Medical storytelling

Narrative medicine helps DO piece together patients’ stories

Daniel Waters, DO, explains how narrative medicine can help physicians better empathize with patients.

When it comes to matters of the heart, cardiac surgeon Daniel Waters, DO, uses narrative medicine to better empathize with patients. When a patient tells him about symptoms, he listens actively. As the patient’s story emerges, he works with the patient to tease out the narrative’s missing pieces to obtain a fuller picture of what’s going on.

In this edited interview, Dr. Waters, who recently earned a certification in narrative medicine, explains how physicians can use the approach to enhance their bedside manner.

What is narrative medicine?

Narrative medicine teaches clinicians to use patients’ stories as a focal point of their care. The goal is to be empathetic without losing your clinical objectivity.

There are 100 different stories that start with “my head hurts.” To be able to sit down and connect with the plot and the characters of that story is what it means to be a narrative medicine doctor.

Two common patient complaints about their physicians are, “they didn’t really listen to me,” and “I don’t think they care about me.” Narrative medicine teaches you how to listen to a patient’s story, how to care about it, how to empathize with it, and how to put it in context while still being objective.

While the field is still fairly new, physicians interested in narrative medicine can partake in basic workshops from its originators at The Columbia University Medical Center, or obtain certification from a growing number of schools that offer narrative medicine programs. I received my certification in narrative medicine from Lenoir-Rhyne University.

How did you get into narrative medicine?

It was serendipity more than anything else. Narrative medicine found me. This is what I’d been looking for for 30 years. My mother constantly read to me when I was a kid. I’ve been writing stories since high school and have never found a reason to stop. Three years ago, I came across an article about narrative medicine, which led me to earn my certification.

Daniel Waters, DO

I got my certificate so I could offer narrative medicine training to the internal medicine, general cardiology, and interventional cardiology residents at Mercy Medical Center of North Iowa in Mason City, where I’m the director of medical education. When the residents get here in August, I’m going to institute a narrative medicine seminar that will extend through the academic year.

Every patient encounter starts with a story. Residents will be taught to understand those stories, who the major characters are, and what the plot looks like. We will also practice reflective writing, where residents will be given about 10 minutes to answer a writing prompt, but they won’t know when it’s coming or what the prompt is going to be. Learning how to tell a story helps physicians become better listeners.

How is narrative medicine similar to osteopathic medicine?

Narrative medicine is essentially osteopathic in its approach. As a DO, I don’t just want to hear about patient symptoms and look at lab tests. Let me spend a couple minutes listening to the patient tell me what’s going on. Narrative medicine and osteopathic medicine have parallel goals.

The hope is that by practicing narrative medicine, we will have an additional tool to empathize with patients.

2 comments

  1. I agree that listening to, and discussing the patient’s [ongoing] story is crucial to understanding and helping with his or her medical conditions. I worked for a few years at a big hospital clinic where my time was always limited to “one problem” and my patients were encouraged (by support staff at the direction of management) not to “waste their (and my) time” on other matters. I did not believe this was the appropriate way to provide care and had conflicts with corporate management staff, whose response was, “That’s the way it has to be; it’s like that everywhere.”
    I left the hospital clinic and opened my own small office, and my patients loved my care. They frequently remarked (to me and to others) that I listened to them and didn’t just “rush them through their visits” or “stand with my hand on the doorknob”, as their previous and other concurrent providers did.
    However, this approach takes more time, limiting the number of patients that can be seen. Besides seeing fewer patients, it was difficult to obtain compensation for my time, to the point that I could not meet my expenses. After two years of spending all my own money to support the office and to maintain this approach, I had to close my solo practice. I am now deeply in debt and will be returning to a corporate medical environment, where I expect I will have to become one of those doctors who stands at the door, in order to meet my production expectation.
    What is the solution?

  2. Encorage people to write a list of concerns. It allows you to see their agenda and the most concerning thing may be #5. Sometimes, I review it, examine based on it, and order lab that’s appropriate. If the list is so extensive it can’t be addressed in one visit, I explain I need more time at a second visit or negotiate what the best means of follow up could be for that person. It’s fun and targeted. I also have prompt after the visit for my note. Doesn’t take that much more time.

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