Rx Narrative: Story As Medicine

Marie Ennis-O’Connor

DotMED The Creative Medicine Conference #DotMED14

@JBBC

“Everything we see hides another thing”

How can we open ourselves up to

seeing more?

Story

“We use them to derive meaning

from experience and to pass along knowledge, values, and wisdom.”

@LouiseAronson

Stories are how we shape our world

The way we understand our lives and identities

“Story was crucial to our evolution—more so than opposable thumbs.

Opposable thumbs let us hang on; story told us what to hang on to.” Lisa Cron

“Stories seem to contain that timeless thread

of human connection. This is what our

brains were wired for reaching out and

interacting with others.”

PNAS.org: Speaker–listener neural coupling underlies

successful communication by Greg J. Stephens, Lauren

J. Silbert and Uri Hasson

Your Brain On Story

https://www.youtube.com/watch?v=q1a7tiA1Qzo

Empathy is an essential step towards compassion

Can story be the bridge to

build empathy and

compassion in medicine?

Story

“Story becomes the ground that

patients and healthcare

professionals travel together.”

@JBaruchMD

What happens when the patient narrative doesn’t match the

physician’s version?

Conflicting illness stories will hinder treatment because the

meaning we give to our illness is significant in terms of compliance,

managing our illness, and contributing to our well-being.

“Seriously ill

people are

wounded not

just in body

but in voice.”

Illness Is A Call For Stories

narrative wreckage

A patient isn’t a disease with a body

attached but a life into which a disease has

intruded.

“When doctors can see illness

from their patients' eyes they

become better doctors.”

Ronald Drusin, MD, vice dean for education at Columbia's College of Physicians and Surgeons

.

To understand a narrative of illness is to understand

what it means to be human.

Sayantani DasGupta

@sayantani16

“Long before doctors had anything of

interest in their black bags – no MRIs, no

lab tests, no all body CAT scans – what

they had was the ability to show up, what

they had was the ability to listen, and

bear witness to someone’s life, death,

illness, suffering, and everything else

that comes in between.”

“The simple yet complex art of listening is, in and of

itself, a clinical intervention.

Listening constitutes the very heart and soul of the

clinical encounter..””

“Please Hear What I'm Not Saying: The Art of Listening in the Clinical

Encounter” Mary T Shannon. Perm J. 2011 Spring; 15(2): e114–e117.

Medicine is inherently stamped

with narrative.

Patients and doctors tell two different stories

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Health care is supposed to build on the story with each contact, but if we don’t know the story, each contact becomes a closed episode of its own, disconnected from every other episode. Fragmentation results as the outcome of a nonstoried approach to health care.

Narrative Medicine: Relationships, Stories, and Healing

Lewis Mehl-Madrona MD

“The ability to acknowledge,

absorb, interpret, and

act on the stories and plights of

others.” Rita Charon

Narrative Medicine

Charon R. Narrative medicine. New

“A medicine practiced without a genuine awareness of what patients go through may fulfil its technical goals but it is an empty medicine, or at best, half a medicine.”

Charon R. Narrative medicine. New York: Oxford University Press; 2006

Narrative medicine represents a storied understanding of health.

It’s a return to listening to the

patient’s story.

Saving and prolonging life incur an obligation to

accompany patients on their illness journeys.

Thomas R. Egnew. Suffering, Meaning, and Healing: Challenges of Contemporary Medicine. Annals of Family Medicine. 2009.

"The doctor is the patient’s only

familiar in a foreign

country"

“I want my patients' passions listed on their

charts. Because if that's not there, then the only

thing I read is ‘endometrial cancer,’ carpal-tunnel

syndrome, fibromyalgia, chronic fatigue, and

mother died when she was 40 of breast cancer. I

don't want to look at this person and simply

think, she's doomed. I want to know what her

passion is in life. Who is this person sitting in

front of me?”

Pamela Wible @pamelawiblemd

“Not every patient can be saved, but

his illness may be eased by the way

the doctor responds to him—and in

responding to him the doctor may

save himself….”

Anatole Broyard