Keeping the human element in medicine is increasingly difficult in the era of big data and technology, but the growing field of narrative medicine seeks to maintain empathy between provider and patient.
Narrative medicine functions under the idea that understanding a patient’s story builds compassion in the physician, which in turn results in better care. It also includes providers sharing their own stories — offering a cathartic experience for those on the front lines of health care.
In 2000, Rita Charon, M.D., founded the first program in narrative medicine at Columbia University's College of Physicians and Surgeons in New York. It all started when she became a general internist with her own patients.
“It kind of became clear only then ... that what [patients] paid me to do was to listen to what they said — to be a sophisticated, skillful reader and listener,” Charon, the program’s executive director, says. “They didn’t really know what they were telling me — I had to interpret. I started to appreciate how complicated it was to understand what a patient tells me.”
Columbia’s program offers a master’s degree in narrative medicine geared toward everyone from clinicians to writers. The program has 20 faculty teaching in the graduate program, and 25 students graduated last year.
One of the core classes is Giving and Receiving Accounts of the Self, which explores the value of literary practice in medicine. The class includes a clinical component in which students act as witnesses to the patient-provider interaction.
The program even recently launched a certificate of professional achievement in narrative medicine for those interested in gaining a foundational understanding of the discipline. For this term, 28 students are enrolled in this online offering.
And during a time when burnout among many front-line health care staff is climbing, injecting a little empathy back into the experience appears to go a long way.
In a 2016 study published in Obstetrics & Gynecology, the journal of the American College of Obstetricians and Gynecologists, researchers introduced a narrative medicine curriculum at three different obstetrics and gynecology training programs with 66 participants. Results showed that those who attended the workshops experienced decreased emotional exhaustion, compared with an increase in exhaustion in low-attendance participants.
One hundred miles south of Columbia, Temple University’s Lewis Katz School of Medicine started its narrative medicine program a year ago by hiring a director of narrative medicine — Pulitzer Prize-winning journalist and author Michael Vitez.
He says the program is building as it moves along, and the school is designing a certificate in narrative medicine, with a master's program to follow in the future.
Today, narrative techniques have been embedded into Temple’s medical school curriculum, and all residency programs at Temple University Hospital in Philadelphia have expressed interest in continuous narrative medicine workshops, according to Vitez.
In February, the program hosted its first story slam. It brought together faculty physicians, fellows and medical students who shared five-minute stories with more than 100 Lewis Katz School of Medicine students about their experiences in medicine.
Tyler Rainer, then a fourth-year student, won for her story “Tattoo Graveyard,” in which she described the death of a 12-year old patient who came into the trauma surgery department with 12 gunshot wounds.
“Stories are an indispensable part of medicine, but too often [they're] overlooked in our culture for many obvious reasons — so much data and information [and] time pressure that people are getting away from stories,” Vitez says. “The goal is to help doctors and nurses and students to process the incredible things they see and feel ... and find meaning in what they do.”