One Story among Many: Narrative Episodes and the Construction of Doctors’ Identities (original) (raw)
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‘Forty bucks is forty bucks’: An Analysis of a Medical Doctor’s Professional Identity
The study of narrative has focused on the narrator, often overlooking the transactional and relational role of the interlocutor, particularly in doctor-patient interactions where interactants co-construct the case. However, the role of the doctor as a narrative facilitator has rarely been explored. Using a case study from a doctor-patient interaction, this fine-grained discourse analysis demonstrates how a doctor assists his patient to construct her narrative while also enacting salient aspects of his own identity. The doctor uses discursive strategies, such as alignment, repair moves, and mitigation, which act as vehicles through which the doctor constructs his professional identity, providing ‘space’ for the patient’s narrative, and assist in building trust and rapport.
‘What do we do, doctor?’ Transitions of identity and responsibility: a narrative analysis
Advances in Health Sciences Education
Transitioning from student to doctor is notoriously challenging. Newly qualified doctors feel required to make decisions before owning their new identity. It is essential to understand how responsibility relates to identity formation to improve transitions for doctors and patients. This multiphase ethnographic study explores realities of transition through anticipatory, lived and reflective stages. We utilised Labov’s narrative framework (Labov in J Narrat Life Hist 7(1–4):395–415, 1997) to conduct in-depth analysis of complex relationships between changes in responsibility and development of professional identity. Our objective was to understand how these concepts interact. Newly qualified doctors acclimatise to their role requirements through participatory experience, perceived as a series of challenges, told as stories of adventure or quest. Rules of interaction within clinical teams were complex, context dependent and rarely explicit. Students, newly qualified and supervising do...
Current Narratives, 2009
The successful development of a professional identity is paramount to becoming a successful doctor. This study investigates medical students' professional identity formation over time through the analysis of their narrative accounts of events recorded during their first two years of medical school using longitudinal audio diaries. The data was analysed for underlying narrative plotlines. Six dominant discourses from societal narratives about doctors and medicine were found within the students' narratives: The Privilege narrative, the Gratitude narrative, the Certainty of Medicine narrative, the Good Doctor narrative, the Healing Doctor narrative, and the Detached Doctor narrative. A further two narrative plotlines were identified as emerging narratives that contest master narratives and which are frequently found in the current culture within a modern medical school: the Informed Servant narrative and the Uncertainty of Medicine narrative. Following an overview of these narrative plotlines identified within medical students' audio diaries, a single event narrative is presented in full, in order to provide a deeper understanding of how these are played out as medical students try to make sense of the events they experience and of their own development as a doctor.
Background: The successful development and sustaining of professional identity is critical to being a successful doctor. This study explores the enduring impact of significant early role models on the professional identity formation of senior doctors. Methods: Personal Interview Narratives were derived from the stories told by twelve senior doctors as they recalled accounts of people and events from the past that shaped their notions of being a doctor. Narrative inquiry methodology was used to explore and analyse video recording and transcript data from interviews.
A Doctor’s story: counter narrative and tellability
I begin with a potentially provocative question: “Does anyone intentionally tell something that we could call a master narrative?” With this question, I want to draw your attention to the obvious disparity between the concepts of “master narrative” and “counter narrative”, and their relationship with tellability and prototypical narrativity. Molly Andrews (2004, 2) aptly points out that “counter-narratives exist in relation to master narratives, but they are not necessarily dichotomous entities.” Michael Bamberg (2004, 360) equally notices that “master narratives are setting up sequences of actions and events as routines and as such have a tendency to ‘normalize’ and ‘naturalize’…” In addition, Bamberg warns us against forgetting that “these master narratives also give guidance and direction to the everyday actions of subjects; without this guidance and sense of direction, we would be lost “ ( 360).
