In the United States, healthcare is a business. While there are many amazing healthcare workers who serve our communities, medical insurance companies play a prodigious role in how medicine is practiced. Because of this, we have seen trends in healthcare away from the traditional family doctor, toward industrialized hospital systems. In turn, this has led to the depersonalization of much of our medical care.
Narrative medicine has largely rejected this impersonal form of medical practice, in favor of embracing a patient’s narrative and relationship with their physician. Within this paradigm, physicians are not only trained in science, but also trained in the arts and humanities. In this way, physicians learn the importance of the human experience in illness and develop the interpersonal skills needed to provide compassionate, empathic care (Columbia University, 2020; Lewis, 2010).
Narrative medicine was first established in medical education at Columbia University. Physician and recipient of a doctorate in english literature, Rita Charon established the Department of Medical Humanities and Ethics at Columbia (Columbia University, 2018; Harvard University, 2021). Charon has devoted herself to defining and studying narrative medicine and has helped to establish similar programs in medical institutions across the country.
In her book, “The Principles of Narrative Medicine,” Charon outlines the divides between doctor and patient that hinder the healing process. In the development of narrative competence, physicians are taught to recognize these divides as a means of better understanding the full weight of the patient’s experience (Zaharias, 2018). By taking time to listen attentively to their patients and making a concerted effort to understand the context of the patient’s life, a physician can better identify and treat illness in a holistic and empathic manner (Charon, 2001).
While studying the improved efficacy of narrative-based medicine is difficult, it is not impossible. In large scale studies of narrative medical education it was found that this type of training reduces physician burnout, increases cultural competency, enhances empathy and communication, and promotes team-building (Remein et al., 2019). On the patient side, narrative medicine has been found to enhance well-being and reduce pain (Fioretti et al., 2016).
As medicine continues to evolve, we will continue to see a shift toward narrative competencies. Humans are not simply a collection of symptoms, but rather, living stories that must be appreciated in order to provide the best care!
