Narrative Medicine
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Narrative medicine is the discipline of applying the skills used in analyzing literature to interviewing patients. The premise of narrative medicine is that how a patient speaks about his or her illness or complaint is analogous to how literature offers a
plot Plot or Plotting may refer to: Art, media and entertainment * Plot (narrative), the connected story elements of a piece of fiction Music * ''The Plot'' (album), a 1976 album by jazz trumpeter Enrico Rava * The Plot (band), a band formed in 2003 ...
(an interconnected series of events) with
characters Character or Characters may refer to: Arts, entertainment, and media Literature * ''Character'' (novel), a 1936 Dutch novel by Ferdinand Bordewijk * ''Characters'' (Theophrastus), a classical Greek set of character sketches attributed to Theoph ...
(the patient and others) and is filled with
metaphors A metaphor is a figure of speech that, for rhetorical effect, directly refers to one thing by mentioning another. It may provide, or obscure, clarity or identify hidden similarities between two different ideas. Metaphors are usually meant to cr ...
(picturesque, emotional, and symbolic ways of speaking), and that becoming conversant with the elements of literature facilitates understanding the stories that patients bring. Narrative Medicine is a diagnostic and comprehensive approach that utilizes patients'
narrative A narrative, story, or tale is any account of a series of related events or experiences, whether non-fictional (memoir, biography, news report, documentary, travel literature, travelogue, etc.) or fictional (fairy tale, fable, legend, thriller ...
s in clinical practice, research, and education to promote healing. Beyond attempts to reach accurate diagnoses, it aims to address the relational and psychological dimensions that occur in tandem with physical illness. Narrative medicine aims not only to validate the experience of the patient, it also encourages creativity and self-reflection in the physician.


History and development

In 1910, the Carnegie Foundation for the Advancement of Teaching created the ''
Flexner Report The ''Flexner Report'' is a book-length landmark report of medical education in the United States and Canada, written by Abraham Flexner and published in 1910 under the aegis of the Carnegie Foundation. Flexner not only described the state of m ...
'', which set out to redefine medical educational practices. The report argues that the goal of medicine is "an attempt to fight the battle against disease most advantageously to the patient." Flexner wrote that "the practitioner deals with facts of two categories. Chemistry, physics, biology enable him to apprehend one set; he needs a different apperceptive and appreciative apparatus to deal with other more subtle elements. Specific preparation is in this direction much more difficult; one must rely for the requisite insight and sympathy on a varied and enlarging cultural experience." In the late 20th century, narrative medicine came to emphasize an aspect of wider cultural elements in medicine. From the 1990s, physicians such as Rachel Naomi Remen and Rita Charon, who also holds a
doctorate A doctorate (from Latin ''doctor'', meaning "teacher") or doctoral degree is a postgraduate academic degree awarded by universities and some other educational institutions, derived from the ancient formalism '' licentia docendi'' ("licence to teach ...
in
English literature English literature is literature written in the English language from the English-speaking world. The English language has developed over more than 1,400 years. The earliest forms of English, a set of Anglo-Frisian languages, Anglo-Frisian d ...
, argued that medical practice should be structured around the narratives of patients. In 2000, Rita Charon first used the term 'Narrative Medicine' to describe a method of using what she calls "narrative competence," which is "the capacity to recognize, absorb, metabolize, interpret, and be moved by stories of illness."


Methodology

The teaching of narrative medicine involves close reading of texts, writing assignments of personal reflection about the text, and discussion of the personal reflections. With the development of 'narrative competence' comes greater understanding and empathy that facilitate the patient and clinician working together. Close reading
Close reading In literary criticism, close reading is the careful, sustained interpretation of a brief passage of a text. A close reading emphasizes the single and the particular over the general, via close attention to individual words, the syntax, the order ...
is a technique in teaching literature wherein the formal aspects of a text are studied. Students are directed to the read a text "for its information, ambiguity, complexity, texture, and mood as well as for its plot." These methods can be adapted to film, art, and music in the form of 'slow looking' and 'close listening.' Creative Writing Following a close reading of a text, students write about their personal encounter with the text, which "unleashes the curiosity and imagination of the writer." Discussion In turn, Narrative Medicine teachers apply "close reading" to the students' reflective writing.


