What Is Narrative Medicine?
I believe Dr. Rita Charon of Columbia University may have fostered a significant breakthrough in medical education.
Harboring a love of medicine and literature alike, and after writing about the potential benefits of connecting the two disciplines for many years, she has developed a very interesting and practical way of training students of medicine (at whatever age) to learn the meaning of compassion, concern, empathy, understanding, and the essence of human existence. She knew that literature teaches us these things and she also knew that anyone directly involved in patient care needed to have these qualities. Thus, the natural conclusion is to use the humanities - the arts – and particularly the study of literature and composition - to help us grasp the importance of understanding the stories that our patients are telling us and also helping us to know better how to communicate and interact with them and with our colleagues.
Of course, most medical students have had to go through the study of literature and fine arts as part of their undergraduate education, but usually this was just because they had to study this in order to get credits for the required courses they needed to graduate. However, the concept of integrating the use of literature and composition along with the scientific aspect of medical training is a novel and worthwhile endeavor that will surely enhance the quality of care ultimately received from those who have undergone this process.
Narrative medicine training also has the potential of keeping students focused more on what their education is really all about – caring for patients who need them to be calm, supportive and understanding listeners and communicators. Medical students have always been immersed in a sea of information that they somehow need to grasp and learn in a fairly short period of time. The facts and information consumed sometimes seem haphazard, unrelated and unimportant to becoming a medical professional. Knowing and truly understanding why and for what real purpose this “torture” is occurring would be extremely helpful for students to give them the right perspective as they learn what it really means to be entrusted with the life and well-being of another person.
Dr. Charon’s students in the unique Narrative Medicine Program at Columbia University are taught through the use of reading literature and also by writing down the more emotional and sometimes stressful aspects of patient care in “parallel charts” (not in the official medical record). They learn to better understand what patients are telling them, not just from what they say, but also from their gestures and body language. In addition, by reflecting and composing their thoughts and emotions after each patient interaction, they are discovering new things about themselves as well as their patients. In essence, they are clearly spending time and energy focusing on the patients and themselves as humans rather than as entities or automatons respectively.
In my estimation, just the idea that an entire program at a medical school is devoted to this activity is a magnanimous step forward in the creation of better health care professionals of all kinds –physicians, nurses, PA’s, NP’s, therapists, etc. - those who can empathize, understand and learn from others, and those who have enough knowledge of human relationships to be able to interact well with people of all walks of life.
Columbia University is the only medical school that currently has such a program, but I am hopeful it will be the first of many. Other schools have begun to apply these narrative medicine concepts into their training programs as well although not as formally as Columbia University. If this becomes widespread, it will certainly help provide a basis for training students of medicine and nursing to become truly professional, empathetic and knowledgeable about their relationships with their patients and other professionals and at the same time learn more about themselves.
Furthermore, I truly hope the widespread adoption of this type of training will influence those of us in the profession that did not have the advantage of going through a narrative medicine program. The development of post-graduate educational programs and conferences would be very helpful for all of us to learn and study the arts in a new light - using that study of medical humanities as a basis for a new enhanced, integrated and more complete approach to patient care.
This page was last updated on May 22, 2010.