Medical Students Learn to Tell Stories about Their Patients and Themselves

A small group of third-year medical students and interdisciplinary faculty sit around a table. The students look weary—stethoscopes slung around their necks, white coats slightly rumpled, pockets overflowing with smartphones, pens, scraps of paper, a half-eaten candy bar. They are not sure what to expect, but they are glad to sit down.

“Tell us a story about one of your patients,” an attending physician invites the group.

The students exchange uncertain glances. Finally, one takes the plunge. “Patient is a 32-year-old Latino male who presented with—”

Another faculty member smiles as she holds up a hand. “That sounds like a case presentation. Tell us a story.”

So begins an hour-long session in the internal medicine clerkship. One by one, students tell stories about their patients. Faculty and peers listen, eventually question, comment, and probe. The encounter touches on ethical, communication, and relational issues, but its primary goal is to introduce students to the concept of narrative medicine. At its core, the session is designed to help students appreciate the value of attending to the patient’s story and realize that when we tell stories about our patients, we are also telling stories about ourselves.

Students enter their third year longing to work with patients. Inevitably, this means learning something about the events and experiences that make their patients unique human beings. But students discover that their physician role models are often more focused on evidence-based medicine than patient-centered care. There does not seem to be enough time to listen to patients’ stories, or they are deemed “not relevant” to clinical care [1, 2]. As a result, these third-year students lose the opportunity to acquire compassion and empathy for their patients. If we, as their teachers, are not attentive to the narrative aspects of medicine, students’ capacity to relate to their patients’ stories might be lost.

The narrative medicine movement developed with the aim of returning attention and emphasis to patients’ stories [3-5]. The pioneering work of Rita Charon highlighted specifically literary aspects of patients’ narrative, such as frame (why the story is being told and for what purpose), tone (language, metaphor), time (both the chronological trajectory and the significance of time in the story), plot (what happens), and desire (what motivates the narrator to keep telling and the audience to keep listening to the story) [6]. Charon argues that narrative competence, including how to interpret, respond to, and be moved by patients’ stories, is an essential component of doctoring [7]. The inclusion of narrative medicine approaches in medical education is intended to stimulate critical thinking, develop moral imagination, and foster the desire to act beneficently to promote patient welfare.

Drawing upon this framework, the patient stories session introduces a narrative approach by addressing five specific objectives. First, it helps students distinguish between a “story” and a case presentation [8]. This is a valuable distinction. Case presentations organize facts; stories, with their coherent narrative arc, provide meaning [9, 10]. It is only the patient’s story that can tell us what the illness means to the patient, how illness has interrupted and perhaps permanently altered the patient’s life. By focusing on the patient’s view of his illness, the storyteller mentioned above began to reflect on what it might be like to be his patient—a young man with rectal bleeding untreated for a year because of lack of insurance. continua a leggere

Articolo di Johanna Shapiro, Elena Bezzubova e Ronald Koons su American Medical Association