Allied use of narrative

The term 'Narrative Medicine' refers to training in interpreting literature and applying that skill to understanding the accounts of patients. Associated fields also use 'Narrative-based Medicine', a main proponent of which is the English
General Practice General practice is personal, family, and community-orientated comprehensive primary care that includes diagnosis, continues over time and is anticipatory as well as responsive. Definitions A general practitioner (GP) is a doctor who is a consu ...
physician John Launer, who holds a degree in English literature. His approach comes from an orientation of
Family therapy Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychotherapy focused on families and couples in intimate relationships to nurture change and ...
, wherein patients are invited to expand on and explore new directions in the accounts of their illnesses.


Narrative in Medicine

A broader field is the use of narrative in general in helping doctors and patients deepen understanding of the ways of relating to illness and healing. In the 1990s and early 21st century, this approach is exemplified by the American physician Lewis Mehl-Madrona and the British physician
Trisha Greenhalgh Patricia Mary Greenhalgh (born 11 March 1959) is a British professor of primary health care at the University of Oxford, and retired general practitioner. Early life and education Trisha Greenhalgh was born on 11 March 1959. She attended Folk ...
.


Educational programs

A number of schools in the United States offer advanced classes in narrative medicine. *
Columbia University Columbia University in the City of New York, commonly referred to as Columbia University, is a Private university, private Ivy League research university in New York City. Established in 1754 as King's College on the grounds of Trinity Churc ...
has developed educational programs in the field of narrative medicine. ** Interprofessional Education: The Division of Narrative Medicine at
Columbia University Irving Medical Center Columbia University Irving Medical Center (CUIMC) is the academic medical center of Columbia University and the largest campus of NewYork-Presbyterian Hospital. The center's academic wing consists of Columbia's colleges and schools of Physician ...
collaborates with all clinical programs at the medical center, in addition to leading the Interprofessional Education programming. ** Rounds and Workshops: The division hosts events and trainings, including "monthly rounds and weekend intensive workshops" for the public. ** Master of Science: Columbia University created the "Master of Science in Narrative Medicine" program in 2009, making it the first graduate program devoted to narrative medicine. ** Textbook: In 2016, the first textbook in narrative medicine was published: "The Principles and Practice of Narrative Medicine." ** Certification Program: In 2017, an asynchronous online "Certification program in Narrative Medicine" began. *In 2016, the Lewis Katz School of Medicine launched a Narrative Medicine Program run by Mike Vitez, a Pulitzer Prize-winning journalist, and Naomi Rosenberg, an Emergency Medicine physician. The program's goal is to protect, support, and nourish the humanism that brings physicians into the profession, and to teach the skills of narrative that help at the bedside and beyond. The program has curricular and extracurricular components. Reflective writing forms a significant component of the Professional Identity Formation thread in the MD curriculum. Electives in medical humanities range from exploration of narrative medicine to photo storytelling to improvisational acting. Students also conceive and complete individual or group projects for elective credit under the guidance of the faculty. Extracurricular activities include a wide array of writing and narrative medicine workshops—some led by students—for students, residents, and hospital staff. "Narrative Medicine Talks" is a regular speaker series, and the program hosts fall and spring Story Slams for the Lewis Katz School of Medicine and Temple Hospital Community. On December 7, 2019, LKSOM hosted its inaugural Narrative Medicine Conference. *
Montefiore Medical Center Montefiore Einstein Medical Center is an academic medical center that is the primary teaching hospital of the Albert Einstein College of Medicine in the Bronx, New York City. Its main campus, the Henry and Lucy Moses Division, is in the Norwo ...
created a program in Narrative Medicine within its Department of Family and Social Medicine. Residents learn how to use personal narrative to enhance empathy, as well addressing stress, loss, and balance. * The
Ohio State University The Ohio State University (Ohio State or OSU) is a public university, public Land-grant university, land-grant research university in Columbus, Ohio, United States. A member of the University System of Ohio, it was founded in 1870. It is one ...
Humanities Institute supports the multidisciplinary initiative of narrative medicine. The program runs concurrently with their other undergraduate and graduate programs, where students "strive to develop narrative competence that enables them to deliver care that is not only more empathetic and compassionate, but also more effective." * The
University of California Irvine The University of California, Irvine (UCI or UC Irvine) is a Public university, public Land-grant university, land-grant research university in Irvine, California, United States. One of the ten campuses of the University of California system, U ...
College of Medicine has created an Integrative Medicine Program within the Department of Family Medicine. *In 2020, the University of Southern California Keck School of Medicine began a Master of Science program in Narrative Medicine. * In 2011, Western University created the Narrative Medicine Initiative (NMI) and has incorporated narrative medicine into its undergraduate, postgraduate, and continuing medical education departments. They work to answer questions such as "How does the art of storytelling improve health care education and the experience of patient care?" Western holds regular (at least annual) narrative medicine rounds during which local patients and physicians share their stories of disease and illness, with a focus on how the stories will improve physician's ability to handle future stories. * Lenoir-Rhyne University has established the Thomas Wolfe Center for Narrative, with the slogan "Heeding the call for narrative in a fragmented world." The program offers graduate-level and certification courses in several narrative training disciplines, one of which is narrative medicine. *
Saybrook University Saybrook University is a private university in Pasadena, California. It was founded in 1971 by Eleanor Camp Criswell and others. It offers postgraduate education with a focus on humanistic psychology. It features low residency, master's, and ...
takes a broad approach to narrative medicine through its mind-body medicine program, which follows the mind-body approach to health and wellness as a way to improve quality of life for patients. *
Misericordia University Misericordia University is a private Catholic university in the Dallas, Pennsylvania area, United States. It was founded by the Religious Sisters of Mercy in 1924 as College Misericordia; in 2007 it became a university and changed its name. ...
requires a course in narrative medicine for all students in its Medical and Health Humanities major. The growing field of narrative medicine extends beyond the United States: * The British Medical Journal began writing seminars to promote this type of narrative among emerging physicians. * At
University of Southern Denmark The University of Southern Denmark (, SDU) has campuses located in Southern Denmark and on Zealand. It offers a number of joint programmes in co-operation with the University of Flensburg and the University of Kiel. Contacts with regional indu ...
narrative medicine is a required course for all undergraduate medical students. *In Italy, the Healthcare Area of ISTUD (Institute of Management Studies) offers a Master in Applied Narrative Medicine that is designed for health care professionals


