momentum over the years. This has led to the creation of narrative-based medicine (NBM), which is a really great sign for the common medical future. Although it contrasts with evidence-based medicine, narrative-based medicine is able to address many shortcomings of the evidence-based one. NBM is a specific form of patient-physical communication that has a particular approach in treating patients depending upon the field of application.
The medical narrative involves both the patient’s narrative as well as the caregiver’s narrative. The patient’s narrative has become dominant in modern times as it promotes the know-how of the patient’s illness. The narrative is crucial to providing the context, meaning, and perspectives from the difficulty that the patient is facing. The details of one’s illness can be possibly found out even if other means cannot. Victor von Weizsäcker’s findings demand the patient’s narrative into medical practice. This is important because it won’t be limited to certain medical cases, but an illness narrative explains the most genuine reality of death or life or a patient. This approach can be studied in physician-patient, patient-oriented relations, and communication. The narrative medical knowledge was pointed out first by Kathryn Montgomery Hunter, who stated that the narrative is the final means of casuistry in the medical field, which allows medical practitioners to exchange their therapeutic and diagnostic worldview to match common principles to the single case and to have a higher level of generalization which can be more open to change and practicable (Kalitzkus, 2009).
Narrative-based medicine and evidence-based medicine have been integrated to form a narrative evidence-based medicine that calls for more interaction between the caregivers and the patients. The impact of narrative medicine is immense to both patients and caregivers (Datta, 2021). Caregivers can make good sense of the sufferings of the patients and can feel how the patients are going through. Patient stories will provide a social context as well as other details of the illness experience and suggests coping strategies. It is also very useful for the personal development of not only caregivers but patients too.
The story of a physician as well as caregivers to the patients is equally important. It helps to the dehumanization of medicine similar to that of the patient’s stories. The reflection on caregivers or medical professionals is not very usual, and their vulnerability is known very little. But the experiences they have before can be very useful for understanding the professional role of the practitioner and their relation with the patients. These caregivers may also go through innumerable sufferings and illness of their own which may have an impact on the way they care and treats patients. Such reflection helps the caregivers like physicians to build empathy and know-how of the patient’s situations. Such narratives also help to know the reality of the patients by finding, integrating, and explaining their similarities with that of the patients and the patients to their own.
Patients can tell the physicians or caregivers how they got ill when they encounter each other. Physicians then interpret the experience shared by the patients and apply the medical knowledge for the diagnosis of the disease or illness and start a pertinent therapeutic action. The medical perspective given by the doctors will change the patient’s narratives and their experience. They also get to the reasons for all the things that have happened, and the story they will plot in the future will change in a better way. The impact of illness narrative is immense when the caretakers or physicians take the supportive role in making a narrative, construct a story and deliver it well. This will significantly help the patients to cope up with the illness they are going through and will impart personality growth as well. The narrative should be comprehended as a larger part of the patient’s life story. Having said that, caution must be taken as the inverse effect may take place. Patients may get demotivated and devalued by the medical findings. The form of story may result in a bad impression upon the patients about their health and their illness which should be properly taken care of.
When patients give more information about their illness apart from their symptoms and are comfortable telling the whole picture about their life, this will definitely help in an accurate diagnosis. Furthermore, the revealing of the physical health along with mental health and personal lives will make the therapeutic intervention even more effective and pertinent to the patient. Let’s take an example of that. If a patient is going through some sort of financial difficulties and having trouble with it, the prescription of generic and cheaper medicine would mean a lot for the patients. Similarly, if the Storytelling from the patients is clearer to the medical professionals and caregivers, the sense of responsibility towards the patients also remarkably improves, which in turn motivates the professional to intervene effectively.
Patients are not the only one who has a meaningful impact through Narrative medicine. Narrative medicine changes the method in which health professional get their education and knowledge. The medical institutions impart the knowledge to be proactive listeners when the medical personnel have to deal with patients. This helps to get to know the patients better as they are from different backgrounds and cultures (Aull, 2005). Apart from the patient’s illness, Healthcare personnel will now be able to evaluate multidimensional traits of patients, including financial background, educational attainment, cultures, among others. Now, the medical personnel brief and explain to the patients in accordance to the patient’s understandability and in a way they feel comfortable. Even explaining the proper things and methods for care and how the disease happened to have a significant impact on the patient’s life. The patients now will be able to grasp what actually their medical condition is, how severe it is, why the medications are needed, what precautions and food habits to follow, how to be careful and care for oneself, among others. Health literacy is achieved well through this method which will significantly help the patient.
The importance of evidence-based methods like testing and screening is very vital as they help in providing quantitative data. Narrative medicine provides an additional layer of understanding in the areas of qualitative analysis from patients as well as doctors, which is not possible only from the evidence-based methods. Such revelation of the story will help to figure out the pertinent treatment for patients of a given condition, and the medical researchers or physicians can be engaged better in their research as they get to understand the patient’s better.
