Untold Stories: Storytelling in Modern Medicine

By: Josephine Kelly, BME ‘27

Imagine you are in the emergency room awaiting a doctor. When the doctor finally approaches you after several hours, they rattle off some questions (“How are you today?”), write down a few notes, and deliver orders to nurses. They then leave, and you are left alone once again for hours, unsure of what to do and your story untold.

Experiences like this are more than common in clinical settings and often end in patient dissatisfaction. Imagine another scenario: consider if the doctor had taken the time to listen to your concerns. Wouldn’t you feel much more satisfied with the personalized care? Narrative medicine is defined as the ability or potential to reflect on, connect with, and identify a patient’s suffering [1]. This can seem like common sense: Doctors should be forming personal and caring relationships with their patients. Despite the rapid advancements in technology and how narrative medicine is being integrated into them, narrative medicine’s place in medical education is cloudy. Medical students should be explicitly taught how to combine humanities comprehension with their biomedical backgrounds.

Narrative medicine is a format of medicine meant to tie together patient care and storytelling. This level of shared reflection can grant patients a means of catharsis in addition to granting medical students growth in imagination, empathy, and reasoning skills. The relationship between patient and doctor is one of the most important relationships during the healing process; that human connection allows for much more than it is granted for all parties. In one study, medical students were asked to try narrative medicine in its three stages: attention, representation, and affiliation. Attention involves being present in patient interactions; representation involves finding importance in those interactions; affiliation involves the emotional connection with patients and their friends or family [1]. Some of these details seem to be concepts that should already be present in everyday clinical practice. The study focused on the effect that narrative medicine had on the medical students, and the results were resoundingly positive. Students felt a much stronger sense of belonging and self-fulfillment; they felt more confident in their ability as doctors. They also enjoyed the fresh perspectives they experienced when talking to patients and gained a better concept of their professional values and morality [1]. The cultivation of a narrative competence can also benefit overall competence in medical areas since symptoms are viewed as a story rather than a path to diagnosis [2]. Furthermore, knowing a patient’s thought processes and daily decisions can be valuable to preventing a repeat of certain medical issues or explaining present ones in case problems arose due to the patient’s daily practices or choices [3]. If narrative medicine benefits both the healthcare providers and the patients, why should it not be used in practice?

A critique of narrative medicine mentions the folly of narration with its added flourishes or lacking details. Patients may not know exactly what to share or how to explain certain information. How can the doctor be sure they are receiving all the most relevant details on top of the narrative nuances? People often present themselves as they want to be seen when given the opportunity. What stops a patient from constructing a new narrative? Furthermore, patients may not want the pressure of presenting all the necessary details on their own with little prompting. It may feel as though they are given the job of concluding their own diagnosis, which is certainly not something a patient is prepared to do. Moreover, much of the evidence used to support the usage of narrative medicine is empirical and qualitative and, as such, highly prone to manipulation whether due to placebo or personal biases [4].

On the contrary, narrative medicine is not as “patient-led” as it may seem. It more heavily leans on the doctor’s ability to practice empathy in doctor-patient interactions and truly listen to what the patient has to say. Conversations should be guided by the doctor with questions that echo evidence-based medicine but are then followed up with deeper personal questions. The goal is not to have the patient diagnose themselves but rather have the doctor listen to their story, maybe comprehending some contextual problems along the way [3]. Upon the point of circumstantial evidence due to bias, medical students participating in narrative medicine studies may be providing skewed perceptions of how well the practice of integrating humanities is actually affecting their mental state [5]. However, these skewed perceptions of how they are gaining skills in practicing empathy and connecting with their patients are what will grant them the confidence to genuinely develop such skills. Narrative medicine is a newer practice that has yet to be deeply explored, but with its strong bonuses to the patient and doctor psyche collectively, it has the potential to benefit many.

Narrative medicine not only calls for doctors to ask “How are you today?” but also “What are your concerns?” Narrative medicine should be taught to medical students to prevent the stonewalling that many patients experience and give more interactive care involving the patient’s input. Narrative medicine has been proven beneficial in multiple case studies spanning very different medical focuses as well as in the mental states of both healthcare providers and patients. Patients’ untold stories deserve to be brought to light.

References

1. Liao, H. C. & Wang, Y. H. (2023). Narrative medicine and humanities for health professions education: an experimental study. Medical education online, 28(1), 2235749. https://doi.org/10.1080/10872981.2023.2235749

2. Chu, S. Y., Wen, C. C., & Lin, C. W. (2020). A qualitative study of clinical narrative competence of medical personnel. BMC medical education, 20(1), 415. https://doi.org/10.1186/s12909-020-02336-6

3. Murphy, J. W., Choi, J. M., & Cadeiras, M. (2016). The Role of Clinical Records in Narrative Medicine: A Discourse of Message. The Permanente journal, 20(2), 103–108. https://doi.org/10.7812/TPP/15-101

4. Ahlzén R. (2019). Narrativity and medicine: some critical reflections. Philosophy, ethics, and humanities in medicine : PEHM, 14(1), 9. https://doi.org/10.1186/s13010-019-0078-3

5. Untold Stories: Storytelling in Modern MedicineRemein, C. D., Childs, E., Pasco, J. C., Trinquart, L., Flynn, D. B., Wingerter, S. L., Bhasin, R. M., Demers, L. B., & Benjamin, E. J. (2020). Content and outcomes of narrative medicine programmes: a systematic review of the literature through 2019. BMJ open, 10(1), e031568. https://doi.org/10.1136/bmjopen-2019-031568