As a health professional, have you ever considered the helpful impact of knowing your patient’s stories: what matters to them, how they find meaning/purpose in living, and how they pull life together to recharge themselves? More healthcare associations, like the Academy of Lifestyle Medicine and the American Medical Association, are addressing the factors of care that allow clinicians to delve into this sense for patients (and themselves too) of life cohesiveness or the finding of meaning, purpose, and spirituality. This focus on listening and being personally moved by patient stories as you apply the science of your care is called narrative medicine. It changes/heals patients and providers alike.
Listening for Meaning, purpose & spirituality are the meat of narrative medicine
Writing as a Registered Dietitian and a Board-Certified Healthcare Chaplain, I have long listened for these human elements in caring for patients. My goal in interacting is much more than just building rapport and using motivational interviewing skills to help patients set realistic goals for behavior change. Strategies in narrative medicine are much more than strategies to convince them to act for better health. Allowing patients to share their reactions and what resonates with them in living, in dealing with disease or being healthy “distinguishes compassionate care from routine care.”[i] People heal when all aspects of their constitution are taken into account and addressed. Humans are not automatons. Meaning, purpose, and spirituality are strong social determinants of health.[ii] Narrative medicine brings the “human element back into medicine,”[iii] so nothing important is overlooked. Clinicians need to develop subjective, personal skills for getting to the heart of the matter.
Practitioners themselves are transformed by this deeper care
Getting to the heart of the matter as we care for patients also empowers practitioners. We are transformed by genuine human interaction with clients. Moreover, we are challenged to be honest with our own needs and reactions as we listen to the patient’s heartfelt sharing. They teach us about life and ourselves. They help us understand where we are wounded as humans, and reveal what matters most to us as well. In these moments, practitioners are immersed in a “very rare opportunity where an intervention changes both the patient and the practitioner simultaneously.”[iv] When we confront our own blocks, unfinished emotions, and the baggage of living, we can become more transparent to ourselves, our patients, and even our colleagues. This enhances our ability to collaborate. Working with other health professionals can be a conflict-rich environment without this kind of exploration into the human aspects of living and caring.
How to start offering narrative based care
How do we start practicing narrative medicine and provide spiritual care to patients? Many of the strategies outlined in the literature seem short-sighted. Many return the seasoned practitioner and even the student back to undergraduate humanities coursework and creative writing exercises to sensitize them to be able to listen to the ebb and flow of a story. Some teach techniques to document encounters using a narrative framework that they attempt to perfect with creative writing techniques. While the rationale of this non-linear formation shows that practitioners need to grow in the capacity to follow a story and become sensitized personally to what the patient shares, they miss the essence of subjective professional formation. What follows are a few suggestions that are much simpler and more organic to the process of whole-person care.
Firstly, slow down and pull up the diagnostic listening lens that impacts most of our clinical encounters. We want to get curious, relinquish control, and allow the human interchange to progress. Listen emotionally and humanly to what they say. Allow an image of the experience they share to form in your mind. Be moved. Ask a question to get the ball rolling, and then open the door. The ability to do this comes from nurturing our emotional and spiritual well-being. Exposing ourselves to good literature, music, or art, as the literature describes for Narrative Medicine, contributes to refreshing ourselves. Still, they are not enough to fully equip us to practice NM. We rush to get to the diagnostic meat when we are burnt out or busy. Ask a question from the introduction here, and listen to what they tell you. Try to hear and read between the lines. Next, notice where you struggle and which patients tend to create discord inside you. This could be an exaggerated positive or negative reaction, where you find returning to information-giving especially calming. These are clues to your unfinished emotional and spiritual/MPS business lies.
Subjective formation allows you to be honest with yourself and colleagues when giving feedback and providing others with authentic fodder for growth. Something as simple as asking a patient, “What must I know about you to provide the best care?” is a simple way to start practicing narrative medicine inside your practice. Consider also completing an engaging and impactful small group formation through renewedpractitioner.com and the 10-week Clinical Formation Experience.
[i] Kohn, Balla J, Stories to. Tell: Conducting a Nutrition Assessment with the Use of Narrative Medicine, JAND, 2016, 116, 1, 10-14
[ii] Long K, Symons X, VanderWeele T, Balboni T, Rosmarin D, Puchalski C, Cutts T, Gunderson G, et al, Spirituality as A Determinate of Health: Emerging Policies, Practices, and Systems, 2024, Health Affairs, 43:6
[iii] Charon R, Narrative Medicine: Honoring the Stories of Illness, New York, NY, Oxford University Press, 2006
[iv] Columbia University Medical Center. International Network of Narrative Medicine, http://www.narrativemedicine.org/innm.html