January 2014 – Narrative Medicine, S Vas

What is it???
• Be able to describe what Narrative Based
Medicine is
• Be aware of the advantages and
disadvantages of Narrative Based Medicine
• Consider the role of Narrative Based
Medicine in your practise as a GP trainee
“One day when Pooh Bear had nothing else to
do, he
thought he would do something, so he went
round to
Piglet's house to see what Piglet was doing. It
snowing as he stumped over the white forest
and he expected to find Piglet warming his toes
Narrative as a linguistic form
• It has a beginning, a series of unfolding events
and an end
• It has a narrator and a listener whose different
viewpoints affect how the story is told
• The narrative is concerned with individuals;
their feelings (not just facts) and how people
feel about them
Narratives in Medicine
“episodes of sickness are important milestones in
the narratives of patients’ lives”
• The narrative (verbal +/- written) provides
meaning, context and perspective for the patient’s
• Understanding the narrative provides a framework
for approaching a patient’s problems holistically
BMJ 1999 Greenhalgh and Hurwitz
Emphasis on the Medical History replaces the “native
ability” to elicit and appreciate patients’ narratives
1998 Kleiman
An Example of Narrative Medicine in Practise
• http://www.youtube.com/watch?v=24kHX2
The CSA (http://www.rcgp.org.uk/gp-training-and-exams/mrcgp-examoverview/~/media/Files/GP-training-and-exams/MRCGP-Clinical-Skills-Assessment-Jan2012.ashx ):
– Being curious about the patient and trying to understand their perspective will help you
to identify their views (Heading 12)
– How is the problem affecting the patient? What changes have they had to make to their
life because of this problem? Who else is affected by the problem? (Heading 14)
Can be
Promote empathy and
understanding between
patient and clinician
“Questions some of the
certainties of Medicine
and Science”
Encourage a holistic
traditional medical
Enhances listening and
interpretive skills
Time constraints especially with 10
minutes consultations
Would get in the way
of QOF and “boxticking”
Fear of litigation driving the need to
meet the doctor’s agenda i.e. red
Patients seek “conventional medical
explanations for their problems”
Narratives and Fiction
“we construct our view of reality by telling stories” Dr John
Launer (gptraining.net)
Written Tasks