From storytelling to healing: The empathetic power of narrative medicine

When I was studying narrative medicine at Columbia University’s Department of Medical Humanities and Ethics, students were asked to tell a story about a significant health encounter. This is what I said: I once accompanied my elderly father to his doctor’s visit. The physician reported that his bad cholesterol was too high, and that he should cut back on all the shrimp he was consuming or else he’d die of heart disease.

Dad’s reply? “At 83, I’d rather die than stop eating shrimp.”

No follow-up questions. End of patient encounter.

On the ride home, I asked my father why he said what he said. He complained that the doctor didn’t take the time to ask why it was so important for him to eat whatever he wanted at his age. Although he had been retired for 20 years at this point, in his mind, he was still a factory laborer who deserved to indulge himself in his retirement, mortality be damned.

‘A person with a story’

My father was not only a patient, but also a person with a story. The physician, however, didn’t recognize his brief retort as a one-sentence story packed with personal meaning. To comprehend how meaningful a succinct narrative can be, consider and reflect upon the literary world’s most famous six-word story: “For sale: baby shoes, never worn.” The story serves as a testament to the power of minimalism in narrative, evoking strong emotions with just a few words.

Patient narratives require empathic inquiry and non-judgmental curiosity. When one is confused by what a patient says, the first step is to acknowledge it and then seek clarity.

Rita Charon, MD, PhD, a general internist and literary scholar, is widely credited for starting the narrative medicine movement. It is an interdisciplinary field that recognizes the importance of the stories patients tell about their illnesses and the stories clinicians construct about their patients. This approach validates patients’ experiences, enhancing the therapeutic clinician-patient relationship, and improving health care delivery.

In her groundbreaking book, “Narrative Medicine: Honoring the Stories of Illness,” she acknowledges the challenge of gathering biomedical data and simultaneously listening to the patient’s story. According to Dr. Charon, the practice of medicine requires narrative competence, or the ability to recognize the story, absorb and interpret it and be moved to action by what we are hearing. She also describes the approach to training clinicians to pay close attention to what patients are saying and to validate what they are hearing.

Hitting the books

In narrative medicine training, the ability to recognize and follow the patient narrative is developed through the practice of close reading. We learn to “read patients” by carefully analyzing written and graphic “texts,” focusing on details, context, subtext and emotional undercurrents. The texts are then discussed in a spirit of collaboration, where meaning is co-constructed. Participants are then given a prompt by the workshop facilitator and are asked to represent in writing how the text and the discussion resonates with them. The participant-generated texts are then read closely and discussed by the participants.

This process helps clinicians develop empathic listening with complete attention, presence and intention. It involves being fully in the moment and tuning into the speaker without getting sidetracked by one’s own thoughts, judgments or preconceptions. This form of listening is rooted in the principles of mindfulness: A mental state achieved by focusing one’s awareness on the present moment.

Using literary and graphics texts in narrative medicine, rather than exclusively practicing with actual patients, offers several advantages that complement and enhance clinical training and practice:

• Building empathy – Fiction texts, in particular, require readers to put themselves in another’s shoes, fostering empathy. This skill is invaluable when interacting with patients, as it enables clinicians to better understand and address their concerns and emotions.
• Safe space for exploration – The texts provide a safe environment for health care professionals to explore challenging and emotionally charged situations without the risk of causing harm to actual patients.
• Diverse perspectives – The works often provide insight into a wide range of human experiences and cultures, allowing readers to engage with perspectives they might not encounter in their everyday practice.
• Complexity and ambiguity – Unlike medical case studies, which often have clear diagnostic and treatment pathways, the texts often embrace ambiguity and complexity. Engaging with such texts can help health care professionals become more comfortable with uncertainty, a frequent reality in medical practice. The texts can sometimes evoke strong emotions.
• Emotional processing – By engaging with these emotions in a controlled setting, health care professionals can develop strategies to manage their own feelings in real clinical situations.
• Renewal and avoiding burnout – Engaging with literature and the arts can be a rejuvenating experience, providing a respite from the demands of clinical practice and reducing the risk of burnout.

Physicians seeking to gain or improve their own narrative medicine skills can enroll in courses offered at Columbia University or at the Keck School of Medicine of University of Southern California. These courses involve pedagogy, qualitative research, narrative ethics and creative writing, among other topics.

Additionally, health care professionals may participate in workshops that are open to the public, such as the programs available through Columbia University’s live group sessions. I personally am a regular workshop co-facilitator. Those interested in these workshops should visit the Connections in Narrative Medicine blog. Additionally, I am also a co-facilitator of bimonthly sessions through the Simulationist Narrative Medicine Community, a free resource I started in 2020 to help teach narrative medicine.

I am always happy to assist those looking to know more via email.

Osteopathic medicine and narrative medicine

Both osteopathic medicine and narrative medicine, while distinct in their origins and primary goals, emphasize holistic approaches to patient care. Their connection arises from their shared commitment to seeing and treating patients as whole persons rather than just as diseases or symptoms.

By valuing the entirety of the patient’s experience and recognizing the profound interconnections between body, mind and spirit, narrative medicine resonates deeply with the osteopathic approach to care.

Related reading:

My journey to finding the right fit: What I learned when I searched for a physician and found my dream OB-GYN

Vulnerability: The path least taken