Narrative Medicine Save

I am a woman in pediatric rheumatology. Even in a predominantly female field, at times I feel compelled to mask my emotional response to the consistently complicated, often overwhelming and sometimes ambiguous nature of the job. Rather than detach, however, I choose to emotionally engage with the medical experience through my own medicine: narratives.

Storytelling and narrative have played a central role in human culture since the first humans inhabited the earth, serving to entertain and to teach people how to be and do better. (1) More recently, research has shown that storytelling can empower girls and women to find their voices, offering a space to disrupt the conventional gender socialization where a woman’s voice is thought to be less than. (2) This female empowerment for women to be champions and change agents through storytelling is augmented through narrative medicine, a novel field giving practitioners in general and women in particular space to be heard.

As Rita Charon describes it, narrative medicine is “medicine practiced with the narrative competencies to recognize, absorb, interpret and be moved by the stories of illness.” (3) Narrative competence, or the ability to “acknowledge, absorb, interpret and act on the stories and plights of others,” incorporates the practice of close reading, close listening, and close viewing. (4) By taking the time to practice the skill of reading between the lines of Emily Dickinson’s “Because I could not stop for Death,”  I was better able to understand a patient’s verbalized struggle with the life-threatening nature of systemic sclerosis. Harnessing the ability to notice the brushstrokes in Claude Monet’s ‘Sunrise’ similarly fortified my ability to describe splinter hemorrhages or livedo reticularis. Understanding the intonations in a spoken word piece support a new level of attention when I listened to a colleague’s cracked voice as they struggle with prognosis and management of systemic Juvenile Idiopathic Arthritis-related lung disease. 

These core narrative skills offer a foundation for deeper connection between patient, providers, colleagues, and self. Importantly, narrative medicine further allows participants to engage with societal expectations, including expectations of females in medicine. 

As a woman in rheumatology, I find the narrative space to be freeing, complementing the multidimensional role that we women in rheumatology embrace. By engaging with my colleagues in a narrative space of art or music or writing, I’ve reflected on the savageness of the Omicron variant of SARS-CoV2, the realities of fatigued practitioners as wounded healers, and the mistaken presumptions where women doctors are all-too-often called nurses. By practicing these narrative-based skills, I have found a community of engaged colleagues interested in advancing their own connectedness with the world.

The option of reflective writing or drawing, however, is just that: one option of many. You may instead choose to engage in formal humanities seminars and visual teaching strategies, attend storytelling events for clinicians or read and contemplate patient or parent stories of healthcare. (5) Use narrative medicine as an educational tool, recognize as an educator, the ability to tell the right story at the right time is essential to capture your audience. Seek out narrative medicine facilitator trainings across the country and spread the word about the value of this growing field. 

Or, perhaps most simply, notice when it’s your turn to listen to a story, and find medicine in the narrative.

For more resources and information on narrative medicine, please visit www.rheumnarratives.com.

1. Lawrence RL, Paige DS. What our ancestors knew: Teaching and learning through storytelling. New Directions for Adult and Continuing Education. 2016;149:63-72.
2. Hlalele D, Brexa J. Challenging the narrative of gender socialization: Digital storytelling as an engaged methodology for the empowerment of girls and young women. 2015;79-88.
3. Charon R. Narrative medicine: Attention, representation, affiliation. Narrative 2005;13(3):261-70.
4. Charon R. Narrative medicine: A model for empathy, reflection, profession, and trust. JAMA 2001;286:1897-902.
5. Fleishman R, McAdams RM, Carter BS & Gautham KS. Narrative neonatology: Integrating narrative medicine into the neonatal intensive care unit. J Perinatol 2022.