Narrative Medicine

The Certified Listening ProfessionalTM (CLPTM) is offered by the International Listening Association (ILA) as one method of fulfilling its mission to advance the practice, teaching, and research of listening throughout the world. Becoming a Certified Listening Professional (CLP) was an important step in my professional and personal growth as a listener. I finished the program this month with a paper about Narrative Medicine. I will write about it in my blogs.

Narrative medicine would seem promising for use because in our day-to-day- lives we communicate with one another through narrative and storytelling.

  • Narrative medicine aims to understand meanings of illness experiences by patients’  story telling (Hyden 1997)
  • Narrative provides meaning, context, perspective for the patients’ predicament according of Greenhalgh and Hurwitz (1998).

Rita Charon (2006) use the term narrative medicine ‘to mean medicine practiced with these narrative skills of recognizing, absorbing, interpreting and being moved by the stories of illness. As a new frame for healthcare, narrative medicine offers the hope that our health care system, can become more effective than it has been in treating disease by recognizing and respecting those afflicted wit it and in nourishing those who care for the sick.’

Dr. Charon’s students in the unique Narrative Medicine Program at Columbia University are taught through the use of reading literature and also by writing down the more emotional and stressful aspects of patient care in “parallel charts” (not in the official medical record). They learn to better understand what patients are telling them, not just from what they say, but also from their gestures and body language. In addition, by reflecting and composing their thoughts and emotions after each patient interaction, they are discovering new things about themselves as well as their patients. In essence, they are clearly spending time and energy focusing on the patients and themselves as humans rather than as entities or automatons respectively.

The patient narrative does not necessarily clarify what are the most important concerns of the patient. The narrative approach requires active listening for the—sometimes hidden—meaning and significance of the particulars in the patient story.

The first approach in Narrative Medicine is to recognize that there are different beliefs between medical professionals and patients.

I like to demonstrate this by the allegory of Edgar Rubin.

Allegory of Edgar Rubin

 Allegory of Edgar Rubin

If you look at the picture, imagine a situation during which a doctor (the listener) sees a vase but the patient (the speaker) sees a face.

Maybe the doctor will say: ‘You think it’s a face. But that’s wrong…it’s a vase. You have to look objectively at the illustration. Then you will see, I’m right.’

When this happens the doctor gives up understanding, abandon a dialogue and stops the effort of overcoming a difference.

A possible active listening response could be: What do you see in this picture? Please share what you see and experience. I try to understand your vision from your value system.  We both should try to understand.

It is important to constantly make a concerted effort to understand the other person.

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