The Patient`s Story: Student Essays on Authentic

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Narrative Medicine: Student Essays on Authentic
Environments and Personal Experiences
Robert J. Bulik, Ph.D.
The Family Home Visit program, a community-based experience for first year medical
students during Block III of the Practice of Medicine I (POM) course, is designed to
improve interviewing skills in a non-clinical setting, to foster the appreciation of patients
as persons and not clients or diseases, and to understand how the family relates (interacts)
to each other and how disease processes or medical conditions may affect the patient and
family. One of the POM I course requirements and an expected outcome of the Family
Home Visit is the Patient’s Story essay, written by students after visiting families in their
homes and reflecting on the experiences (the “story”) of the individuals interviewed.
This element of the curriculum relies on narrative “competence” or narrative medicine:
“…the ability to acknowledge, absorb, interpret, and act on the stories and plights of
others”. While the medical case history and history of present illness are very good
approaches to generating a differential diagnosis, some authors have pointed to the
dehumanizing affect which results in objectifying the process and in “erasing” the
connection between the individual and their disease.2
One approach to humanizing the physician-patient relations can be found in the
nursing and allied health literature and centers on moving from simply patientstorytelling to student-created narrative. In developing a written narrative from what was
heard (or left un-said), the student learns to hear the patient, thus creating a caring and
healing environment within the doctor-patient relationship. The Patient’s Story has the
following elements:
Patient Home Visit – Patient Story Essay
An essay, similar to a short story, contains several elements – an introduction, character development,
setting description, and an interesting plot. Based on the elements of narrative medicine and active
listening discussed in small groups, develop your patient’s Story from your home visit.
In addition to the four elements of a short story, the importance to you of your patient’s story
(meaning-making or interpretation), is an essential element that can be demonstrated in one of two
ways within the essay – at the conclusion of each of the four sections as a transition to the next; or, as
a separate section that provides a conclusion to your patient’s story.
Introduction
An introduction to an essay (or short story) sets the stage for the reader for the story. It provides more
than a simple physical description; it establishes the context for your patient’s story.
Character
Throughout the story, the focus should remain on the character and their thoughts, actions, reflections,
relationships, and history.
Setting
The four methods of direct character presentation are appearance, speech, action, and thought. If
character is the foreground of your story, setting is the background – and as in a painting’s
composition, the foreground may be in harmony or in conflict with the background. As you
characterize your patient in terms of gender, race, and age, you need to also describe what
environment she or he lives within.
Plot
A story can be considered a series of events recorded in their chronological order. A plot (as an
element of the story) is a series of events deliberately arranged so as to reveal their significance to
both the writer and the reader.
Interpretation
As author, reflect on similarities and differences between your own observations and patient’s
descriptions, analyze family interactions, reflect on the influence of family on doctor-patient
relationship, and reflect on the impact of insights gained on future clinical practice.
In order to appreciate or at least understand someone else’s situation, we are sometimes
advised to “walk a mile in that person’s shoes”. When we ask our medical students to
conduct a family home visit, we hope they will come to appreciate the wide diversity of
people and circumstances with which they will be working as practicing physicians – we
are asking them to at least recognize the different “shoe sizes” that exist in all our
communities.

Charon R. Narrative medicine: A model for empathy, reflection, profession, and trust. JAMA.
2001;286:1897-1902.
2
Sobel RS. Recognizing the poverty of the medical case history. Acad Med 2000;75:85-9.
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