Narrative medicine has emerged in response to a commodified health care system that places corporate and bureaucratic concerns over the needs of the patient. Generated from a confluence of sources including humanities and medicine, primary care medicine, narratology, and the study of doctor-patient relationships, narrative medicine is medicine practiced with the competence to recognize, absorb, interpret, and be moved by the stories of illness. By placing events in temporal order, with beginnings, middles, and ends, and by establishing connections among things using metaphor and figural language, narrative medicine helps doctors to recognize patients and diseases, convey knowledge, accompany patients through the ordeals of illnessand according to Rita Charon, can ultimately lead to more humane, ethical, and effective health care.
Trained in medicine and in literary studies, Rita Charon is a pioneer of and authority on the emerging field of narrative medicine. In this important and long-awaited book she provides a comprehensive and systematic introduction to the conceptual principles underlying narrative medicine, as well as a practical guide for implementing narrative methods in health care. A true milestone in the field, it will interest general readers, and experts in medicine and humanities, and literary theory.
Reviewer:Vincent F Carr, DO, MSA, FACC, FACP(Uniformed Services University of the Health Sciences)
Description:Dr. Charon presents her thoughts about the medical profession's failure to hear the life stories of patients. In contrast, she shares many stories of her patients over the years and how many of these patients could not find answers to their problems because their physicians were unable or unwilling to spend the time to understand what they were indirectly telling them.
Purpose:The author offers "narrative medicine" as a new form of clinical practice in which physicians develop a "competence to recognize, absorb, interpret and be moved by the stories of illness." She brings her extensive experience with both patient care and the English language to challenge readers to listen and then feel with the patient the nonclinical aspects of medicine. The author presents a compelling discussion.
Audience:The audience is clearly medical practitioners of all ages and specialties. The author introduces her concepts to her medical students and, as part of their clinical rotation, has them write their thoughts in relation to their patients, the parallel chart. There is much wisdom in this approach for the mental well-being of her students as they traverse the field of residency training.
Features:The author presents the equivalent of a semester course in blending a study of English literature and language, the practice of medicine, and the philosophical foundations for maturing physicians. It takes a significant amount of time to read and reflect on Dr. Charon's work. At first reading, the work appears tremendously wordy (a 13-page preface). But after spending the time to consider what the author is presenting, the beauty of her words shines through. She has incorporated a great number of classic literature and film references that entice readers to investigate further and see how they fit in the discussion. She has also explored her personal thoughts and philosophies of these works. One of the sections that initially appears tangential to the discussion is about the role of autobiographies in literature and history. After reading it however, it becomes quite clear how it perfectly supports the author's premise.
Assessment:This is a great book, but not one for fast assimilation. This is a book that takes much work to understand, but readers will be warmly rewarded for their efforts. I highly recommend that all involved in patient care read this a number of times, with each reading separated by a few years, so that they may understand where they have come from, where they currently are, and where they should be headed. Well done.