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How Narrative Medicine Heals And Why We Need More Of It

Discussion in 'Hospital' started by The Good Doctor, May 14, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

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    Over 20 years ago, physician and healer, Rita Charon, Columbia University, pioneered a renaissance of physician empathy and listening through what she termed “narrative medicine.”

    Charon writes, “The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others…By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care.”

    The techniques used in narrative medicine (reflective writing, literary and artistic analysis, etc.) are not only useful on the side of the health care professional but can also be highly effective on the side of the patient and patient caregiver.

    As the mother of a son with a congenital heart condition, I benefit from using narrative medicine techniques to heal, gather strength and attempt to understand my son’s pain as well as my own and that of our family. Through writing, sharing, and publishing poetry in various medical humanities journals, I am better able to express and articulate my thoughts and feelings.

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    In return, I have received an abundance of feedback from health professionals acknowledging my story. This connection has increased my confidence in the care being provided and improved my feelings of being heard, acknowledged, and understood. Exercising the principles and practice of narrative medicine has had the added benefit of providing me with more compassion and understanding of the difficult job of those individuals providing medical care for my son.

    Frustrated with the knowledge that Hypoplastic Left Heart Syndrome is a rare and complex condition with no cure, as well as the understanding that it is likely one day our son will need a transplant, I wrote the following poem, which was published in the University of Oklahoma College of Medicine Journal, “Blood and Thunder” (2016).

    The Pump

    The pump works,
    but it’s leaking in a few places.
    It’s not very efficient.
    It’s been worked on several times,
    but they can’t seem to fix it.

    Can’t you try some stronger couplings?
    Can’t you just use a backflow preventer?
    How about a compression fitting?
    No?
    Why not?
    Keep trying.
    Try harder.

    It keeps leaking.

    The experts tell us this isn’t an ordinary pump.
    They claim this pump has several strange inlets and outlets.
    They say this pump has been put in backwards.

    With this pump,
    you can’t just shut it off for a few hours to work on it.
    There can be no appointments scheduled in advance,
    there are only emergencies.

    With this pump you can’t go online and order new parts.
    This pump isn’t made of metal or plastic,
    it’s made of tissue.

    This pump doesn’t pump water,
    it pumps blood.

    With this pump,
    replacing it with new parts
    requires someone else’s pump to stop.

    Parents may read the poem and relate to my fear, while health care providers may upon close reading see the author attempting to rationalize mortality, while being torn by the reality of the actual condition of the heart and the fine line between the living and the deceased.

    While more studies need to be completed, a 2020 article in BMJ Open concludes, “(narrative medicine) programming leads to high participant satisfaction and positive outcomes across various competencies.” Competencies included: relationship-building, empathy, perspective-taking/reflection, resilience and burnout detection/mitigation, confidence/personal accomplishment, narrative competence, and ethical inquiry.

    Most medical schools around the country offer, and many require narrative medicine coursework. However, most is not enough. Through the merger of the humanities and medicine, 21-century health care may turn once again toward the whole human being and not just the disease. Requiring narrative medicine courses will not only help patients, I believe it will help remind all health care professionals why they choose to be a part of the noble profession to heal.

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