Sharing stories: Narrative medicine in an avidence-based world (original) (raw)

2004, Patient Education and Counseling

Our lives are made up of stories. Stories have a direction and draw the reader into the mystery of what will happen next. Some of our earliest memories are of stories told to us at the end of the day by parents and loved ones. The practice of medicine is lived in stories: "I was well until. .. ." "It all started when I was doing. .. ." are common openings of the medical encounter. But stories do more than facilitate conversation. Narrative probes the depths of medical experience [1], and allows for greater understanding of our patients [2], our work, and ourselves [3]. Stories, for the writer, and often for the reader, can be the work of meaning, and even creation [4-7]. This allows for great possibilities. "To do its work, writing creates and recreates the past in the present moment. It reaches into the shadows and pulls what cannot be seen or spoken onto the page where it is open to discussion and revision. .. . As writers write to represent, to understand, to integrate experience, they are free to try out alternatives, to see both experience and themselves as they are, as they were, as they might be [8]". In this way, writing and narrative can be seen as an act of being, paying attention and capturing details of the present moment. Writing narrative is, simultaneously, an act of observing, of becoming, of predicting, and of making choices about how one might act differently or rewrite the story, our part or that of others. Yet stories have an uncertain place in the world of medicine. There is an increasing push toward evidence-based thinking. The anecdote is disparaged as "soft" in contrast with "hard" clinical data. But as details of disease are pursued, there are details of a life that may be left behind [9]. The language of biomedical disease conflicts with the details of patient illness [10,11]. More recently there have been calls for moving beyond "taking" a history from the