Narrative Medicine: How storytelling could improve patient care
by Elisha De-Alker
As I looked into the eyes of the woman sat opposite me I saw hope. I saw a determination to get better. I saw a daughter who had cared for thirteen siblings. I saw a wife who had cared deeply for her husband. I saw a sister who had held her brother’s hand as he passed away. I saw a mother who was proud of her children. And I saw the pain that being away from home and her beloved dog had left in her heart. Sitting and listening to this patient tell her story, and taking the time to listen from beginning to end, I learned not only about her but about myself. What did she feel about the standard of care during her hospital stay? What were her plans for the future? How could I best support her in that moment, despite only recently setting foot onto the wards as a medical student. This was what medicine was about at its root – caring. And I knew that moments like this would be harder to come by in a future cluttered with admin, time restrictions and heavy caseloads.
Stories are the lifeblood of medicine. The stories we tell about ourselves, our narratives, are how we identify ourselves in an ever changing and fast paced world. Each patient tells their story, and from what they tell us we piece together a haphazard jigsaw of their life; why they are placing their trust in our ability to help them, their vulnerabilities, their deepest cares and concerns. We fill in the gaps of their puzzle with test results, observations, and collateral history from anxious relatives. Without their story to frame the whole picture, we would be reaching blindly into the dark and coming out with ill-fitting solutions for complex problems.
One approach to medicine that embodies these ideas of using stories to bridge the gap between patient and professional is narrative medicine. The idea of person-centred care at its core, narrative medicine looks at holistically meeting patients’ needs through effective communication – a story is no good without someone to truly listen to it. Storytelling is not a one way street. The healthcare professional brings their own story to each patient encounter, and the portrayal of their understanding and the way they listen determine whether a patient feels heard, understood and empathised with.
Despite this concept sounding familiar, and the need for reflection recognised as important enough by the General Medical Council that it has published guidance on the topic (GMC, 2020), there are arguments against narrative medicine from both the perspective of the doctor and the patient. Consultations are too short. Patients prefer a quick, no nonsense approach. We prefer to keep our emotional distance from patients and keep our boundaries firmly in place.
No matter how much space we try to put between ourselves and our work, it will always affect us. Narrative medicine does not just aim to recognise illness as a human experience to improve patient care – it also aims to realign what we understand about ourselves as healthcare professionals, and how we relate to our colleagues (Charon, 2001). When we are able to openly reflect on our experiences, to consider how our own story might limit us in our ability to care for our patients, and to ask the question of ‘what could I do better next time’, we allow ourselves to fully engage with the patient in a way we never could by keeping ourselves closed off and at arm’s length.
This approach to patient care allows patients to feel understood. Empathy gives patients permission to feel their illness is valid. It allows them to enter the sick role and hold onto hope that they will be able to cope as their narrative (their identity) changes over their time in our care. A healthcare professional effectively practising narrative medicine encourages the patient to ask the questions they are scared to ask, and might otherwise hold back, if they feel someone is not listening or is dismissive of their concerns.
Stories help with efficient diagnosis and delivery of health care. Talking through experiences has a therapeutic effect for doctor and patient (hence the use of Balint groups, time set aside for doctors to speak about things weighing on their minds, often used in psychiatric settings). Even so, trying to find the time to truly listen to patients in a busy ward or clinic setting is an almost impossible feat. However, as with many approaches to healthcare, it is one more tool to add to box, and one that for some patients will make all the difference.
Elisha is a third year medical student at Hull York Medical School. She is passionate about improving access to medicine and medical education, lifestyle medicine and writing.
Handles: @amedicsjourney on Instagram
General Medical Council (GMC) (2020). The reflective practitioner – guidance for doctors and medical students. [Online]. Available at: https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/reflective-practice/the-reflective-practitioner—guidance-for-doctors-and-medical-students [Accessed 25/11/2020].
Charon, Rita (2001). Narrative Medicine: A Model For Empathy, Reflection, Profession and Trust. [Online]. Available at: https://jamanetwork.com/journals/jama/fullarticle/194300. [Accessed 21/11/2020].