A hallmark of modern medicine involves providing compassionate care through an empathetic doctor-patient relationship. This post describes one powerful technique for developing empathy among medical providers: narrative medicine writing. What is empathy? A basic definition of empathy involves your ability to understand someone else’s perspective by putting yourself in their (metaphorical) shoes. Empathy can involve cognitive aspects (i.e., understanding why a person is feeling sad or happy) or emotional aspects (i.e., sharing the “feeling” of being sad or happy). Daniel Goleman and others have suggested that when we experience both cognitive and emotional empathy, we are moved to help others in distress, making “compassionate empathy” the ultimate goal for practitioners in helping fields like medicine. Even if you’ve never won the Olympics or grieved the death of a close loved one, you can probably imagine what it is like, to some extent. That ability to imagine how you would feel in someone else’s shoes is the seed of building an empathetic relationship. Why is empathy important? While most of us possess the ability to empathize and “show empathy” to varying degrees, people unable to empathize with others often stand out, receiving labels and “pathological” diagnoses. From a social perspective, empathy is constantly at work in our daily lives as we read the emotions of others. But empathy is more than just a way to understand others so we know how to react in social transactions. Putting yourself in someone else’s shoes allows you to understand their motivations, goals, and plans, which can make you a better problem-solver. In medicine, in addition to helping you build rapport with your patients, understanding your patients’ lived experience through empathy can make you a better diagnostician and increase patient satisfaction and treatment compliance. Narrative medicine So, how can you practice being more empathetic? Try storytelling. Dr. Rita Charon’s pioneering writing and research brought “narrative medicine” into focus as an official discipline aimed at improving medical practice through a holistic understanding of patients. Dr. Charon founded the first narrative medicine program in the U.S. at Columbia University in 2000, solidifying its status as a scientific discipline, and today, as many as 80 percent of U.S. medical schools have integrated narrative medicine into their curricula. Especially during the COVID-19 pandemic, its importance is increasingly recognized in health care. Courses that teach narrative medicine focus on close and critical reading of stories from literature. Students examine how pieces of the story fit together, exploring the characters, and seeking to understand the events or situations that contributed to different events or emotional states. Then, students compose personal reflections in the form of a written assignment. These exercises help students practice narrative competencies and develop insights into patients as individuals with a “whole story” rather than collections of symptoms. Narrative competence guides the questions a physician asks and facilitates building the mental structure of a patient’s “story,” taking into account the patient’s entire situation, including family, job-related concerns, and so forth. For example, the words a patient uses when speaking about their illness can offer insights into how they view themselves and their disease. In summary, narrative medicine, as a tool, is useful for training physicians the skills they need to deliver humanistic health care. Or, in Dr. Charon’s words, “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.” Why should I practice writing medical narratives? If the idea of writing stories about medicine seems unappealing, remember that there are many benefits to developing narrative competencies on your own. For starters, the use of narratives is immediately relevant to effective medical practice. Just as you must learn how to write a succinct, well-structured Subjective-Objective-Assessment-Plan (SOAP) note, constructing a patient narrative becomes automatic with practice. When you write about a patient encounter, you must organize and structure your thoughts, just as you do when preparing to present a case to an attending physician. Eventually, you’ll develop insights into the kinds of questions to ask during patient interviews. Reflection and narrative writing can help you develop reflexes to spot gaps in a patient’s history, for example, and you’ll start to see patterns in patient histories that can guide your differential diagnoses and inform your treatment plans. You should also practice writing medical narratives because they are relatively easy to write; most people find writing a narrative much easier than a research article. You can write about any patient, interaction, procedure, diagnosis—whatever captures your interest. Narrative pieces tend to be shorter than research publications, and online journals are relatively quick to publish them. In addition, if you’re applying to the U.S. residency Match, having a narrative publication on your CV can help you in many ways. Many residency program directors and faculty members reviewing applications will appreciate seeing evidence of narrative writing skills, especially if they’ve implemented narrative medicine training in their programs. Relatively few applicants have narrative publications, so your application will stand out. And if your narrative publication is about a topic that catches the eye of an interviewer, you’ll have a great topic to discuss during your interviews. Where can I submit my narrative writing? Many platforms solicit narrative writing submissions, including The Intima, the Northwest Narrative Medicine Collaborative, Ars Medica, and many more. Sites like Stanford, Temple, and Lookforzebras.com, to name a few, have also aggregated lists of journals or online periodicals that publish narrative writing. [Editor’s note: KevinMD also accepts submissions, with the opportunity to share your story on The Podcast by KevinMD.] If the prospect of narrative writing still seems intimidating, remember: you’ll get better with practice. You don’t need to be the next Oliver Sacks or Michael Crichton; your end goal doesn’t have to be publishing. With practice, you’ll develop a set of skills that will help your future patients. And that, after all, is something worth writing about. Source
