Narrative Medicine – the methodology of doctor-patient communication analysis (original) (raw)
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Narrative based medicine: why study narrative
BMJ (Clinical research ed.), 1999
One day when Pooh Bear had nothing else to do, he thought he would do something, so he went round to Piglet's house to see what Piglet was doing. It was snowing as he stumped over the white forest track, and he expected to find Piglet warming his toes in front of the fire, but to his surprise he saw that the door was open, and the more he looked inside the more Piglet wasn't there. 1
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:
Person Centered Medicine, 2023
This chapter reviews the key principles of narrative medicine and its central importance for person centered medical care. The last two decades have seen the emergence of narrative medicine as a complement to biomedical approaches. Narratives are the vehicles through which patients understand and communicate their health problems, past history, and current concerns. Clinicians, in turn, offer narrative accounts of the nature of symptoms and illness that make sense of patients’ suffering, clarify its potential course and outcome, and provide a rationale for specific treatment interventions. Narrative medicine gives explicit attention to the ways that people convey their symptoms, predicaments and concerns and how the meaning of these experiences is interpreted and understood. Close reading or unpacking of the origins, meaning and significance of the narratives of patients and clinicians can inform person centered care. Narrative understanding can contribute to more accurate and complete characterization of patients’ needs, a stronger clinical alliance and more effective interventions.
The Use of Narratives in Medical Work: A Field Study of Physician-Patient Consultations
2000
Medical reasoning involves more than just summarizing clinical data and guidelines. Illness trajectories of chronic patients are often long, complex and full of uncertain information that requires interpretation. Understanding the complex interrelations is an important aspect of medical reasoning that displays narrative rather than scientific characteristics. While the qualities of the medical record as a repository of information or as
BMJ open, 2016
Since its birth about 30 years ago, Narrative Medicine approach has increased in popularity in the medical context as well as in other disciplines. This paper aims to review Narrative Medicine research studies on patients' and their caregivers' illness experience. MEDLINE, Psycinfo, EBSCO Psychological and Behavioural Science, The Cochrane Library and CINAHL databases were searched to identify all the research studies which focused on the Narrative Medicine approach reported in the title, in the abstract and in the keywords the words 'Narrative Medicine' or 'Narrative-based Medicine'. number of participants, type of disease, race and age of participants, type of study, dependent variables, intervention methods, assessment. Of the 325 titles screened, we identified 10 research articles fitting the inclusion criteria. Our systematic review showed that research on Narrative Medicine has no common specific methodology: narrative in Medicine is used as an interven...
Listen to me: why narrative medicine matters in healthcare
Advances in Social Sciences Research Journal, 2019
In contemporary societies, the relationship between patients and health professionals is undergoing substantial changes, together with the growing recognition of the former as active participants in deliberation and decision making on the management of their condition. Accordingly, adequate knowledge of disease/illness is necessary to set up a dialogue between patients/citizens and experts/professionals. In the health field, narratives constitute the axial point between distinct but complementary realities, emphasizing that the physiological meaning of disease falls short of individual and social translation. These renewed alignments of experiential and biomedical knowledge determine not only physicians' involvement, but they also require reconsidering the training of health and humanities students and their role in the care of patients. Moreover, hospital managers, journalists, civil organizations, government and patients' associations are elicited to participate in the outline of new borders and new landscapes in healthcare. The intra-subjective and inter-subjective dimensions of Medicine include not only the patient-doctor encounter, but also all the other members of the therapeutic relationship-relatives, other health professionals, community-, including teams and organizations. Listening to all these participants in healthcare is mandatory in order to face the ethical, scientific and technological challenges of a fast changing world. Narrative Medicine provides the tools and the skills to promote listening, interpretation, representation and affiliation, standing out as the interdisciplinary field of knowledge that can build the bridge to the future of a more humane healthcare.
Ethical Considerations Related to Narrative Medicine
Patient Centered Medicine, 2017
Narrative medicine is of great significance in the area of health care, which underpins the ability of acknowledgment, absorption, and interpretation according to which plights and stories of patients are extensively considered for the commencement of actions. It reflects the manifestation of a model that entails effective medical practice with the aim to achieve best possible outcome. Adopting different approaches to narrative medicine (such as the method of close literature reading and reflective writing) facilitates with the opportunity to examine and explore central medical situations. Narrative medicine is responsible for the development of effective communication between patient and healthcare professionals, alongside inaugurating substantial discourse with the community regarding health care. With the advancement in clinical conditions, the scope of narrative medicine has become a growing need, and thus, several developed countries have already included narrative medicine as an integral part of health care. However, the major ethical problem associated with patient narratives is the use of data with intention other than treatment which may result in maleficence. Therefore, the practice of narrative medicine requires balancing all the aspects of health care against any possible harm.