Dr. Rita Charon asks ”What might medicine be for? When we, as mortals, live our lives in the glare of our deaths” at TEDxAtlanta.
Where did the story go?
By Lars Midbøe
The story has always been a central part of medicine and health care. Both Hippocrates and Florence Nightengale emphasized the importance of listening to the patient’s and loved ones’ stories of symptoms and suffering. And as recently as the fall of 2015, a new important report came from the Institute of Medicine in the USA, which again underlines the importance of listening to the stories: Improving Diagnosis in Healthcare.
Many patients and relatives feel that they are not listened to when seeking care. Many among the care staff also testify that it is difficult to get time and space to listen properly. There are certainly a number of reasons for this: slim organizations, lack of staff and financial mechanisms to name a few.
Rita Charon, a physician and literary critic, working at Columbia University in New York City, gives in her book ”Narrative Medicine – honoring the stories of illness” many examples of the story’s significance in the meeting between patient and caregiver. It is by openly and attentively listening and receiving what the patient tells that the doctor, nurse or any caregiver can create the affiliation required for good, effective care and treatment. But it is not about passive listening or just recording what the patient says. Charon is similar to the work of the caregiver at heart: the relaxed, open-listening phase (diastolic) must interact with the powerful expressive, where the medical competence, with all the scientific knowledge and physical touch (systolic); this is when the heart works and pumps efficiently. Both parts are equally necessary to meet both the disease / injury and the person behind the symptoms.
But it is not about passive listening or just recording what the patient says. The open listening phase must interact with the powerful expressive, where the medical competence, with all the scientific knowledge and physical touch.
Since the end of the 1990s, narrative medicine has developed into a clinical method to increase the ability of both doctors and other professions to understand and meet patients’ illness, suffering and vulnerability. By learning from, for example, literary and film studies, dramaturgy and philosophy, caregivers can develop the ability to discern the different, sometimes contradictory, voices, needs and desires that are often hidden in one and the same patient’s story. Close reading and conversations with colleagues and others about fictional texts can increase professional sensitivity and ability. Equally important is to practice and develop your own writing, both clinical and more personal.
Developing employees’ abilities and conditions for listening in healthcare should be as important and prioritized as introducing increasingly advanced technical devices and methods for diagnostics. Unless professional and compassionate listening is included as a natural part already early in the care’s meetings with patients and relatives, the care risks going awry. Increasing the narrative competence – and the space to use it in daily activities – should be an important way of meeting the problems facing healthcare.
For those who want to know more about narrative medicine, there is an excellent overview and summary of Katarina Bernhardsson in ”Culture and health: A broader perspective”. The website for the Program of Narrative Medicine, Columbia University includes lectures by Rita Charon, whose book is also available as an e-book.