Narrative Medicine

What is it, and why is it a good idea?

Wendy Hind, a physician who has a son with a congenital heart condition, recently wrote a moving blog about the benefits of Narrative Medicine (NM). NM incorporates individual’s stories into health sciences as they are seen as being fundamental to the human experience. NM helped Wendy both as a doctor and as a mother of a sick child.

NM entails:

The benefits of this empathic collaborative type of interaction are manyfold as stress, feelings of isolation and repressed emotions can exacerbate any physical ailment. Time spent empathically encouraging the patient to tell their story can precipitate healing from the first encounter – before medical treatment is even started.

Narrative Medicine in action

I attended an oncology appointment with a friend whose new consultant spent time during the first meeting getting to know Debby, listening compassionately to her story, and I witnessed Debby visibly relaxing. Her attitude from then on changed and she began to look after herself better and became strong enough for treatment to begin.  

At the next appointment, the oncologist was delighted and surprised that the scan results showed a reduction in the size of the tumours, though treatment had not yet started. However, an unfortunate previous experience which I also witnessed, when there seemed to be a lack of interest in her story, and judgmental comments made about the fact she had smoked for many years, had left her feeling hopeless.  

More than a name on a chart

Such a contrast to an empathic physician who showed an interest in not only her symptoms but in her narrative – in her feelings and what mattered to her – who played a major part in her quitting smoking, starting to eat properly again and perhaps even to the cheering scan results. Debby gained 18 fulfilling months, way beyond her prognosis. She gained the time and the desire to fulfil her dearest wish which was to be reunited with her estranged daughter.

Providing effective training in the skills of empathy and building rapport with patients is an essential part of any training programme particularly as we now have evidence showing that emotions directly modulate the immune system; chronic stress impairs immune function.

Patients are likely to feel safer and calmer when they are listened to and encouraged to tell their story, even in situations where diagnosis and treatment are not immediately available, as they no longer feel alone with the problem. The fight/flight/freeze response will remain ‘on’ when there is any perceived threat, and this primitive though essential ‘survival’ state dampens down the healing process until there is a perception that we are safe. Better to get out of the firing line and use our valuable resources for this than to utilise energy on healing in the heat of danger! 

Inflammatory cytokines and gut microbiota are actively involved in what has been termed ‘affective immunology.’ Recent compelling evidence has shown that the emotional and immunological systems share more than a role to keep us safe – they communicate! Thus, attending to both are part of the healing process. Fascinating research at UCL demonstrated that expressing emotions reduces stress (frontal lobe activity is increased, amygdalae activity decreased, and cortisol is lowered)… and chronic stress impairs immune function!

DasGupta and Charon believe that training in Narrative Medicine benefits both the practitioner and the patient – stress levels are reduced for both. This skill being taught in all medical schools could enhance physician satisfaction and help reduce burnout, especially when unable to offer an explanation as to the cause of complex chronic health issues.