A narrative approach to medicine

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A narrative approach to medicine
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Aims and objectives

• What is narrative based medicine?
• To consider narrative as a way of learning and
  understanding
• To try some narrative of our own
• To consider if and how you might use this in your
  future learning and practice

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Types of narrative

• The patients story
• Narrative provides meaning, context, and
  perspective for the patients predicament
• Doctors narrative
• Exploration of own feelings and reactions
• Anecdotes fictional literature
• Anecdotes and fiction are a window onto the
  world

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Why use narrative?

• Understand a patients experience
• Encourages empathy and promotes understanding
  between the clinician and patient
• Encourages a holistic approach
• Facilitates reflective practice
• Enhances listening and interpretive skills
• Gives meaning to the patients experience and so
  can be therapeutic
• Memorable

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Medical uses

• Facilitating the traditional medical history
• Counselling
• Psychotherapy
• Education

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Working in pairs

• What are some of the challenges to a narrative
  based approach?

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Challenges to a narrative based approach

• Video consultation skills teaching now primarily
  based on COT competencies
• A target based approach to WPBA
• Time constraints of the 10 minute consultation
• Fear of litigation and need to meet the doctors
  agenda red flags etc
• QOF, LQOF

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Look closer
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Time for you to have a go!

• Close your eyes and spend 2 minutes reflection on
  an embarrassing, funny or memorable event
• Working in pairs take it in turns to share you
  experience

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Write your own story

• Over the next 10 minutes write a description of
  an experience that has changed your practice
• A memorable patient
• A memorable consultation
• A memorable meeting or lifetime event
• Your experience as a patient

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After coffee small group work

• Person A - Tells their story
• Person B - Listens without interrupting, then
  discusses it with person A to explore the story
  its context, meaning and implications for the
  individual.
• Person C - Observes the process, this is a
  listening exercise, watching and listening to how
  they story unfolds Language, emotion, details,
  body language etc
• Final 5 minutes discuss the process between all
  of you before changing places

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Time to coffee
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Trio working

• Person A - Tells their story
• Person B - Listens without interrupting, then
  discusses it with person A to explore the story
  its context, meaning and implications for the
  individual.
• Person C - Observes the process, this is a
  listening exercise, watching and listening to how
  they story unfolds Language, emotion, details,
  body language etc
• Final 5 minutes discuss the process between all
  of you before changing places

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Recommended reading

• Ruth Picardie Before I say goodbye
  Recollections and observations from one womans
  final year
• John Diamond because cowards get cancer too
• Jean-Dominique Bauby The diving bell and the
  butterfly
• Narrative based medicine BMJ 1999 a series of
  five articles