Narrative and the practice of medicine

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The Permanente journal, 2007

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

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

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.

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

Journal of General Internal Medicine, 1998

American Journal of Psychiatry, 2009

Studying the history of rhetoric is as much about examining how people have used this art as it is about how scholars have constructed theories about it. Carol Berkenkotter's work, Patient Tales. Case Histories and the Uses of Narrative in Psychiatry, speaks to those dual dimensions of rhetorical inquiry, theory, and practice, in the context of medical discursive practices in the mid-eighteenth to twentieth century in the United States and Great Britain. Focusing on the history of a genre, the psychiatric case history, by means of rhetorical, narrative, and linguistic analysis, Berkenkotter also addresses issues of disciplinarity more generally. To those ends, the body of the study is divided into two parts with eight chapters among them. Part One and its five chapters cover the 'Asylum Age', the mid-eighteenth through the early nineteenth centuries. The three chapters in Part Two follow the aftermath of that age into the twentieth century, when biomedical perspectives called for more quantitative forms of patient assessment. By adding to a growing, interdisciplinary body of work on medical rhetoric, 1 Berkenkotter's study engages rhetoric on numerous levels: historically, methodologically, visually, and thematically. The Introduction (pp. 1-16) situates the inquiry. As Berkenkotter explains, her object of study is the psychiatric case history report, a genre that is now 250 years old. Its development, she suggests, unfolds within the historical give and take of two other, contrasting, or polarized, medical genres, the single case study of one individual, which appears in the mid-eighteenth century, and the experimental study involving many patients, which emerges in the twentieth. 2 Thus framed, Berkenkotter explains, her own study demonstrates how narratives structure genres and how genres structure disciplines in sometimes subtle but substantive ways; in particular, both the content and formal features of medical genres have influenced the discipline over the time period under consideration and in response to particular cultural concerns. Conversely, the medical discipline, its narratives, and its genres, have shaped the ways in which patients have been char