Narrative Medicine

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The Lancet

For personal use only. Not to be reproduced without permission of The Lancet. 'Nature and the world do not tell stories, individuals do.' C K Reissman 1 Clinicians spend their lives in the midst of narrative: listening to story fragments, interpreting word sequences, observing gesture, deciphering symptoms, ascribing causes, and suggesting treatments. We are creatures, says the writer Italo Calvino, "possessed of an ocean of words", who offer ourselves to each other as links in stories that go on and on. 2 Clinical practice is predicated upon recognising and responding to such links-whether symptom, sign, expression, mood, behaviour pattern, or feeling. What is narrative? A narrative is a pattern of events placed in an order of sorts, involving a succession of occurrences or recounted experiences from which a chronological sequence may be inferred. Temporal succession alone cannot make a story, but what has been termed the principle of "and then" coupled with a notion of causality which gives meaning to phrases such as "that's why" and "therefore" underpins a narrative coherence to events recounted. 3 In stories, connections can be posited without logical demonstration and occurrences related in ways that may differ, even conflict. Events may unfold in unilinear or multilinear fashion or take place simultaneously, according to bizarre patterns or sequences. Through stories we are able imaginatively to enter into other worlds, shift viewpoints, change perspectives, and focus upon the experience of others. People generally seek medical advice as first-person narrators of snippets of life story, to which they invite responses and sometimes interpretation. Not selfconsciously framed as stories with a beginning, middle, or an end, these fragments typically display variable threads of story-like structure as simple chronological sequences, as a drama of gradually unfolding awareness, or as more or less complex meandering observations reported by patients, their relatives, or friends. In the reception, fashioning, and analysis of such materials, processes of selection, interpretation, and classification take place. Narrative appreciation can help clinicians integrate biography and anecdote, life story and case history, with impersonal aspects of medical and scientific knowledge. 4 Four clinical tales from my own practice illustrate these points:

Advances in Social Sciences Research Journal, 2019

In contemporary societies, the relationship between patients and health professionals is undergoing substantial changes, together with the growing recognition of the former as active participants in deliberation and decision making on the management of their condition. Accordingly, adequate knowledge of disease/illness is necessary to set up a dialogue between patients/citizens and experts/professionals. In the health field, narratives constitute the axial point between distinct but complementary realities, emphasizing that the physiological meaning of disease falls short of individual and social translation. These renewed alignments of experiential and biomedical knowledge determine not only physicians' involvement, but they also require reconsidering the training of health and humanities students and their role in the care of patients. Moreover, hospital managers, journalists, civil organizations, government and patients' associations are elicited to participate in the outline of new borders and new landscapes in healthcare. The intra-subjective and inter-subjective dimensions of Medicine include not only the patient-doctor encounter, but also all the other members of the therapeutic relationship-relatives, other health professionals, community-, including teams and organizations. Listening to all these participants in healthcare is mandatory in order to face the ethical, scientific and technological challenges of a fast changing world. Narrative Medicine provides the tools and the skills to promote listening, interpretation, representation and affiliation, standing out as the interdisciplinary field of knowledge that can build the bridge to the future of a more humane healthcare.

Journal of Applied Communication Research, 2009

If sickness calls forth stories, then healing calls forth a benevolent willingness to be subject to them, subjects of them, and subjected to their transformative power. (Charon, 2006, p. 216) The field of communication boasts a rich history of narrative theory and practice

The Permanente journal, 2007

The Permanente journal, 2017

The art of medicine has roots that lie deep in developing the biopsychosocial connection. Understanding a human body (both its physiology and pathology) along with components of emotional and spiritual cores can lead to provision of excellent medical care and better outcomes. The harmonization of psychosocial consequences of a biological disease is helpful not just for health care professionals but also for patients. Where it keeps the empathy and compassion alive and results in greater patient satisfaction, it also helps boost the physician's morale.Our objective is to reflect on the impact of narrative medicine on physician-patient dynamics for health care professionals in a clinical setting. This article was written after synthesizing the findings of evidence-based literature, retrieved from different sources, along with our own reflections on our encounters with patients.One could infer from the evidence-based research that the practice of narrative medicine improves one&#39...

Patient Education and Counseling, 2004

Our lives are made up of stories. Stories have a direction and draw the reader into the mystery of what will happen next. Some of our earliest memories are of stories told to us at the end of the day by parents and loved ones. The practice of medicine is lived in stories: "I was well until. .. ." "It all started when I was doing. .. ." are common openings of the medical encounter. But stories do more than facilitate conversation. Narrative probes the depths of medical experience [1], and allows for greater understanding of our patients [2], our work, and ourselves [3]. Stories, for the writer, and often for the reader, can be the work of meaning, and even creation [4-7]. This allows for great possibilities. "To do its work, writing creates and recreates the past in the present moment. It reaches into the shadows and pulls what cannot be seen or spoken onto the page where it is open to discussion and revision. .. . As writers write to represent, to understand, to integrate experience, they are free to try out alternatives, to see both experience and themselves as they are, as they were, as they might be [8]". In this way, writing and narrative can be seen as an act of being, paying attention and capturing details of the present moment. Writing narrative is, simultaneously, an act of observing, of becoming, of predicting, and of making choices about how one might act differently or rewrite the story, our part or that of others. Yet stories have an uncertain place in the world of medicine. There is an increasing push toward evidence-based thinking. The anecdote is disparaged as "soft" in contrast with "hard" clinical data. But as details of disease are pursued, there are details of a life that may be left behind [9]. The language of biomedical disease conflicts with the details of patient illness [10,11]. More recently there have been calls for moving beyond "taking" a history from the

Sociology of health & illness, 1997

The article gives a review of the last ten years' of research on illness narratives, and organises this research around certain central themes. Four aspects of illness narratives are discussed: 1. a proposed typology giving three different kinds of illness narratives -illness as narrative, narrative about illness, and narrative as illness; 2. considerations of what can be accomplished with the help of illness narratives; 3. problems connected with how illness narratives are organised; and 4. the social context of telling and its influence on the narrative. It is argued that as social scientists we can use illness narratives as a means of studying not only the world of biomedical reality, but also the illness experience and its social and cultural underpinnings.

Every patient has a story to tell, and every experienced physician has a bank of stories to recall. A patient's visit is not chance but a search for a cure, amelioration of state, advice, guidance, a prescription, or for seeking reassurance, comfort, and in some circumstances, permission to "be well". From the simplest tale to the most complex, narratives abound. Sometimes, the most intimate information shared with the physician confidante, go dark and deep, with a yearning to "tell all" after a period of suppression. Successful communication and rapport also depends on the carer's response, the degree of concentration, listening skills, body language, eye contact engagement, the patient relationship and empathy.