| Monday, January 01, 0001
There's an old marketing adage that goes "make the customer the protagonist of your story." That is to say that if you're a business, don't simply tout all the benefits of your product, but pitch your marketing so that you assume the role of the sidekick to the customer, one who's helping them on their own journey. Physicians can take approach with their patients as well, being sure to cast them as protagonists in the story and providing medical advice which will help them down the road.
Maybe this all sounds a bit strange, the process of breaking down patient interactions as one would a piece of literature, but it actually has a name and some research behind it: Narrative medicine. Narrative medicine is a bit like the liberal arts approach to medicine. Boiled down, physicians practicing narrative medicine utilize many of the same skills that students, analysts and critics use in "close reading" a film or piece of text, with their patients. That is, they look to "read between the lines" of what patients are saying by taking special note of a patient's tone, their body language, their word choice, syntax and even the pauses they take between words. Then, once arriving at their conclusion, they help the patient by dispensing advice and a diagnosis specific to their particular "story." This kind of attention to detail, when done effectively, can enhance the quality of patient care, creating a fuller holistic approach to medicine that helps the patient feel cared for and empathetically connected, and also helps the physician accurate diagnose the patient with an increased perception.
Maybe it's just my English degree talking, but I'm drawn to a quote from a KevinMD article, A Dire Need for Narrators in Medicine that reads: "simply put, the physician is both healer and historian. The practice of medicine is a tactful balance, a constant challenge to construe information rapidly and responsibly." She goes on to compare physicians to writers who must "interpret unspoken words to make a diagnosis and propose a course of treatment" (Kumar). In this sense, physicians really do play a role similar to that of a writer within the medical context.
Hard and Soft Science
Immediately, "narrative medicine" doesn't have all the "hard science" backing of traditional medicine. It's secondary, supplementary even, to the hard facts and symptoms style of traditional medicine. With an emphasis on productivity, efficiency and financial logic, many physicians opt for these hard cues to minimize risk making the prospect of integrating narrative medicine into their practice a long and burdensome task.
I'd never suggest that every physician become a full-fledged narrative devotee, but if there's anything a reader can take from Rita Charon's research (JAMA, 2001) it's that many of the skills which writers cultivated for their craft can translate easily into any healthcare approach, and with successful results.
Listening and Interpreting
When performing any kind of critical analysis, whether it's a film, a text or a piece of music, the initial stage is always of listening and interpretation. Astute analysts will straddle a delicate line, drawing upon their own knowledge and experience, but will also leave the mental door open to the onset of new thoughts, ideas and concepts which they can add to their existing ones. They look for patterns, symbols, tropes and structure as a way to interpret the grander whole of the piece.
So too must physicians accomplish this task with their patients. When speaking with patients to acquire a medical history or simply to make a diagnosis, physician's must "decode" the language of the patients, seeing beyond their words. Close-reading physicians will ask verifying questions to shine light onto darkened areas they don't understand, and to pay special attention to non-verbal cues and body language. For example, do patients become visibly troubled by a certain word? Are they hesitating over a certain principle? How are they verbalizing their complaints? Any particular vocabulary they're using? Answering these questions can lead to greater physician understanding.
We all know that office appointments are short, as little as 15 minutes, and so this type of diagnoses needn't be overly thorough, but there's something to be said about trusting instinct as a human listener. Narrative physicians can follow up anything that stands out in the patient's delivery, and adjust their own delivery accordingly.
Knowing your Audience
Whether they're writing for a small, loyal gaggle of fantasy nerds or the entire internet community of diabetics, writers know that their work means nothing if they're not addressing the proper audience. Writers will tailor their work to suit the needs, understanding and even marketing level of their audience, dispensing with certain words and phrases and implementing others to best suit their potential readership.
Physicians must also be extremely wary of their audience when they're delivering information to any party. With patients, it's best to minimize medical jargon and terminology that they may struggle to comprehend. When speaking with other physicians, or with a specialist over some lab reports, physicians can use more medical terminology than they might with a patient.
Make a Statement, Adequately Support It
When proposing any sort of argument, statement, declaration or hypothesis, writers know that the unstoppable formula is to present their finding, and then to back it up with any amount of evidence they have to support their claim. They also leave room for argument and inquiry and address these claims soundly and adequately.
Physicians can also enact this kind of structure in their delivery. When delivering any kind of diagnosis, they should be sure to explain HOW they arrived at that particular diagnosis, what symptoms they followed and what in the lab work indicates this particular diagnosis. Then, should the patient have any questions, concerns or misunderstandings, the physician can follow up and address these individually, so as to help the patient feel secure and informed.
Streamlining for Better Understanding
A beloved professor of mine once told me that the absolute "key" to being a great writer was being able to take any idea, principle, or concept and explain it simply and succinctly to any audience.
I believe this to be true of physicians as well. Drawing upon their entire breadth of knowledge in the world of medicine, years of medical school and all the data available, the ability to take these (at times) extremely complicated medical conditions, and deliver them soundly to a patients is truly a skill that saves lives.
However, writers will often use various means to make their points, whether it's by using analogies, parables or other metaphors. Physicians can be creative this way as well. Phrasing their diagnoses as a narrative, and making the patient the "protagonist" of the story helps them stay engaged in the process, as well as feel connected to their physician. It creates an atmosphere of caring and compassion, and shows that the physician is truly engaged in helping the patient.
I'm certainly not saying that every physician should drop what they're doing and enlist in literary criticism classes at the local community college (though, if they can pull it off, I certainly wouldn't oppose it either). I am saying that there's a fair amount of truth to Charon's work, in that many of the skills that make for great writers will also translate to great doctors. If KevinMD and all the other physician blogging platforms are any indication, there's certainly a market for literate doctors who can utilize the processes of creating strong and engaging writing that also perform medicine. Those who don't wish to write can still take these writer's skills with them for better physician-patient interactions and enhanced health all around.
Charon, Rita, MD, PhD. "Narrative Medicine A Model for Empathy, Reflection, Profession, and Trust."
The Patient-physicianRelationship286.15 (2001): 1897-902. JAMA. Web. 15 May 2014.
Dizon, Don S., MD. "Can Narrative Medicine Inform Quality of Care?"
KevinMD.com. KevinMD, 7 Apr. 2014. Web. 15 May 2014.
Kumar, Sonal. "A Dire Need for Narrators in Medicine."
KevinMD. KevinMD.com, 11 May 2014. Web. 15 May 2014.