You and I are different from who we were yesterday, last year, three years ago. We have been impacted by the pandemic, loss, and stress. We are struggling to bring some semblance of normality back into our lives. War, climate change, racial discontent, political division, and economic upheaval have affected our psyche and health.
We long to tell our stories, first to ourselves and then to those whom we trust to listen and validate them, with the hope that by doing this, we will begin the journey to healing. But who will truly listen?
The application of narrative medicine to the patient encounter allows the physician and patient a channel for the patient’s story to come to the surface so it will be heard, acknowledged, absorbed, and interpreted with a sense of compassion and empathy. This is not a novel approach but rather the way medicine was practiced prior to the age of corporate health care.
Here is a glimpse into the world of narrative medicine from a patient’s perspective — a moment in time when the physician enters the world of his patient and when an important connection is formed between the two.
I enter the space of the exam room filled with fear and anxiety. My health story is complicated, with plenty of twists and turns. It seems my resolve is being tested yet again. I feel my heart pounding in my chest, my eyes darting about the room to find something calming to focus on. And so, I focus on the pastoral scene hanging on the wall and wish somehow I was there instead of here.
I hear a knock on the exam room door as my doctor enters the room. We are masked(following medical guidelines), so there is an air of detachment between us. You ask how I’m doing and that it’s good to see me again as you sit at your desk in front of the computer.
I wonder how I am to answer your question when many factors affect my answer truthfully. You move your chair and are now facing me as you ask the even bigger question, ” What is most concerning to you right now, and how may I be of help?”
As I give my response, you are not compelled to make a data entry on the computer, but rather, you look intently at me and carefully listen to my response — to my story. You ask if other troubling matters are occurring and affecting my life. You realize that I am more than a collection of data in an EMR; I am a unique individual whose life is composed of many experiences, all of which impact my health. I tell you that I am not certain that I possess the courage to face the potentially difficult times ahead. You tell me that I do. It is reassuring to hear your confidence in me.
As we converse about my health, you occasionally pull up on the computer relevant test results and other data that will be used to develop a plan of action and invite me to take a look. You ask me if I agree with this plan because you realize that we form a partnership regarding my health. I have a voice in my health care, and I am not simply a bystander. Your choice of words and your tone of voice calm my troubled mind. You have taken the necessary time to determine our best course of action moving forward. A bond of trust is built between us, and I feel that my health is in the best hands. I leave the exam room feeling somewhat better, knowing that I’ve had the opportunity to have my questions addressed and my story told. My mindset is one of confidence because I know I have you, my doctor, walking my health journey with me.
Dr. Rita Charon, the Executive Director of Columbia Narrative Medicine at Columbia University, pioneered the field of narrative medicine.
Narrative medicine’s guiding principles play an important part in establishing a strong relationship between physician and patient. However, its benefits extend beyond those directed to the patient… its application is also of benefit to the physician.
“Physicians who develop narrative competence are able to walk alongside their patients as they navigate their disease processes and support their colleagues and reflect upon their hardships as providers in a career fraught with loss.”
“With narrative competence, physicians can reach and join their patients in illness, recognize their journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care. By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care.”
The ability to voice our stories is a step toward potential resolution. This process helps relieve the burden that is within us and allows us to feel that we are not alone in the struggle. That, in itself, is very powerful and healing.
For those physicians who are unfamiliar with narrative medicine and who may feel that they do not have the time within their schedule to apply this concept to their patients, I say try it. See if you experience a closer connection with your patients; as a result, you might recall what initially led you into the field of medicine. Narrative medicine may also be used to rediscover your humanity and your sense of self which may have been weighed down and lost through burnout and stress. This may be the spark that re-ignites your love of medicine.
To those administrators of corporate health care systems, I ask that you allow the opportunity for your physicians to take the necessary time to interact with their patients instead of the “revolving door” approach. Time spent by the physician intently listening to the patient’s health story certainly has more validity than that same physician spending hours doing clerical tasks that could have been assigned elsewhere. At the same time, a strong connection is formed between physician and patient, leading to increased levels of satisfaction on both sides. Isn’t that what we all want?
The relationship between physician and patient is special, built on a foundation of trust and compassion. Narrative medicine serves as a pathway to enhance this experience even further.
May we all find the peace we search for.
Michele Luckenbaugh is a patient advocate.
Image credit: Shutterstock.com