Narrative and the practice of medicine
The Lancet
For personal use only. Not to be reproduced without permission of The Lancet. 'Nature and the world do not tell stories, individuals do.' C K Reissman 1 Clinicians spend their lives in the midst of narrative: listening to story fragments, interpreting word sequences, observing gesture, deciphering symptoms, ascribing causes, and suggesting treatments. We are creatures, says the writer Italo Calvino, "possessed of an ocean of words", who offer ourselves to each other as links in stories that go on and on. 2 Clinical practice is predicated upon recognising and responding to such links-whether symptom, sign, expression, mood, behaviour pattern, or feeling. What is narrative? A narrative is a pattern of events placed in an order of sorts, involving a succession of occurrences or recounted experiences from which a chronological sequence may be inferred. Temporal succession alone cannot make a story, but what has been termed the principle of "and then" coupled with a notion of causality which gives meaning to phrases such as "that's why" and "therefore" underpins a narrative coherence to events recounted. 3 In stories, connections can be posited without logical demonstration and occurrences related in ways that may differ, even conflict. Events may unfold in unilinear or multilinear fashion or take place simultaneously, according to bizarre patterns or sequences. Through stories we are able imaginatively to enter into other worlds, shift viewpoints, change perspectives, and focus upon the experience of others. People generally seek medical advice as first-person narrators of snippets of life story, to which they invite responses and sometimes interpretation. Not selfconsciously framed as stories with a beginning, middle, or an end, these fragments typically display variable threads of story-like structure as simple chronological sequences, as a drama of gradually unfolding awareness, or as more or less complex meandering observations reported by patients, their relatives, or friends. In the reception, fashioning, and analysis of such materials, processes of selection, interpretation, and classification take place. Narrative appreciation can help clinicians integrate biography and anecdote, life story and case history, with impersonal aspects of medical and scientific knowledge. 4 Four clinical tales from my own practice illustrate these points:
Narrative reflective practice in medical education for residents: composing shifting identities
Advances in Medical Education and Practice, 2010
As researchers note, medical educators need to create situations to work with physicians in training to help them attend to the development of their professional identities. While there is a call for such changes to be included in medical education, educational approaches that facilitate attention to the development of medical students' professional identities, that is, who they are and who they are becoming as physicians, are still under development. One pedagogical strategy involves narrative reflective practice as a way to develop physician identity. Using this approach, medical residents first write narrative accounts of their experiences with patients in what are called "parallel charts". They then engage in a collaborative narrative inquiry within a sustained inquiry group of other residents and two researcher/facilitators (one physician, one narrative researcher). Preliminary studies of this approach are underway. Drawing on the experiences of one medical resident in one such inquiry group, we show how this pedagogical strategy enables attending to physician identity making.
International Review of Qualitative Research, 2014
This article reflects on a project in which the author guided several physicians as they wrote their first autoethnographic research articles, which were then presented at the International Congress of Qualitative Inquiry in 2011. Revisiting three of the physicians' stories, the article articulates the significance of having physicians-scientists by trainingengage autoethnography as an emotional, literary, poetic, and embodied practice. The author discusses the limitations of the ''bridge'' metaphor to capture the full impact of this project and other autoethnographic efforts and argues instead for the ''rhizome'' as more descriptive of the multiple, messy, boundary-crossing connections that are generated through autoethnographic writing and performance.
From Doctors' Stories to Doctors' Stories, and Back Again
The AMA Journal of Ethic
Stories have always been central to medicine, but during the twentieth century bioscience all but eclipsed narrative's presence in medical practice. In Doctors' Stories, published in 1991, Kathryn Montgomery excavated medicine's narrative foundations and functions to reveal new possibilities for how to conceive and characterize medicine. Physicians' engagement with stories has since flourished, especially through the narrative medicine movement, although in the twenty-first century this has been challenged by the health care industry's business-minded and data-driven clinical systems. But doctors' stories-and Montgomery's text-remain crucial, schooling clinicians in reflection, ethical awareness, and resilience. Physicians who write even short, 55-word reflective stories can hold to humanistic and ethical understandings of patient care and of themselves as healers even as they practice in systematized settings and employ evidence-based expertise.