By Donna Bulseco
In medicine, stories convey meaning, and as patients, we benefit when doctors, nurses, healers, EMTs, therapists and caregivers listen carefully to the stories we tell. That is one of the tenets of narrative medicine, a multidisciplinary program developed in the early 2000s by internist and literary scholar Rita Charon and a group of clinicians and humanities professors at Columbia University.
Focusing on works of literature, such as Gustave Flaubert’s novella “A Simple Heart,” Virginia Woolf’s modernist novel To the Lighthouse, or “One Minus One,” a short story by Colm Tóibín about the death of the narrator’s mother, narrative medicine teaches clinicians and medical students how to interpret and respond to concepts such as point of view, voice, metaphor and plot through the close reading of a text. Being deeply engaged with stories is a different skill than skimming lab results or doing a physical exam but, as it turns out, narrative skill proves to be just as valuable and equally important for patient care during the clinical encounter—an idea that seemed radical over 25 years ago.
It’s not just the patient that benefits; the practitioner gains self-awareness as well. “The opportunities afforded by close reading bring the reader to look attentively at his or her own ways of making meaning,” says Charon in The Principles and Practices of Narrative Medicine. “Narrative medicine is committed to developing deep and accurate attention to the accounts of self that are told and heard in the contexts of health care.”
The focus on story allows doctors and others to develop a collaborative and deeply empathic approach to healing, says Ssanyu Birigwa, a narrative medicine clinician, Indigenous bone healer and adjunct professor for the Master of Science Narrative Medicine program at Columbia University. “Narrative practice and active listening allow us to be curious about narratives of the body that are layered in so many ways,” says Birigwa.
Narrative medicine has also contributed to medical humanities, a writing genre that’s long been in play in the literary world in work by physician/writers such as William Carlos Williams and Anton Chekhov to more recently, Abraham Verghese, Rana Awdish, Suzanne Koven, Paul Kalanithi and Atul Gawande. Clinicians and patients create their own stories born out of reflection and compassionate caregiving.
Two new books out this spring underscore the restorative nature of writing. Where It Hurts: Dispatches From the Emotional Frontlines of Medicine (which I edited) is an anthology of short stories, essays and poems by clinicians that grew out of that impulse to share these stories, calling forth the deep emotions all of us feel. A Prescription for Burnout: Restorative Writing for Healthcare Professionals by Carolyn Roy-Bornstein, M.D., provides the groundwork for those wanting to use writing “to foster mindfulness and gratitude and learn how to build space for these simple but powerful tools” into their daily lives.
How to Share Your Story With Your Doctor
As patients, we often feel rushed during medical appointments, but sharing a story can focus the dialogue between you and your doctor so s/he has a moment to take in your side of the story and start assessing your condition.
Beforehand, consider what’s relevant to share about why you are there. Use specific details, but prioritize the ones that concern you the most. “You don’t have to share everything—begin with what feels most true or most pressing in your body,” suggests Ssanyu Birigwa. “A simple question like ‘Can I share a bit more about what this has been like for me?’ helps you sense whether the clinician has the space to listen and receive.”
It also helps to talk it out ahead of time with a family member or friend, or write to a prompt like “Describe a moment when you felt your body let you down” or “I got worried about my health when…[describe what happened.]” “Putting your concerns in writing or role-playing them with another person helps you to focus on what you want to say.”