Wednesday, September 30, 2009

USING NARRATIVE IN MEDICINE

The study of literature and creative writing helps doctors and medical students to better understand the perspectives of their patients, and to relate to them in a more supportive and less strictly rational-scientific way. That's according to a new article by Jessica Singer Early, Ph.D., and Meredith DeCosta, M.Ed. in the Yale Journal for Humanities in Medicine. 

The article gives "a historical framework for understanding the inclusion of literature and creative writing courses in medical school around the world," and cites the major figures in the field, such as Rita Charon and Robert Coles. 

The authors cite Elliot G. Mishler's 1985 The Discourse of Medicine: Dialectics of Medical Interviews, summarizing it in this way: "Through an analysis of doctor-patient discourse, Mishler theorizes that doctors and patients operate in separate orbits. He names these orbits, or ways of communicating and thinking, the 'technical rational' and the 'life world.' The technical rational is the voice of medicine and belongs to doctors who are trained to think and act in a highly scientific manner. The life world represents the voice of patients who share their personal lives through emotions and stories. Mishler describes the divergent ways in which doctors and patients communicate and how this difference often leads patients to feel alienated, misinterpreted, or ignored when visiting doctors. If doctors discount the stories and feelings of their patients by relying only on their technical rational training, then they may miss important opportunities to communicate and connect with patients, and, perhaps, to discover information relevant to their patients’ health and willingness to follow medical regimes."

Probably most patients (myself included) have had some experience with doctors who don't listen to them, don't solicit their so-called "illness narratives" -- the story of how they're doing and how they got to feel that way. It is, needless to say, pretty infuriating to be dismissed like this, especially by someone in whose care you find yourself. And likewise, a big relief to be treated by someone who, perhaps through the study of stories, has seen into life worlds of other people.

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