what the patient needs

Programs in Narrative Medicine, like the one at the College of Physicians and Surgeons of Columbia University, train health care providers (physicians, nurses, and therapists of all kinds) to recognize, absorb, interpret, and to be moved by stories of illness--the patient's chief complaint (CC), the history of the present illness (HPI), and the past medical history (PMH).



It is no longer sufficient to scroll through a bullet list of symptoms, ie. low back pain and stiffness. Check. Lower extremity weakness and numbness. Check. Calf swelling. Check.

The patient needs more from his provider than a diagnosis, and a referral or prescription. He needs to know that his provider hears him, understands him, and addresses all the ways he is suffering:
               ~physically because of the symptoms of his illness...pain, exhaustion, weakness, etc.
               ~emotionally because of anger, shame, guilt, or despair
               ~spiritually when there is no hope for recovery
               ~financially if he becomes disabled because of his illness or injury

"The good physician treats the disease:

the great physician treats

the patient who has the disease."

~William Osler~

Ten minute office visits do not suffice to expose all that must be said, nor do they permit the kind of longitudinal relationships that are so important to understanding and responding to illness. This process takes time.

"Medicine practiced without a genuine

awareness of what patients go through

may fulfill its technical goals

but it is an empty medicine,

or at least, half a medicine."

~Rita Charon~


 

The whole other issue in narrative medicine is the patient's ability to tell his story. Patient's are not born knowing the language of medicine. They don't know what the provider needs to hear in order to understand their illness. Fatigue is not the same as weakness. Tingling means something different from numbness. Stabbing pain means something different from aching pain.

"If storytelling is important,

then your narrative ability to put into words,

or to use what someone else

has put into words effectively,

is important, too."

~Howard Gardner~

 

Patients may be ashamed to admit to unhealthy behaviors that put their health at risk. They may be reluctant to share the emotional impact of their illness on their marriage, children, and co-workers. They sometimes lie in order to deny or minimize the seriousness of the condition, saying the crushing pain that accompanied their heart attack felt like "a little indigestion," or the fungating mass in their breast just appeared "a week or so ago." An attempt to assuage their worst fears.

Medical history taking is a collaborative effort. For both the storyteller (the patient) and the listener (the provider), it requires a shared language, common purpose, and mutual effort. It is never too soon to begin...to learn...to change.

"People hear facts,
but they feel stories."
~Brent Dykes~

jan