As an internist at Presbyterian Hospital in New York City, Rita Charon realized that more could be gained from learning a patient’s story than just charting symptoms as a series of head-to-toe facts. Encompassing health and sickness in a storied structure, with form, frame, characters, plot, and point of view—skills Charon learned while pursuing a PhD in English at Columbia University—had clinical significance.
In 2000, Charon founded the Program in Narrative Medicine at the Columbia University College of Physicians and Surgeons to teach future doctors how to elicit, interpret, and act upon the stories of their patients. The skills came through rigorous training in close reading, attentive listening, and reflective writing on stories of illness. By studying how narratives work, doctors could build trust, develop empathy, and foster a sense of shared responsibility in a patient’s health. An article in the March 2011 issue of Academic Medicine described an experiment that followed 891 diabetic patients for three years to see if their health outcomes related to their physicians’ empathy levels, which was measured in part by “an understanding of the patient’s experiences, concerns, and perspectives.” The results showed “the likelihood of good control [of diabetes] was significantly greater in the patients of physicians with high empathy scores than in the patients of physicians with low scores.”
“Stories are complicated things. They do not relinquish their meanings easily,” Charon says. “By teaching clinicians how stories work, what happens to their tellers and listeners, and where stories hide their news—in form, in metaphor, in mood, in time and space—we enable them to enter the narrative worlds described by their patients. So clinicians can receive what their patients reveal about their lives and health, leading to accurate clinical diagnoses and personal recognition. They hear in depth what their colleagues report about their patients. They even come to be more forcefully aware of their own interior voices in self-awareness.”
Since receiving $185,000 from NEH in 2003, Charon and a group of multidisciplinary scholars and clinicians wrote a textbook in narrative medicine published by Oxford University Press, and have influenced medical education and clinical practices across the United States and around the world. Narrative medicine curricula and projects can now be found in the United States, Canada, Europe, Latin America, the Middle East, and Australia. Going beyond physician training, workshops regularly attract nurses, social workers, mental health professionals, chaplains, and academics. In 2009, to fulfill demand for training, Columbia inaugurated a Master of Science in Narrative Medicine. To reach those who cannot move to New York for a year, an online Certification of Professional Achievement in Narrative Medicine is in the pipeline.
Charon acknowledges time with patients is often limited, making narrative medicine training a vital component. “The clinician has to be expertly trained to hear and register and interpret accurately everything that a patient might say. We cannot afford to squander one word or one piece of evidence. Narrative medicine training strengthens the listener’s capacity and speed and accuracy in receiving what their patients want them to know.”