the trouble often starts with a small piece of fluff in your ear

In narrative medicine, the patient's story (his medical history) can be received, interpreted, and acted upon differently depending upon who is listening to it. For our purposes, this is likely to be a physician, a nurse, a nurse practitioner or physician's assistant, or a therapist in any field. For that matter, it could be the person who delivers the patient's breakfast tray, or mops the floor, or delivers flowers to the patient's bedside. Each of us brings a unique perspective to the process based on our personal experience, expertise, expectations, and even our fears.

 

"If the person you are talking to

does not appear to be listening, be patient.

It may simply be that he has a small

piece of fluff in his ear."

~AA Milne~

~Winnie-the-Pooh~

 

It's easy to see how exhaustion, tight schedules, and productivity quotients can affect a provider's response to the patient's story. He may feel rushed, impatient, frustrated, or anxious, depending upon how his day is unfolding. Not a healthy emotion among them. None of them helpful to the patient.

It's not as easy, however, to know when the patient's story itself is difficult for him to hear...or embrace...or understand.



"Most people do not listen

with the intent to understand.

Most people listen

with the intent to reply."

~Steven Covey~

 

It will be painful for the obstetrician who has suffered her own miscarriage to celebrate the birth of her patient's healthy infant...or to console the patient who loses her own unborn child.

 

If the provider lost his father to lung cancer, he may harbor frustration or anger with the patient who continues to smoke. It may unmask his grief when his patient fails to respond to treatment.

 

Let's say the physician has been training for her first marathon when one of her patients suffers a cardiac arrest during his daily run. Suddenly she feels guilty because she encouraged him to exercise regularly in the first place. She becomes fearful for her own safety and wellbeing

 

Listening to our patients' stories can be difficult depending upon our own circumstances. We are called to be attentive, empathetic, knowledgeable, and effective when we may feel anxious, or helpless, or sad.

 

The practice of narrative medicine encourages the health care provider to explore the patient's entire story, and to reflect upon his own reaction to it. This process promotes accurate diagnosis, and appropriate and effective treatment. It facilitates healing.

 

It also provides a platform for providers to explore the story of their own experience as healers, and to confront the challenges they encounter. This can include organizational and procedural obstacles, as well as emotional, physical, and psychological stressors. Telling their own stories helps wounded providers heal.

 

"The healing that can grow

out of the simple act of telling our stories

is often quite remarkable."

~Susan Wittig Albert~

jan