Modern medicine often portrays the discourse between physician and patient as a one-sided transaction – the doctor holds an egocentrist position within the relationship, working through the taught models of assessment and prognosis to try and identify the root cause of the patient’s condition. But what would happen if we disregarded all of the acronyms, guidance and consultation frameworks, asking, ‘What do you think I should know about your situation?’ – a simple question proposed by Rita Charon, a Professor of medicine with a PhD in literary studies.
In Charon’s 2002 paper ‘Narrative Medicine: A model for Empathy, Reflection, Profession, and Trust’, the medic-come-literary scholar examines the use of semantics within a clinical context in order to try and gain a deeper understanding of the effects of language and its consequences in a patient interaction. The ideas explored in this paper paved the way to a novel area within the field of the humanities, one which revolves around medicine and healthcare. Columbia University’s recently inaugurated Master of Science degree in Narrative Medicine is a course on the front lines of innovation when it comes to appreciating alternate approaches in the continuum of patient care. Charon writes:
‘With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care.’
The programme encourages clinicians to look towards the often-neglected humanities in an attempt to bridge the gap between art and physiology. Literature is one such facet in which a narrative can be observed and is often described as the study of the human condition – a sentiment echoed by Charon in a 2018 interview. She moves on to discuss the inclusivity and sense of community that seems to be lacking in modern parochial healthcare systems of the West. Over her career within narrative medicine, Charon proposes a simple idea: replace the wooden, stereotypical approach with a new fluid model; one that helps to provide precision care that caters to the individual, avoiding a one-size-fits-all approach.
There is of course an issue with this agenda. The problem lies more specifically with the disparity between America’s ‘privately funded patchwork’ of fragmented health systems and the socialized medicine of the NHS. Consultation times in the current climate of the healthcare service are simply too short to spin the chair onto the patient and ask them to tell you everything in just seven minutes. Publications by the NHS and the British Medical Association offer advice to help patients get the most out of their appointments but the suggestions are mainly focused on ensuring an efficient consultation rather than forming a holistic view of the patient’s concerns. For our friends across the Atlantic, where the majority of healthcare is provided via the private sector, this would be more feasible. Clinicians in America have the time to probe even deeper into the patient’s understanding of their self – albeit in a system with considerably less strain than ours – perhaps a nod to the fact that such programmes are of less interest here in the UK.
However, some of Charon’s suggestions, at a more basic level, could be attained and implemented by many clinics across Britain. What Charon is ultimately proposing here is a greater sense of patient autonomy; something that allows for a greater degree of transparency between the clinician and their patient. Although practical guidelines are not very amenable to change, the individual manner of the clinician certainly is. Again, this is a sentiment shared by Dr Charon in just a few of her many TEDx talks that can be found on YouTube. Through her anecdotes, exploring her personal successes by way of narrative storytelling in her own clinic, she outlines her method very candidly – recounting how we are often told in school, university and beyond, that you should read as if every word counts. It is here an important parallel with literature can be drawn– if we can read where every word counts then surely, we can listen as though every word counts.
Illness therefore exposes a patient and their vulnerabilities. Through narrative medicine we are provided with a novel framework to illuminate how concrete facts and symptoms of health can be imbued with a better sense of the patient’s self and individualism – a doctor helps the patient to understand that in the limits of life we have meaning and likewise patient’s teach the clinician about the need for partnerships, helping us understand what it means to be stood in solidarity against our own mortality. Charon concludes that ‘by bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care’ – something we can all agree that the world needs now more than ever.
Alexander Thornton
Rita Charon’s original paper can be found here:
https://jamanetwork.com/journals/jama/fullarticle/194300
Information for the MSc in Narrative Medicine can be found here:
https://sps.columbia.edu/academics/masters/narrative-medicine/full-time-master-science
Thanks to Abi Curran for helping with the revision of the article.
THE WORSLEY TIMES 
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