Narrative Medicine

Dr. Jerome Groopman is a physician who writes periodically for The New Yorker magazine, and about whom we blogged several years ago. He has just written another gem for The New Yorker, this time about the importance of narrative medicine. It is titled Why Storytelling Is Part of Being a Good Doctor, with the subtitle indicating that physicians’ education puts science front and center, but narrative can be a surprisingly powerful medicine.

Narrative medicine is a topic that has slowly but steadily gained traction in health education and health care during the past decade. It’s mostly about the concept of striking a balance between the patient’s history, the subjective comments during the patient encounter, qualitative testing and observations, and balancing that with data per se. You can gain a sense of Dr. Groopman’s thinking within the context of the art of medical decision making through his participation on this panel.

There is a beautiful quote in Dr. Groopman’s lastet New Yorker article in which he cites the pediatric neurosurgeon Dr. Jay Wellons:

“The extraordinary plasticity of the juvenile brain, its ability to recover and adapt, offers hope. He rejoices in seeing young patients grow into adults and reflects that his field offers ‘the opportunity to fundamentally improve, or even bring back, a child who is pure potential, for whom nothing is truly determined and all possibilities exist.’”

Further on, Groopman writes: “Illness and its treatments, Chekhov is telling us, do not exist independently from socioeconomic and cultural factors. In a freshman seminar on the literature of medicine which I teach at Harvard, we address the social determinants of medicine.”

One cannot mention narrative medicine without mentioning Oliver Sacks, which Groopman does toward the end of his essay: “Part of being an adept physician, one senses from reading Sacks, is being an adept storyteller. This insight has developed into a discipline within medical education, ‘narrative medicine,’ which Wellons brought to the pediatric-neurosurgery department at Vanderbilt.”

The road of narrative medicine often leads from writing narrative notes in patient records, to writing articles for journals, and then chapters in textbooks or perhaps even entire textbooks. But writing essays for the general public, or blogging, or writing book oriented toward the public, while an extension of the narrative requires a different skill set. When first trying his hand at writing for public consumption, Groopman showed his draft to his wife. She told him in no uncertain terms that it was awful.

“I reread my words and concluded that she was right”, Groopman admits. “What’s more, I realized that many of the problems with my draft reflected the conditioning that occurs during medical training. I had used technical jargon, as if communicating with colleagues, rather than addressing a general reader. And I had removed myself from the stories, a result of the psychological distancing needed to remain steady while helping a patient coping with a life-threatening disease. Finally, I’d focussed on the clinical details of the cases, instead of exploring patients’ emotional and spiritual dilemmas—the very thing that had moved me to write in the first place. What I needed was a new kind of training, analogous to my medical training but very different.”

Groopman concludes: “Identifying this drive to narrate—to tell stories as a human once the doctor’s work is done—is perhaps the key insight of Wellons’s book. After all, the word ‘doctor’ comes from the Latin ‘to teach.’ By writing stories, we as doctors aim to teach others about our patients while learning about ourselves.”