The interaction between the medical professionals and patients are not that easy as they generally come from different background and walks of life (Kelly-Irving et al., 2009). It is always challenging to interpret the stories from the patients, and the same goes the other way around. Everyone has been through such situations as a patient or as a medical practitioner. Listening skills and proper communication are the key areas where both the medical practitioners as well as patients need to take care of. Without these, medical professionals cannot interpret stories from the patients, and the patient cannot ask pertinent queries to the medical practitioners. It is in the interest of both the parties, i.e., patient and medical professional, to have a favorable environment where one can present as well as perceive in a well and effective manner.
To better understand the story from the patients for better understanding of the situation and symptoms, and to better recommend them, these steps can be really beneficial and effective. The first is planning the interaction in advance. A well-prepared and well-rehearsed medical practitioner can guide and help the patient in a better way as they can structure the answers to the queries and possible remedies very effectively. While doing so, the practitioner must be very careful with her or his words as they can be misinterpreted, or the patients may get offended. Breaking down the information and putting it simply can be a great solution, to begin with. Under-communication must be prevented. It is the right of the patients to know what she or he is going through except for certain situations where their close ones or relatives are eligible to know the facts. Accommodating the views and understandings from the patient’s partner or friend is also important as the patient may miss out on something regarding her or his conditions. It is also equally important when the recommendation provided by the medical professionals are delivered to the patients and his or her companion. The patient may not be in the position to hear or remember all the things that the medical professions say. Therefore, it is always in the best interest of the patient as well as the medical professional to have a patient’s relative or companion accompany him or her during the diagnosis and therapeutics. Health care workers must make sure that the patient is comfortable in telling about her or his medical complications as well as comfortable in listening to the recommendations and suggestions from the medical professionals.
Secondly, the medical practitioners must be fully aware of the possible non-verbal communication they might use when interacting with the patients. Eye contact, hand gestures, body postures are equally important as they have a meaningful impact on the patients. Similarly, Patients may not understand everything at once. They might need further support as well as information about their medical condition. A medical practitioner must make sure that the patient can communicate with him or her via phone or email, or in-person at an arranged time to get to know about the medical situation of the patient. Fourthly, the simpler the language, the better the understanding. Medical practitioners should explain everything in a simple and cogent manner. They should be open to hear further queries from patients and encourage patients to jot down the things that the professional has told.
Additionally, Medical practitioners must have a discussion with their colleagues and should not be hesitant to take other’s insights and additional training if it is required. One cannot comprehend and understand everything and may miss out on certain things. Even the proper communication, interpreting stories, and careful hearing can be learned from others. These techniques are really vital while interacting with the patients. Furthermore, strong trust is required to make patients more open to their complications. Medical practitioners should build the bridge and establish trust with them by having a positive interaction and providing them with a comfortable environment. The patients must be reassured that they are safe and open consultation is always for the benefit of the patients. Similarly, it is the duty of the medical professional to aid the patients to have emotional control, to find common ground if any disagreements arise during the interaction. As a professional, One must always be careful in this part along with taking necessary feedbacks and improvement suggestions at the very end.
To sum up, Narrative medicine is a must qualitative approach towards not only treating patients but making the interaction between the medical practitioners and patients robust and effective. This approach not only benefits in the way how the patients are treated well but will set a precedent for practitioners to handle the future medical complication in other patients too. With the implementation of series of techniques and methods, Health workers can interpret their patient’s stories well, and the patients also can take the exact and pertinent recommendations better. Everyone should be responsible on narrative writing practices in clinical settings because it may be a risk if it is done improperly or haphazardly (Charon, 2011).
References
Aull, F. (2005). Telling and Listening: Constraints and Opportunities. Narrative, 13(3), 281–293. https://doi.org/10.1353/nar.2005.0015
Charon, R. (2011). The Novelization of the Body, or, How Medicine and Stories Need One Another. Narrative, 19(1), 33–50. https://doi.org/10.1353/nar.2011.0004
Datta, M. (2021, April 5). A Patient’s and Doctor’s Perspective on Narrative Medicine. Research Blog. https://researchblog.duke.edu/2021/04/05/a-patients-and-doctors-perspective-on-narrative-medicine/?utm_source=rss&utm_medium=rss&utm_campaign=a-patients-and-doctors-perspective-on-narrative-medicine
Hurwitz, B. (2000). Narrative and the practice of medicine. The Lancet, 356(9247), 2086–2089. https://doi.org/10.1016/s0140-6736(00)03412-7
Kalitzkus, V. (2009). Narrative-Based Medicine: Potential, Pitfalls, and Practice. The Permanente Journal, 13(1). https://doi.org/10.7812/tpp/08-043
Kelly-Irving, M., Rolland, C., Afrite, A., Cases, C., Dourgnon, P., Lombrail, P., Pascal, J., & Lang, T. (2009). Patient-physician interaction in general practice and health inequalities in a multidisciplinary study: design, methods and feasibility in the French INTERMEDE study. BMC Health Services Research, 9(1). https://doi.org/10.1186/1472-6963-9-66
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