Michael Pratte is a second-year medical student at the University of Ottawa.
Around the moment my scalpel cut into human flesh for the first time, it occurred to me that I wanted to be a writer. As healthcare professionals, we, in a way, participate in the invention of stories every day. We are privileged, though, to be trained in the use of utensils capable of both creating the protagonist and seeing them through their conflict. The patient, in whose story we play a role of narrative and catalyst, also acts as the blank page; our sutures, scans and blood tests provide the plot elements needed to see them to their story’s conclusion. The natural similarities between storytelling and physicianship give rise to an important question; in a field filled with history-taking, note-writing and emotional, challenging conversations, why does the teaching of rhetoric and narration play such a small role? Here I argue that, due to its demonstrated ability to help both patients and learners navigate the complexity that is modern health care, Narrative Medicine should be integrated as a longitudinal curriculum in Canadian medical schools.
The concept of Narrative Medicine, pioneered by Columbia University in 2000, was built upon the premise that effective healthcare requires a complex, interdisciplinary dynamic between a physician’s medical acumen and their ability to comprehend the suffering of others. The premise is that writing about medicine fosters narrative competence and introspection meant to enhance clinical interactions and facilitate difficult situations. Over the years, it has evolved into a way for patients to use writing to celebrate their incredible efforts against overwhelming illness, for physicians to chronicle doctor-patient bonds that transcend all types of love and for both to express frustration, awe and acceptance towards the ultimately inevitable finality of death. At the same time, with the increasing computerization of health, medicine is facing its biggest challenge yet. The empathy, compassion and humanity of the profession is threatened by the efficacy, complexity and bureaucracy of modern care. Medical students, who are taught compassion, humanity and interprofessional collaboration before entering their clinical years, are often dismayed; working in the hospital, they are suddenly bombarded with what has become known as the “hidden curriculum” of medicine. Too often, learners rapidly become jaded by dehumanized, rapid-fire care, micro-aggressive work environments and emotionally-sterile interactions that have become commonplace in the hospital. As healthcare burnout increasingly becomes a matter of prime importance to medical governing bodies, there is no better time than now to develop new tools to facilitate the introduction of learners.
It is Narrative Medicine that has answered the call. In addition to the proven benefit it has shown for patients writing about fighting their illness, there is growing evidence that the development of skills in careful, introspective writing might improve the ability of learners to empathize and interact with others. The incredible thing about Narrative Medicine is how it, in many ways, often writes itself. The triumphs and the losses of patients fighting against illness and the experiences of physicians supporting them often tell incredible tales that the most creative of writers would struggle to conceive. With communication skills enhanced by literary techniques, medical learners have reported improved interactions with their peers and superiors as well as a newfound ability to aid patients on their path through illness. Just as writers learn techniques to convey their narratives, medical students should receive training on effective ways to create their own medical histories. It isn’t a far stretch; the very act of writing involves the narrator placing themselves into a different perspective, anticipating their audience and their message. This is particularly important in medicine, where patients and physicians alike struggle to navigate difficult, abstract concepts such as suffering, life’s meaning and death. Practice in narrative creation will also help learners see from the patient’s perspective, an essential aspect of giving holistic care that is tailored to each patient’s needs and desires.
For the reasons I have listed above, writing should be integrated into medical education as a longitudinal way of enhancing pre-existing curricula; much like anatomy may be taught in parallel with the current body system of study, Narrative Medicine should also be taught in parallel with learning about physiology and symptoms, the foreshadowing that clues us into how each patient’s story will end. With respect to integrating Narrative Medicine into curricula, literature and medicine do not have to be separate and, in fact, students may come to consider them both as important aspects of their career. This has already been done within the arts; in recent years, there has been a movement towards integrating visual analysis of artwork into medical curricula to promote empathy, visual literacy and sensitivity. This gives a natural way for Narrative Medicine to seamlessly enter into medical education. Already, early attempts at integrating it into a school’s curriculum have shown excellent responses to current issues in medicine, including combatting dehumanization of care and improving palliation, and point towards a need and a desire for change.
It must be said that Narrative Medicine is not a solution to every problem in medicine. The best physician writer in the world could not write away growing wait times across the country or the looming opioid epidemic. But it must be understood as a powerful tool to gain traction against many issues, from physician burnout to dehumanization of care, that is not at odds with other toolsets that we may have. There is a power there, hidden within the lines of our stories, a power of wonderous healing capacity far beyond that of any treatment we know. I, along with many others who have taken up Narrative Medicine, intend to be there, at the forefront, using writing to speak out against issues in health care and chronicle the timeless struggles of our patients against illness. And as medicine evolves over the years, I hope that writing will become a skill just as essential as any physical examination. If for no other reason than the fact that theses stories deserve to be told.
Of Course a Masterpiece Of Content
argue that while the debate between free speech and professional responsibility is an important one, the main reason that physicians should be reluctant to blog is simple self-protectionism: posting personal material, including narratives about patients, online may leave a physician vulnerable.
That is a very motivating outpouring on a very important subject.
Basically, you are asking yourself important questions about who you are and what you are doing. Like what is a doctor for ? what am I doing this for ? What did I achieve today ? How does this fit into the history of the profession and the history of our culture ? What is a human being ? and, and, and …
And the only way to make any sense of any of this is to talk to others and to read the books of others, and the lives of others, and the history of everything. And of course, the same remarks are germane to anyone, regardless of profession.
Nothing, absolutely, nothing, is as useful for understanding and progressing (in whatever it is that you are doing) than to take the time to write it down in a form that makes it accessible (understandable even perhaps) to others.
So here I am rambling on, but, for what it is worth, congratulations : you are one of those who “gets it”.
Gordon Friesen, Montreal
Thank you for the wonderful reply (and apologies for the last response)! I totally agree, and happy that you do as well! I can only hope that medical curricula are more open to adopting this in the future. The change starts with professors and program directors!