Founder of narrative medicine, Rita Charon, M.D., Ph.D. discusses the art of listening with UF pre med undergraduates and Ms. Derica Brown.
Narrative medicine is a new approach to optimizing communication between physician and patient, between all health care providers and patients, and between providers in health care teams. Dr. Rita Charon, MD, Ph.D. of Columbia developed the concept of narrative medicine as she grew increasingly aware that the most important diagnostic and therapeutic tool that physicians have available to them is the patient case history. She became interested in the patient story as a narrative and, in the process of pursuing narrative theory, acquired a Ph.D. in English from Columbia. She then began to develop a curriculum that introduces medical students to narrative theory and the importance of patient narratives.
The importance of the case history has long been recognized. In fact, George T. Harrell, founding dean of the University of Florida College of Medicine and the Pennsylvania State University college of Medicine at Hershey, discussed the matter in his plans for educating medical students. "As early in his educational process as possible the future physician should be introduced to the idea of self-education by the experimental method, learning by doing. He should learn how to communicate with people since seventy percent of correct diagnoses in practice are made on the basis of the history of the illness alone. The interpretation of a patient's story and the explicit instruction of the patient in the details of his care, administration of medications and other instructions, can be effective only if the physician can make him/herself understood so that the patient later does exactly the one thing desired. Many patients are often confused about the exact intent of the physician's instructions." Though physicians have recognized the importance of narrative, recent developments in medical practice have tended to make connectionwith patient more difficult.
Since the late 19th century, the basic trend medical education and practice has been a shift from developing empathetic practitioners to fostering unemotional scientists. While patients may recieve the best clinical care, they may not have a healing relationship with a physician. Eventually, lack of empathetic communication can even decrease the efficacy of clinical care.
Because narrative medicine offers a means to analyze and describe how patients approach disease (that may differ from the way in which physicians understand sickness), and shows how to focus on interaction, it offers a means to counteract much of this trend. By training physicians to understand narrative structure and to see case histories as narratives, narrative medicine increases the physician's ability to communicate with patients and to maximize the information acquired in an interview. Narrative medicine also encourages physicians to read literature and increase their understanding of the human condition, emphasizing the use of reflective writing as a means to develop empathy, aid memory and to help physicians solve ethical dilemmas. Writing and reading thus encourages the development of reflective practitioners, physicians who develop effective and empathetic patient-physician relationships.
"First the Patient must be given the opportunity to tell his own story. A doctor obtains a good history by being first and foremost a good listener and, second, a good interrogator."
From a set of instructions for training medical students, UF-COM, 1950s
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