In my studies of bioethics, mediation, and, now, law, I have been struck by the pervasive applicability of narrative medicine.  The telling of one’s story, others’ hearing of it, and the remedying of relational schisms—all crucial elements of narrative medicine’s purpose as a discipline—constitute the main concerns of the bioethical and legal realms.  Health-care clinical mediation seamlessly unites medicine and law—disciplines that often appear at odds with each other—in its use of narrative medicine’s promotion of storytelling and the co-construction of narrative between adverse parties.

Mediation is one form of alternative dispute resolution (ADR), which seeks to avoid litigation as a means to resolve conflicts.  A mediator acts as an unbiased third party, who listens to the stories of parties in dispute and helps the parties hear one another, find common ground, and ideally reach a consensus.  As I studied mediation, participating in discussion of mediation theory and in role-play exercises, I couldn’t help but recognize many of narrative medicine’s goals and techniques.  Leaving temporal space for others to tell their stories; getting the chance to tell yours (unless you are the mediator, of course); weaving multiple stories into a new, united one; and serving as a literary interpreter of sorts, employing narrative ethics when determining whether to fill others’ narrative gaps: such narrative-enhancing techniques engender mutual respect and comprehension, and the clarity necessary for problem-solving.

Thus, the study of narrative medicine continues to inform my perception and experience of other disciplines.  Such disciplines’ fusing with narrative medicine will, no doubt, enrich both them and narrative medicine: the more perspectives we consider, the more effective we can be as storytellers and listeners.

A recent New England Journal contains an excellent Perspectives article by Dr. Steube, an academic OB/Gyn reflecting on the "adverse anecdote" influencing clinical practice:

"I’ve come to appreciate that the influence of a randomized, controlled trial — no matter how well conducted or generalizable — pales in comparison with that of the audible bleeding of a profound postpartum hemorrhage. As I tell residents and fellows, in the human mind, adverse anecdote — what I’ve come to call Level IV evidence — is more convincing than even the tightest of confidence intervals."

It's an excellent account of the way conventional evidence-based medicine combines with the singular experience of the patient and clinician -- our focus in Narrative Medicine. Even though Dr. Steube doesn't name narrative as such, her "adverse anecdotes" are really just another example of the power of the individual incident. Stylistically, too, the article moves fluidly between phrases like "odds ratios and heterogeneity P scores" and "a baby free-floating in the abdomen." 

The full text should be available through an institutional website, like Columbia's libraries. Post your thoughts below!

One of the biggest challenges I’ve faced since returning to medical school has been how to find space for narrative in between the conferences and lectures and rounds and clinic and consults that fill up my days. I’ve found two resources in particular to be incredibly helpful.

One is an ultra low-tech notebook. I like the Moleskine paperboard ones, but anything pocket-size and bound (rather than spiral) will do. Officially the notebook is for “clinical pearls” that attendings and residents cast before swine—I mean, the med students. But it’s also an excellent place to scribble down brief notes and observations, a few chosen words that recall a whole image. So my notebook is now full of odd juxtapositions, like “malodorous flesh wound: topical flagyl (crushed!)” and “butterflies dangle from ears, white dress slit to knees, it’s not ok, no it’s not ok.”

The other, slightly more technological, is the New Yorker Fiction Podcast. I first started listening to it when rotating at an affiliate hospital; each half-hour episode would just about cover my door to door commute. Downloads are free—music to a student’s ear, although I would willingly pay for these. The stories are uniformly excellent (it is the New Yorker, after all), and the readers are all accomplished writers themselves. Yesterday evening, while cooking dinner, I listened to Salman Rushdie read and discuss a Donald Barthelme story. It was the most highbrow lasagna I’d ever made. 

(Both images are clickable and will open in a new window.)

So there you go: two solutions to keep narrative alive.  Share other ideas in the comments section!

Hello Everyone!

Over the past year I've been asked by friends, family and even medical school admissions officers " What is Narrative Medicine?" Typically I explained to others that narrative medicine is an interdisciplinary exploration of the interpersonal aspects of medicine and it aims to develop clinical skills that will improve the effectiveness of healthcare. Some people immediately understood what that meant and pushed for more details. Others responded with a blank stare or a polite smile which indicated to me that they didn't quite understand what I was doing with my time. I wished I could help others not only understand, but also experience the power of narrative medicine. My desire to "show and tell" inspired me to launch this project with my colleagues at Columbia University. So I welcome you to The Intima, an e-journal dedicated to exploring the theory and practice of narrative medicine!