Defined broadly as medicine practiced with narrative competence, narrative medicine incorporates textual and interpretive skills into the practice of medicine. When doctors can recognize, absorb, interpret, and be moved to action by the narratives of their patients, they can practice a medicine marked by empathy, accuracy, and effectiveness. Unlike movements for humanism in medicine or professionalism in medicine, narrative medicine both calls for generous and empathic health care while proposing practical methods to achieve such care. Through rigorous and disciplined training in such narrative skills as close reading of literary texts and clinical texts, narrative writing about patients, and reflection on one's own clinical experiences, doctors can learn to attend accurately to what their patients tell them (in words, silences, gestures, and physical findings), can reconcile the multiple contradictory versions of any given clinical story, can interpret their own emotional responses to patients, can imagine robustly each patient's plight, can adopt the patient's or family's perspective on the events of illness and–as a result of all these–can offer singularly fitting care.
Narrative medicine is an outgrowth of insights gained and habits developed through the study of literature and medicine, patient-centered medical interviewing, and relationship-centered care. Its tradition includes biopsychosocial medicine, primary care medicine, the humanities and medicine movement, and narrative ethics. Narrative theory and knowledge provide fundamental conceptual frameworks for all of these dimensions of medicine while narrative skills and methods provide means of achieving narratively competent care.
There are practical and conceptual implications of narrative medicine in many aspects of clinical work. By far, the most important of these is the individual patient-doctor relationship, which can be fortified with accuracy and empathy through narrative methods. In addition, narrative medicine can help doctors to understand their own clinical experiences and their own journeys through doctorhood. Narrative practice can enhance professionalism by clarifying doctors' responsibilities toward one another as well as toward members of other health professionals. And perhaps a narratively sophisticated medicine can help to open the discourse–so urgently needed–with patients and potential patients within society to bring us closer to just and egalitarian health care for all.
The Program in Narrative Medicine was established in the Department of Medicine at Columbia University in 1996. Inaugurated and directed by Rita Charon, M.D., Ph.D., the Program supports an educational, research, and scholarly agenda for the entire Columbia University community. Its mission is to fortify medicine with ways of knowing about singular persons available through a study of humanities, especially literary studies and creative writing. To reach this goal, the Program trains health care professionals and trainees in many disciplines—medicine, nursing, social work, physical therapy, occupational therapy, psychoanalysis, pastoral care—in such narrative skills as close reading of literary and clinical texts, writing about patients in ordinary human language, and reflective autobiographical writing to reveal the self.
Since its establishment (first as the Program in Humanities and Medicine and, since 2000, as the Program in Narrative Medicine), the Program has directed required curriculum in the College of Physicians and Surgeons in the humanities, hosted faculty reading and writing groups, sponsored lectures and readings by poets and novelists at the medical center, undertaken externally-funded outcomes research in narrative training, and overseen the editorship of the journal Literature and Medicine.
Rita Charon, Narrative Medicine: Honoring the Stories of Illness (New York: Oxford University Press, 2006).
Rita Charon, "The Self-Telling Body." Narrtive Inquiry 16 (2006): 191-200.
Rita Charon, "Narrative Medicine: Attention, Representation, Affiliation." Narrative 13 (2005): 261-70.
Rita Charon, "Narrative Medicine: A Model for Emaphty, Reflection, Profession, and Trust.: JAMA 286 (2001): 1897-902.
