WHY NARRATIVE MEDICINE?
In 1988, Arnold P. Gold, a distinguished professor at Columbia College of Physicians and Surgeons, established a nonprofit foundation to promote humanistic values in medical education and practice. As the foundation’s website explains, “He feared that burgeoning scientific discoveries and advances in technology were shifting the focus of medicine from caring for the whole person to an over-reliance on technology.” The Gold Foundation originated the now-common White Coat Ceremony for medical students, held for the first time at Columbia in 1993, to highlight “an important emphasis on compassionate, collaborative, scientifically excellent care from the very first day of training.”
Columbia College of Physicians and Surgeons became home to a second, related initiative at the turn of the millennium. With a grant from the National Endowment for the Humanities, Rita Charon, M.D., Ph.D. (English), brought together scholars in medicine, literature, medical ethics, communication, philosophy, psychology, creative writing, film, and related fields. The premise underlying this initiative, as Charon describes it in The Principles and Practice of Narrative Medicine (2016), is that
“The nature of the clinical work itself would be transformed if narrative skills and methods could become part of the fabric of clinical thought and care. And so our goal was to find ways to directly, irreversibly alter the ways that persons seeking healthcare were received.”
Although the original focus of narrative medicine was on improving interactions with patients, it wasn’t long before physicians’ quality of life also became part of the conversation. Ronald Epstein, M.D., professor of family medicine and palliative care at the University of Rochester, captures the interdependence of those goals in Attending: Medicine, Mindfulness, and Humanity (2017):
“I believe that the practice of medicine depends on a deep understanding between clinicians and patients, and that human understanding starts with understanding oneself.”
He also describes what that looks like in practice:
“The ability of doctors to see each patient as a complete human being (and vice versa), in my view, is the basis for the trust and understanding that help the patient through the hard times. It is a learned skill, a habit of mind. . . . [C]linicians have to prepare for those relationships that place them outside their comfort zone — when there is suffering, conflict, uncertainty, or loss.”
From its inception, the narrative medicine movement has emphasized peer-reviewed, replicable studies. Examples appear in REPRESENTATIVE RESEARCH ON NARRATIVE MEDICINE and REPRESENTATIVE PRINT AND ONLINE RESOURCES FOR NARRATIVE MEDICINE.
Of course, the idea of incorporating humanities into medical education did not suddenly spring into existence at the turn of the millennium, nor is it limited to the narrative medicine movement. When the Penn State College of Medicine was established in Hershey, Pennsylvania, in 1967, it included the first Department of Humanities in any medical school in the United States; and even outside formal humanities curricula, medical school professors have long offered opportunities for reflective writing and other humanities approaches. As an example of what reflective writing might accomplish, Susan Pories, M.D., associate professor of surgery at Harvard Medical School, published a collection of her students’ essays in The Soul of a Doctor: Harvard Medical Students Face Life and Death (2006).
A representative sampling of narrative medicine and medical humanities departments, courses, and initiatives throughout the U.S. is available here.
Although narrative medicine may include art, music, role-playing, and other expressive activities, this website focuses on the three most common approaches: reflective writing, hearing and telling stories, and close reading of literary texts chosen for their potential to awaken understanding of, and empathy toward, varied mindsets and world views.