the time it takes...the trouble it saves

 

 

 Training in the practice of narrative medicine focuses on motivating and enabling health care providers to uncover the real story behind the patient’s illness…not just his symptoms, but his attitudes toward health and healing, how his illness affects his life and the lives of people around him, and his fears and hopes for the future.

 

“It can be argued that the largest

yet most neglected health care resource

worldwide is the patient.”

~Dr. Warner Slack~

 

Let’s say a woman presents with a complaint of palpitations…the sensation that her heart has been beating rapidly and/or irregularly, off and on, for a couple of weeks. It scares her because her father died suddenly following a heart attack at the age of 54. She limits her caffeine intake, exercises regularly, and is otherwise healthy. When you see her in the office, her cardiac exam is normal…her pulse is 80 and regular. Her blood pressure is normal. So, you schedule her for a stress test and a cardiac event recorder. The only thing that shows up is an occasional episode of sinus tachycardia. You have now run up several thousand dollars in bills and you still have no diagnosis.

 

Had you taken time to ask about recent stresses in her life, she might have told you about the cigarette burn she recently found on her twelve-year old’s shirt sleeve. And how poorly he’s doing in school. And how worried she is about him because if he’s smoking already, what’s next? And how hard it is as a single mother because she has to work two jobs and she can’t keep her eye on him the way she should.

 

“We know that stress is perhaps

the most underrated of all  

our heart disease risk factors.”

~Michael Miller~

 

It’s no wonder her heart is acting up. But her cardiac condition is not the problem. Stress is. And stress can be a whole lot harder to treat than a cardiac arrhythmia. You could run every test known to mankind in an effort to convince your patient that her heart is fine…but until you identify and address the real issue, she will continue to have symptoms. Her problems will only get worse.

 

Narrative medicine encourages us to take time to elicit the patient’s whole story, and to consider the context of his illness. To touch the sensitive spot. To probe the wound. Not only to make an accurate diagnosis but to explore the patient’s fears, expectations, and beliefs about his condition…anything that might delay healing.

 

Or promote it.

 

“The good physician treats the disease;

the great physician treats the patient

who has the disease.”

~William Osler~

 

jan