By Teresa Liccardi, M.D.
I had cared for Mr. Elder (a factitious name) for more than three years. During that time he had suffered worsening poverty, and the ongoing disability of heart and lung disease.
Despite his issues he always had a joke for me, and asked about my family and myself. Gradually, understanding his predicament and nature I was able to coax him to try to improve his diet and use insulin. I was very sad when he passed despite the efforts of many professionals with whom I have never had the opportunity to express my thanks and feelings about our Mr. Elder.
Where two people as strangers have come together, one to treat and the other in trust to expose physically, mentally and spiritually, everything they are in an instant, how does one as a practitioner summate this moment – a prescription no doubt? Yet, is this the only memorialization of that moment: a medical record number, a prescription – or maybe not.
We all enjoy stories. One might say that life is told one story after another. Stories join events, emotions and time lines with a purpose – a theme. In medicine it is similar in that a patient tells a practitioner a story that leads to the understanding of what illness the patient is describing and from that the practitioner synthesizes a working plan: A theme that will lead to an investigation and eventual treatment. Listening to a patient eventually guiding the story to consolidate themes is an art.
I recently met Nancy Bryan, a writer and English instructor at Brookdale Community College, who is developing courses on just this aspect of medicine, narrative medicine. She enlightened me to rethink how I interact with my patients.
When I started researching the phrase “narrative medicine” I was surprised to find that it has become a “hot topic” in medical journals. Narrative medicine rekindles the patient-practitioner relationship as an art and reinstates the bonds that have in the past formed the basis of a physician’s practice.
Johanna Shapiro, Ph.D., assistant editor of the journal Family Medicine, wrote in an editorial on narrative medicine that medicine is in a sense a “storytelling enterprise.” Patients tell their stories to practitioners who listen, digest and re-interpret these stories so that patients may understand their illnesses and practitioners may attempt to heal illness and restore health.
Dr. Rita Charon, professor of medicine and literature of Columbia University, describes narrative competence as an art that allows practitioners to develop a framework of communication that describes patients’ illnesses, acknowledges patients’ suffering, creates bonds with other health-care professionals, recognizes and verbalizes their own personal journeys through medicine, and creates palatable stories that may stimulate changes in public perceptions, attitudes and behaviors toward healthful practices. By developing and implementing skills of listening, reflection and empathy, medical care is nourished rather than technological instruments unilaterally dictated.
Guidelines and recommendations may be better disseminated through personal stories than dictums of health.
In the Journal of the American Medicine Association, Zachary Meisel, M.D., and Jason Karlawish, M.D., medical doctors and economists, discuss how dry research data expounded to the public are shunned in favor of heart-gripping personal stories even if these stories refute hardcore facts.
Such is the case when Mayor Rudy Giuliani and Joe Torre – larger than life figures – recanted their personal stories in the struggle of prostate cancer thus overshadowing the United States Preventive Services Task Force (USPSTF) recommendation against prostate cancer screening in healthy men.
The authors cite several other recent examples where personal narratives compelled public opinion despite objective evidence to the contrary. They conclude that research organizations would send a more powerful message advocating their guidelines if individual personal stories were incorporated in discussions and recommendations rather than disseminating statistical data of large trials and analyses.
Health Affairs, a well-known publication that “intersects health, healthcare and policy” devotes a section, “Narrative Matters,” to personal stories that may influence or highlight health care and public policy issues. The stories are compelling; intersecting personal experiences of health and medicine with the public policy.
It may be that narrative medicine proves to be the vehicle that validates to our policymakers the imperative economic value of practitioners and primary care as the integral bridge between the chiasm of politics, medical science, and humanity.
For more information on narrative medicine visit:
Columbia University at:
www.narrativemedicine.org
Brookdale Community College at:
www.brookdalecc.edu/careerdevelopment
www.brookdalecc.edu/liflonglearning
Charlotte Friedman and Nellie Hermann, professors of the Program in Narrative Medicine at Columbia University’s College of Physicians and Surgeons, will be lecturing Friday, Nov. 8 at Brookdale Community College, Lincroft.
Dr. Teresa Liccardi, who is board certified in internal medicine and nephrology, maintains a clinic for hypertension and chronic kidney disease at the Parker Family Health Center in Red Bank.
