Narrative medicine is the discipline of applying the skills used in analyzing literature to interviewing patients. The premise of narrative medicine is that how a patient speaks about his or her illness or complaint is analogous to how literature offers a plot (an interconnected series of events) with characters (the patient and others) and is filled with metaphors (picturesque, emotional, and symbolic ways of speaking), and that becoming conversant with the elements of literature facilitates understanding the stories that patients bring. Narrative Medicine is a diagnostic and comprehensive approach that utilizes patients' narratives in clinical practice, research, and education to promote healing. Beyond attempts to reach accurate diagnoses, it aims to address the relational and psychological dimensions that occur in tandem with physical illness. Narrative medicine aims not only to validate the experience of the patient, it also encourages creativity and self-reflection in the physician.

History and development

In 1910, the Carnegie Foundation for the Advancement of Teaching created the Flexner Report, which set out to redefine medical educational practices. The report argues that the goal of medicine is "an attempt to fight the battle against disease most advantageously to the patient." Flexner wrote that "the practitioner deals with facts of two categories. Chemistry, physics, biology enable him to apprehend one set; he needs a different apperceptive and appreciative apparatus to deal with other more subtle elements. Specific preparation is in this direction much more difficult; one must rely for the requisite insight and sympathy on a varied and enlarging cultural experience." In the late 20th century, narrative medicine came to emphasize an aspect of wider cultural elements in medicine. From the 1990s, physicians such as Rachel Naomi Remen and Rita Charon, who also holds a doctorate in English literature, argued that medical practice should be structured around the narratives of patients. In 2000, Rita Charon first used the term 'Narrative Medicine' to describe a method of using what she calls "narrative competence," which is "the capacity to recognize, absorb, metabolize, interpret, and be moved by stories of illness."

Methodology

The teaching of narrative medicine involves close reading of texts, writing assignments of personal reflection about the text, and discussion of the personal reflections. With the development of 'narrative competence' comes greater understanding and empathy that facilitate the patient and clinician working together. Close reading Close reading is a technique in teaching literature wherein the formal aspects of a text are studied. Students are directed to the read a text "for its information, ambiguity, complexity, texture, and mood as well as for its plot." These methods can be adapted to film, art, and music in the form of 'slow looking' and 'close listening.' Creative Writing Following a close reading of a text, students write about their personal encounter with the text, which "unleashes the curiosity and imagination of the writer." Discussion In turn, Narrative Medicine teachers apply "close reading" to the students' reflective writing.

Allied use of narrative

The term 'Narrative Medicine' refers to training in interpreting literature and applying that skill to understanding the accounts of patients. Associated fields also use 'Narrative-based Medicine', a main proponent of which is the English General Practice physician John Launer, who holds a degree in English literature. His approach comes from an orientation of Family therapy, wherein patients are invited to expand on and explore new directions in the accounts of their illnesses.

Narrative in Medicine

A broader field is the use of narrative in general in helping doctors and patients deepen understanding of the ways of relating to illness and healing. In the 1990s and early 21st century, this approach is exemplified by the American physician Lewis Mehl-Madrona and the British physician Trisha Greenhalgh.

Educational programs

A number of schools in the United States offer advanced classes in narrative medicine. The growing field of narrative medicine extends beyond the United States: