When a patient needs to see a doctor, the visit might include an interchange of symptoms, that leads to a diagnosis and recommendation for treatment or testing. But more than 20 years ago, Dr Rita Charon says she recognized the importance of hearing the patient’s story, to effectively treat the whole person. Charon is Professor of Medicine and Professor of Medical Humanities and Ethics at Columbia University and founded the practice known as Narrative Medicine.
“Narrative Medicine is a way of practicing as a clinician who knows how to listen to what patients tell them. So, it’s particular training for doctors, nurses, social workers in skill to understand the words and the gestures and the silences of what patients convey to us about their illness,” explained Charon.
While there are obstacles, like time constraints people in the medical profession face when it comes to practicing Narrative Medicine there are medical facilities like UK HealthCare incorporating the approach.
In the Department of Integrative Medicine, Dr. Rob Slocum who is the Narrative Medicine program coordinator said he works with patients one-on-one and he also holds workshops. He explains how a workshop can be as beneficial as a one-on-one session.
“Well, Narrative Medicine makes use of patient’s or anyone’s story for purposes of healing, growth, encouragement. So, in this context, we have a shared prompt for writing as contrasted with a conversation that I might have with a patient in a room or via telehealth,” reported Slocum.
On this day Dr. Slocum demonstrates how he encourages someone to begin the process of telling their story in a workshop. Sitting around a table with pen and notebook in hand, two women agree to be part of Slocum’s demonstration. Due to the sensitive nature of the subject matter, the women are identified by first names only. Shelly, a massage therapist from Ohio, and Hayden an information specialist from Kentucky listen carefully as Dr. Slocum gives them an idea or a prompt and asks them to write two paragraphs.
“So, the prompt is simple, my best gift, yours. The best gift you’ve ever received or given or hope to receive or give, my best gift,” said Slocum.
After the women finish writing, twenty-five-year-old Hayden tells the group that her best gift is her boyfriend, Trent. Dr. Slocum asks more about why Trent is her best gift and her story goes deeper. Hayden tells an emotional account of how Trent was there for her when her best friend died.
“About a year and a half ago my best friend passed away tragically in a car accident, sorry. So he like was able to be there and it’s like almost happy tears. Tragic, sad tears cause she passed away but happy tears that he was there," said Hayden.
Dr. Slocum responded to Hayden, “That’s beautiful, how hard that situation would have been without his support but because he was there for you. It’s almost like knowing that he could be there in the worst of times."
Fifty-seven-year-old Shelly shares that her best gift is her sobriety in AA for more than 30 years.
“I’ve been given a way of living that brings connection and power into my life,” said Shelly.
She also tells the group she is dealing with a chronic health issue. Both women notice how quickly they open up with the simple prompts given by Dr. Slocum.
Shelly spoke for both women, “It took minutes and we were all sharing from deep within. It wasn’t like superficial.”
Shelly said she believes having a chance to expound on her own story with help from a clinician as skilled and present as Dr. Slocum could be beneficial to her healing.
“I think as much information as a patient can have about themselves helps put the puzzle pieces together. If I can’t see it all myself or if I’m looking at it from a distorted lens, having someone else objective hear it helps me figure out what’s accurate and what isn’t and keeps me closer to the facts of the situation versus what I’m imagining,” explained Shelly.
At UK HealthCare, Dr. Slocum said there is a team approach to Narrative Medicine. He said other healthcare providers refer patients to him and in his experience the approach is effective.
“I’m a Ph.D.not an M.D., so, I don’t give medical advice but I will say that working through the story of a patient can certainly help them to find their way by their story to a better sense of balance, a better sense of being able to manage stress, better able to identify strategies. I believe I see many of the patients I talk with improving. But it’s at their pace, it’s work. This is hard work. It’s not possible to do it in many cases all at once,” said Slocum.
The first publication of Narrative Medicine as a discipline was in the Journal of American Medicine in 2001 according to Dr. Rita Charon. She said Narrative Medicine is now being taught nationally and internationally. Charon talks about how she uses a Narrative Medicine routine when she meets a patient for the first time.
“Which is, ’I’ll be your doctor, I need to know a lot about you. Please tell me what you think I should know,'” said Charon.
That approach is appealing to University of Cincinnati graduate Rena Lenchitz. She started the master’s of science in narrative medicine in 2023 at Columbia University. Lenchitz says she wanted to have a framework and a different perspective on medical education before she applies for medical school.
“When we think about Narrative Medicine in the context of my own aspirations for a career as a physician or anyone else’s, it’s the idea of really welcoming somebody in. You know, offering a space where someone can share their story, can share a piece of their life, can share a piece of their health, their well-being which at times is very vulnerable or often threatened by perhaps illness or something else. There should be a space where we have these conversations that really put the patient at the forefront,”said Lenchitz.
As for Dr Rita Charon founder of the field, she says a lot of her work is spent in doing patient advocacy.
“And working with actual patients who are looking for some power to let the rest of us know what needs to be done. I think this is the future,” said Charon.
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