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Narrative Medicine

We have all heard that evidence-based clinical practice includes three essential components: best available research evidence; clinical experience; and patient values. Most programs in EBCP, including this blog, focus on the interpretation and application of research evidence. Lip service is given to clinician experience and patient values. I believe the reason for this is not that these other two elements are viewed as less important but rather that a formal process of incorporating these elements is not universally recognized.

Recently I attended a 2-hour session presented by Dr. Virginia Barber and Dr. Michelle Barber (they are not related). This session focused on Narrative Medicine. (1) This term is attributed to Rita Charon who described the process in her book Narrative Medicine: Honoring the Stories of Illness. (2) Dr. Charon is the director of a master’s program in narrative medicine at Columbia University.

As clinicians we sometimes come off like Dragnet’s Sgt. Joe Friday with “Just the facts, Ma’am.” By learning to listen with intent and allow the patient’s story to come out we can provide more empathic, respectful and ultimately meaningful interaction. The practice involves something Dr. Charon refers to as “narrative competence.” In this situation the meaning of the narrative is judged in light of the narrative situation: Who is telling the story? Who is listening? How is the story being told? Why is it being told? The process requires involvement of both the teller and the listener. (3)

It’s obvious that narrative competence has implications in far more than medicine. In fact, it has applications in any endeavor that involves human relationships. (4) When I think about this process for myself, I realize that I need to listen to my patients differently. It’s important not only to know what my patient is experiencing, but what those experiences mean to them.

One of the things that Gordon Guyatt and the EBM workgroup at McMaster have done is to define and in a sense codify the process of incorporating research evidence into clinical decision making. In my view, narrative medicine does much the same for patient values.

1 – Barber, M. Barber, V. Whose Story Is It, Anyway? 13Aug 2016. (Presentation: Palmer College of Chiropractic, Davenport IA.)

2 – Charon Rita. Narrative Medicine: Honoring the Stories of Illness. New York: Oxford University Press; 2006.

3 – Charon R. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA. 2001;286(15):1897-1902. doi:10.1001/jama.286.15.1897.

4 – Hurwitz B, Bates V. The Roots and Ramifications of Narrative in Modern Medicine. In: Atkinson S, Macnaughton J, Richards J; Whitehead A, Woods A, editors. The Edinburgh Companion to the Critical Medical Humanities. Edinburgh (UK): Edinburgh University Press; 2016 Jun 30. Chapter 32.

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