Narrative Medicine: What Patient Stories Can Tell Us

WASHINGTON, D.C.—Many physicians have dreams of becoming physician-writers—to see their work published in The Journal of the American Medical Association’s A Piece of My Mind column or in The New York Times—but few feel confident they have the skills and knowledge to pursue these goals. At the ACR Convergence 2024 session The Fundamentals of Narrative Medicine, two outstanding speakers regaled the audience with stories and practical tips on this very subject.

Origins of Narrative Medicine

Catherine Rogers

The first speaker was Catherine Rogers, MFA, MS, associate director and lecturer, Program in Narrative Medicine, Columbia University and Columbia University Vagelos College of Physicians and Surgeons, New York. Rogers draws on her background as a performer and playwright—her plays have been staged in New York and Athens, Greece, as she works with medical trainees and practicing physicians on developing their skills in narrative medicine.

The origins of narrative medicine come from the work of Rita Charon, MD, PhD, professor of medicine and chair, Department of Medical Humanities and Ethics, Columbia University Vagelos College of Physicians and Surgeons. Dr. Charon is a general internist who realized that, when working with patients and asking them questions solely about their symptoms, something was missing.

Dr. Charon recognized that patients come to the clinic as people with stories, yet medical school had not taught her to uncover and analyze these stories. Thus, she sought out learning with a literary scholar and pursued her PhD in English. In doing so, she saw that the skills used in literary analysis—understanding narrative through lines, interpreting stories—were highly relevant to medicine and could make doctors better in their professional activities. Thus, she brought together literary scholars, philosophers, actors, art historians and others to develop systems meant to increase the skills of paying attention, representing stories, writing about patients and developing therapeutic relationships.

Benefits of Narrative Medicine

Soon, Dr. Charon and others were able to develop a narrative medicine curriculum for first-year medical students at Columbia. Through these electives, students work, for example, with an art historian and use visits to museums and guided observation of artwork to inform their skills of clinical observation. Other students work with a dancer from the Mark Morris Dance Company and are allowed the opportunity to choreograph pieces that reflect on and represent the experiences of their patients. Rogers leads a class in which, over the span of six weeks, students write a one-act play and are invited to perform these works in public. When students are asked what they have gained from this experience, they respond that playwriting allows them to step into another person’s shoes, to imagine and explore a world different than their own, to gain a respite from the daily stresses of medical training and to grow comfortable with assuming their new role as a doctor (which, to many students, feels like taking on the role of a new character).