Year: 2012
Type: editorial
Abstract: EDITORIAL Narrative Medicine and Narrative Writing Johanna Shapiro, PhD, Assistant Editor, Family Medicine (Fam Med 2012;44(5):309-11) P hysician anecdotes about their patients have always been a part of medical ed- ucation and clinical practice. In the post-Flexnerian era, with the introduction of increasingly sophisticated diagnostic technolo- gies and the rise of evidence-based medicine, to a large extent the clinical anecdote went un- derground. It was still around but told a bit shamefacedly or tagged onto a summary of rel- evant double-blind randomized clinical trials. Yet practicing physicians have always sensed the importance of story in medicine, and in the last decade or so, this awareness has given rise to a narrativist (re)turn in medicine 1 rep- resented through the work of such theorists as Brody, 2 Charon, 3 Greenhalgh and Hurvitz, 4 and Mattingly and Garro. 5 Family Medicine is com- mitted to giving voice to the narrative side of medicine. What follows is intended to help po- tential authors find their narrative voices and help readers to approach such writing with both appreciation and sophistication. Narrative medicine has been variously de- fined, but at its broadest it includes developing a “sense of story” in practitioners, an appreci- ation for and understanding of the fact that, from a certain perspective, medicine is a sto- ry-telling enterprise. 6 Patients offer their sto- ries to physicians, who reinterpret and try to make sense of them and then present them back to the patient for the purpose of allevi- ating suffering and restoring health and well- being. Elements of narrative medicine 7 include attention (being fully present in listening to, observing, and attending to the patient); repre- sentation (how the patient is represented—in writing and in telling—to colleagues, learn- ers, the patients themselves and their family, and to the self of the physician); and affiliation FAMILY MEDICINE (commitment to adopting a position of compas- sionate solidarity with the patient’s suffering, 8 empathy for the patient’s perspective, and ad- vocacy for the patient’s needs). Narrative medicine in turn has led to a re- surgence of interest in the narrative writing of both patients and physicians. Increasing- ly, patients have chosen to reclaim their own voices from the health care system by telling their own stories. 9 Physicians too have felt the need to tell stories about their patients, them- selves, and the ties that bind them, and medi- cal education has incorporated writing about patients (and themselves) as a valuable edu- cational tool to help learners develop critical thinking, challenge facile assumptions, think more deeply about patients and themselves in relation to their patients, become more aware of their own and patients’ emotions, and ward off cynicism and disillusionment. 10,11 Physician reflective writing is perhaps the most widespread reincarnation of the simple clinical anecdote. However, its focus and in- tention are more complex. Reflective writing involves review and interpretation of experi- ences to achieve deeper meaning/ understand- ing and guide future behavior. 12 It extends beyond mere description to engage in mean- ing making. Rooted in personal experience, such writing tells a story that, while based on an illness-related event, yields insights that are primarily not biomedical in nature. It does not render an opinion and is not speculative or abstract but rich in particulars and detail. Reflective writing poses questions that are not necessarily fully or definitively answered and does not force a particular point of view. Rath- er, it allows multiple interpretations to emerge. Its purpose is to develop critical thinking and VOL. 44, NO. 5 • MAY 2012
Source: PubMed
Author: Johanna Shapiro
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1514732715