Narrative Medicine is an approach to health care that prioritizes the stories of patients, seeking to foster narrative competence among practitioners. Rita Charon—physician and pioneering scholar in Narrative Medicine—describes narrative competence as “the ability to acknowledge…interpret, and act on the stories and plights of others.” Mathew Crawford, instructor in TCU’s Pre-Health Professions Institute, explains why this skill is central to holistic patient care in most medical contexts.
Why should narrative medicine be incorporated into medical training?
This relatively new academic field is rooted in the pre-existing philosophical claim that we humans are “storytelling animals,” that we understand ourselves, others, and our world through narrative. Think of the ways stories are central to our lives. They form our understanding of history and politics. Stories are foundational to the literature and film we consume. When we meet someone new, we share stories of our lives to bond; and when something eventful happens, we want to tell that story to those we love. In sum, our stories (individual and communal) give our lives context and shape.
In medicine, there are a host of ways our stories matter, but three stand out and speak to why future physicians should be trained in narrative medicine. Patient stories provide “thick descriptions” beyond what a standard medical history provides that can be a resource for physicians in the diagnosis and treatment of disease. Additionally, when making bioethical decisions, the context of a patient’s life and their perception of their illness can determine what treatments are fitting. Most importantly, I argue, the simple act of listening to the stories of the ill and suffering, acknowledging them, has deep moral worth and is the foundation of empathetic and compassionate care.
How does gender, age, or race affect someone’s health care?
I joke that you can make a whole career in bioethics by declaring, “It’s complicated!” This is one of those times. There is no easy way for me to answer the question regarding gender, age, or race’s effect on someone’s health care. I want to say we need a whole seminar interrogating the history, collective use, and impact of each of those terms before we can start the conversation. Nevertheless, we need to begin with the simple and demonstrable fact that they do affect our health care. Social scientists have documented healthcare disparities in the United States for decades connected with aspects of identity like the question names. However, when we begin to ask how these disparities exist, seeking the level of precision that will allow meaningful and effective response, we get a variety of answers from a host of academic fields—all telling a different aspect of the “how.” (We haven’t even mentioned the “why.”) This variety is actually instructive, it points to the systemic nature of the problems we are facing. There is not a single answer because so much of our collective lives, all aspects, can foster inequities in health and health care. If we can begin with the recognition of how these vast and intwined disparities are embedded in our communities, we can first acknowledge that this is not solvable by the individual patient or physician. It is only “my” or “your” problem in that it is “our” problem. Systemic problems like these by definition require systemic, structural changes.
How can religious customs or beliefs influence options for treatment?
Am I allowed to reuse the “It’s complicated!” line? It is exceptionally fitting here too. I also want to respond that religious customs or beliefs can influence options for medical treatment in virtually limitless ways. Before I am accused of not really answering the question, I will give some context. This question demands that we attend to the concept of religious plurality. We are often at our most vulnerable when we are ill, and to the credit of our healthcare establishment, we have not enacted a one-size-fits all approach where we ignore the plurality of patients, including what treatments are optional for an individual based on religious or cultural practice.
The most common way we understand religious plurality in an American medical context is that people of all religious traditions, including no particular tradition or a decidedly secular tradition, can live in our community and need medical care. Additionally, they represent a variety of ethical perspectives that can permeate all aspects their lives, including how to approach illness and what medical interventions are appropriate. One might think of a religious prohibition against blood transfusions, or the desire for gender-concordant care when nudity is a component of a medical procedure. But this approach can give the false impression that plurality in America is only understood as the difference between religious traditions, when in fact it is essential that we recognize the plurality is internal to each of these traditions. Just because a physician learns the name of a person’s faith tradition, it doesn’t mean he or she can determine what the patient does and does not find ethically appropriate in a medical context. For that, the physician needs to listen to their patients. Thus, the practices of narrative medicine discussed above fit ideally in this context.
While digital technology has improved the operational efficiency in healthcare, how has it negatively impacted patient care?
First, I want to begin by expressing my gratitude for evidence-based medical care and the use of emerging technologies that make that care more accurate, innovative, and accessible. Yet, as the question lays out, it is important to attend to the downsides of digital technology. Abraham Verghese has done some important work in the medical humanities in this context. He argues that in contemporary medicine the actual patient—the embodied person—is regularly being replaced by a digital patient comprised of data collected by a myriad of sources and treated through a computer. As a physician, Dr. Verghese found the ancient art of the physical exam was being neglected and with it, essential elements of the personal connection that makes for excellent care.
This leads me to the most promising emerging technology I see in our near medical future: the common use of artificial intelligence (AI) for diagnosis and treatment plans. AI has already proven itself better at a variety of medical assessments than highly skilled physicians. Sooner than we think we will be seeing the ubiquitous presence of AI in medical care. This issue is thick with ethical implications, but one aspect that can be scary for aspiring future physicians is the idea of becoming obsolete. Will AI take over the main role of a physician? I hope not, and I have good reason to think otherwise. Illness is isolating enough as it is. I highly doubt there is a market for fully human-less medicine. In fact, I have high hopes that these technologies will free up the time physicians need to be present with more patients as the human face to this medically useful data. I hope physicians can care for patients with a wonderful balance of the ancient, personal practices and modern technological accuracy.
What are some of the instructional methods you employ to teach compassionate or ethical care within TCU’s Pre-Health Professions Institute?
All pre-health students need to develop their competencies in the hard sciences. No one wants a future physician or dentist who is unable to get a handle on the biology or chemistry pertinent their field. But pre-health students also need to possess, prior to going to professional schools, interpersonal and intrapersonal competencies that will be the foundation of their compassionate, empathetic, and ethical care. I know I am biased, but I find that teaching and assessing empathy or related competencies pose truly unique challenges in higher education. It is a murky process rooted in forms of life that have shaped each student from childhood. Murky or not, I am convinced that the humanities, the rich collective traditions that wrestle with human meaning, are essential to fostering empathetic, patient-centered future providers. The educational process must involve mutuality; and when done best, I believe the instructor must create a safe space for students to explore, critique, and seek to modify their understanding of what it means to care for someone suffering. Self-reflection is the key! Written and spoken reflections in the dialogue of a course have proven to be essential exercises. To begin this process, I am drawn to the arts, visual and text-based, to help students imagine the lived experience of others. For example, we have partnered with our wonderful School of Art for gallery tours addressing gender and medicine. More broadly, we regularly use detailed medical narratives, fiction, and film in coursework. Recently we have started a listening project where select students learn to listen directly to patient stories individually and as a group. TCU has an abundance of resources most evident in our faculty, and the Pre-Health Professions Institute prioritizes fostering those connections to the betterment of our students.
Learn more about the Pre-Health Professions Institute.