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If you’ve ever visited a doctor and felt that she just wasn’t listening to you describe your condition, you aren’t alone. In fact, many health care providers themselves wish that those in their field were more skilled at listening to patients’ accounts.
Things may be changing, thanks to the emerging field of narrative medicine.
Narrative medicine is a new field of research and health-care practice that centralizes the importance of patient and provider experiences in reconceptualizing compassionate, effective health care. The discipline draws principally upon literary theory, philosophy, and psychology, and aims to foster the acts of listening and recounting within clinical care settings.
The flagship narrative medicine program was founded in 2001 by Rita Charon, M.D., Ph.D. at Columbia University Medical Center, and from it, Columbia University launched a master of science (M.S.) program in 2009. While many medical schools, including the University of Virginia and Stanford University, have narrative medicine seminars, Columbia is currently the only school that offers a graduate degree in the field.
An M.S. in narrative medicine does not, on its own, qualify a graduate to provide clinical care, nor does it lead to licensure in the discipline. Most narrative medicine students are either mid-career professionals who are already qualified as doctors, nurses, social workers, or pastors, or they’re recent college graduates who plan to attend medical school. About a third of students in the program are educators, intellectuals, or artists whose goals include pursuits other than direct patient care.
For program participants, the quintessential practices of narrative medicine are typically taught in workshops in which students collectively analyze literary or artistic works, which may include a poem, an excerpt from a novel, a work of art, or a performance piece. The discussions that unfold are lightly guided by a facilitator, who encourages students to explore the meaning and structure of the works examined. Seminars typically also include individual writing based on a prompt, such as, “Write about the memory of a place,” followed by voluntary sharing.
The principle that underpins the narrative-medicine approach is that such skills as “close reading” will help students develop related skills in “close listening” as they interact with patients. Narrative medicine proponents argue that a health care professional who is listening attentively will also pick up information that may be relevant to the care she is providing; in addition, they emphasize that patients sense the greater receptivity in a provider trained in narrative medicine, and that they will accordingly expand their stories. In today’s health care settings, where a doctor’s attention is frequently a scarce resource, this approach seeks to improve the quality of care delivered and to encourage close listening, reflective practice, and empathetic communication skills into the training of all health care professionals.
While some students may find that a seminar is an adequate introduction to this emerging field, for those who want to develop more advanced practical skills or who want to advocate for a different model of health care services, Columbia’s 38-credit master’s provides an opportunity to learn the methodology deeply, to take relevant electives, and even to produce a capstone project. Courses may include a review of contemporary philosophy and ethics, literature of death and dying, or qualitative research methodology.
The practice of narrative medicine also offers a beneficial tool for care providers to discuss the ethical, emotional, and cultural experiences of delivering health care. Atul Gawande’s recent book Being Mortal — and the widespread popularity it has seen among the general public and care providers — seems to point to a cultural shift regarding the emphasis to place on the non-mechanistic aspects of care. These include everything that is unlikely to show up on a patient’s medical chart. Proponents like Rita Charon and Atul Gawande aim to remind health-care professionals that their role is not just to fix faulty parts, but also to act as trusted advocates and listeners for the trials their patients are facing.