See also

*
Medical humanities Medical humanities is an interdisciplinary field of medicine which includes the humanities (philosophy of medicine, medical ethics and bioethics, history of medicine, literary studies and religion), social science (psychology, medical sociology, m ...
*
Graphic medicine Graphic medicine connotes the use of comics in medical education and patient care. Overview The phrase ''graphic medicine'' was coined by Dr. Ian Williams, founder of GraphicMedicine.org, to denote "the intersection between the medium of comics an ...
*
Narrative criticism Narrative criticism focuses on the stories a speaker or a writer tells to understand how they help us make meaning out of our daily human experiences. Narrative theory is a means by which we can comprehend how we impose order on our experiences an ...
*
Storytelling Storytelling is the social and cultural activity of sharing narrative, stories, sometimes with improvisation, theatre, theatrics or embellishment. Every culture has its own narratives, which are shared as a means of entertainment, education, cul ...
*
Narration Narration is the use of a written or spoken commentary to convey a story to an audience. Narration is conveyed by a narrator: a specific person, or unspecified literary voice, developed by the creator of the story to deliver information to the ...
* Slow medicine *
Health humanities Health humanities is an interdisciplinary field of study that draws on aspects of the arts and humanities in its approach to health care, health and well-being. It involves the application of the creative or fine arts (including visual arts, music, ...
*
Writing Therapy Writing therapy is a form of expressive therapy that uses the act of writing and processing the written word in clinical interventions for healing and personal growth. Writing therapy posits that writing one's feelings gradually eases feelings o ...
*
Reflective writing Reflective writing is an analytical practice in which the writer describes a real or imaginary scene, event, interaction, passing thought, or memory and adds a personal reflection on its meaning. Many reflective writers keep in mind questions suc ...


References


Further reading

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External links


Intima: A Journal of Narrative MedicineColumbia , Narrative MedicineNorthwest Narrative Medicine Collaborative
- community of narrative medicine, medical humanities, and health humanities practitioners in the U.S. Pacific Northwest
English language articles at Italian Narrative Medicine websiteWebsite of Dr. John Launer (Narrative-based Medicine)
{{DEFAULTSORT:Narrative Medicine
Medical humanities Medical humanities is an interdisciplinary field of medicine which includes the humanities (philosophy of medicine, medical ethics and bioethics, history of medicine, literary studies and religion), social science (psychology, medical sociology, m ...
Medical terminology Medical education