|ART AND MEDICINE
|Year : 2016 | Volume
| Issue : 3 | Page : 118-119
Narrative and Dialog
Rachel Hajar M.D.
Senior Consultant Cardiologist, Director, HH Publications and Executive Coordinator for Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
|Date of Web Publication||19-Oct-2016|
Senior Consultant Cardiologist, Director, HH Publications and Executive Coordinator for Research, Heart Hospital, Hamad Medical Corporation, Doha
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Hajar R. Narrative and Dialog. Heart Views 2016;17:118-9
In a peasant house, a sick woman lies on bed. An old physician is writing a prescription on a table, on which there are already three small bottles of medicine. He is surrounded by the patient's relatives, concerned but full of hope, all wearing traditional peasant costumes. An old man and a boy sit on a chair at the other end of the table; a middle-aged pair stand behind the table; an old woman and a small girl sit near the bed of the sick woman. In contrast to them, the physician (whose hat, leather gloves, and umbrella are put on the table) wears an urban costume as a sign of his prominent status.
Alexandru Gh. Sonoc, PhD
Brukenthal National Museum, Sibiu, Romania
Image and text source:
Accessed 2016 Sep 30
| Telling and Listening – the Patient–physician Encounter|| |
”As patient meets physician, a conversation ensues. A story—a state of affairs or a set of events—is recounted by the patient in his or her acts of narrating, resulting in a complicated narrative of illness told in words, gestures, physical findings, and silences and burdened not only with the objective information about the illness but also with the fears, hopes, and implications associated with it. As in psychoanalysis, in all of medical practice the narrating of the patient's story is a therapeutically central act, because to find the words to contain the disorder and its attendant worries gives shape to and control over the chaos of illness.
As the physician listens to the patient, he or she follows the narrative thread of the story, imagines the situation of the teller (the biological, familial, cultural, and existential situation), recognizes the multiple and often contradictory meanings of the words used and the events described, and in some way enters into and is moved by the narrative world of the patient. Not unlike acts of reading literature, acts of diagnostic listening enlist the listener's interior resources—memories, associations, curiosities, creativity, interpretive powers, allusions to other stories told by this teller and others—to identify meaning. Only then can the physician hear—and then attempt to face, if not to answer fully—the patient's narrative questions: 'What is wrong with me?' 'Why did this happen to me?' and 'What will become of me?'
Listening to stories of illness and recognizing that there are often no clear answers to patients' narrative questions demand the courage and generosity to tolerate and to bear witness to unfair losses and random tragedies. Accomplishing such acts of witnessing allows the physician to proceed to his or her more recognizably clinical narrative tasks: to establish a therapeutic alliance, to generate and proceed through a differential diagnosis, to interpret physical findings and laboratory reports correctly, to experience and convey empathy for the patient's experience, and, as a result of all these, to engage the patient in obtaining effective care.
If the physician cannot perform these narrative tasks, the patient might not tell the whole story, might not ask the most frightening questions, and might not feel heard. The resultant diagnostic workup might be unfocused and therefore more expensive than need be, the correct diagnosis might be missed, the clinical care might be marked by noncompliance and the search for another opinion, and the therapeutic relationship might be shallow and ineffective.
Despite—or, more radically, because of—economic forces that shrink the time available for conversation and that limit the continuity of clinical relationships, medicine has begun to affirm the importance of telling and listening to the stories of illness. As practice speeds up, physicians need all the more powerful methods for achieving empathic and effective therapeutic relationships. Narrative skills can provide such methods to help physicians join with their patients, honoring all they tell them.”
Charon, Rita. “Narrative Medicine.” Jama 286.15 (2001): 1897-1902