Emotions, narratives and empathy in clinical communication

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:

The Permanente journal, 2007

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.

International Journal of Humanities and Social Science, 2017

Analyzing a question about medicine (is evidence based medicine the best alternative in dealing with patients?), through an epistemological and hermeneutical approach the paper comes to an ethical answer. Patients are studied by clinicians as objects of a diagnostic investigation, while they are the subjects living their life and enduring illnesses. The paper argues that healthcare professionals (physicians, surgeons, nurses, etc.) should employ a more personalized approach in the way they provide care to patients. Scientific explanations of diseases should be integrated by human comprehension regarding what the disease entails for the patient's life. Rita Charon proposes the narrative method as an efficient and ethic way to provide care to patients, through human virtues such as understanding, empathy and attentive listening. The practice of such virtues encouraged by many pioneers of medicine since Hippocrates, will allow healthcare professionals to be touched and supported in their therapeutic tasks by their patients' desire for good.

Literature and …, 2011

Until about thirty years ago, narrative and narrative theory were the province of those disciplines that have traditionally formed the accepted core of the humanities: literary, cultural, religious, and, to a lesser extent, philosophical studies. researchers in these fields-whether hardcore narratologists or narrative ethicists-tend not to produce narratives, but to receive them. Their work involves commenting analytically on that reception, looking at the determinants, operations, and semantics of individual narratives or of narrative as a genus. narrative theory now populates new and rather different territories-those fields that support narrative production as well as consumption, including history and historiography, ethnography, law, therapy, and of course, medicine. 1 our interest lies specifically in the theoretical and practical uses of narrative in the medical field, and we began with a review of the relevant literature that generated some surprising results. We expected the influence of narrative in medicine, which had captured the interest of physicians and scholars, to be legible in medical and humanities publications. moreover, we had observed the ways in which popular culture reflected that interest in media, ranging from print publications such as The Atlantic Monthly and The New York Times to television series such as House, M.D. 2 We were nonetheless surprised by the sheer volume of articles, essays, and editorials we discovered when we conducted a search in medical and humanities journals using the keywords "narrative and medicine." our search returned no fewer than 7,000 related writings, raising the question of precisely how narrative was being employed by its various proponents, for the remarkable quantity of this research alone does not give one a sense of the range

2000

Medical reasoning involves more than just summarizing clinical data and guidelines. Illness trajectories of chronic patients are often long, complex and full of uncertain information that requires interpretation. Understanding the complex interrelations is an important aspect of medical reasoning that displays narrative rather than scientific characteristics. While the qualities of the medical record as a repository of information or as

Anglo Saxonica, 2017

The singularity of the clinical encounter is made not only of words but also of the eloquence of an equally revealing silence.

Social Change Review, 2017

way illness is affecting the quality of his everyday life. The final objective of effective medical care is to alleviate, if not to dismiss completely the illness and the suffering of the patients.

Person Centered Medicine, 2023

This chapter reviews the key principles of narrative medicine and its central importance for person centered medical care. The last two decades have seen the emergence of narrative medicine as a complement to biomedical approaches. Narratives are the vehicles through which patients understand and communicate their health problems, past history, and current concerns. Clinicians, in turn, offer narrative accounts of the nature of symptoms and illness that make sense of patients’ suffering, clarify its potential course and outcome, and provide a rationale for specific treatment interventions. Narrative medicine gives explicit attention to the ways that people convey their symptoms, predicaments and concerns and how the meaning of these experiences is interpreted and understood. Close reading or unpacking of the origins, meaning and significance of the narratives of patients and clinicians can inform person centered care. Narrative understanding can contribute to more accurate and complete characterization of patients’ needs, a stronger clinical alliance and more effective interventions.