Further readings on narrative medicine

Narrative based medicine in an evidence based world

by Trisha Greenhalgh

In a widely quoted riposte to critics who accused them of naive empiricism, Sackett and colleagues claimed that “the practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice.”1 Sackett and colleagues were anxious to acknowledge that there is an art to medicine as well as an objective empirical science but they did not attempt to define or categorise the elusive quality of clinical competence. This article explores the dissonance between the “science” of objective measurement2 and the “art” of clinical proficiency and judgment,35 and attempts to integrate these different perspectives on clinical method.

Narrative MedicineA. Model for Empathy, Reflection, Profession, and Trust

by Rita Charon

The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. Adopting methods such as close reading of literature and reflective writing allows narrative medicine to examine and illuminate 4 of medicine’s central narrative situations: physician and patient, physician and self, physician and colleagues, and physicians and society. With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care. By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care.

Cultural contexts of health: the use of narrative research in the health sector

by Trisha Greenhalgh

Narrative (storytelling) is an essential tool for reporting and illuminating the cultural contexts of health – that is, the practices and behaviour that groups of people share and which are defined by customs, language and geography. This report reviews the literature on narrative research, offers some quality criteria for appraising such research and gives three detailed worked case examples: diet and nutrition, well-being, and mental health in refugees and asylum seekers. Storytelling (and story interpretation) belongs to the humanistic disciplines and is not a pure science, although established techniques of social science can be applied to ensure rigour in sampling and data analysis. The case studies illustrate how narrative research can convey the individual experience of illness and well-being, thereby complementing (and sometimes challenging) epidemiological and public health evidence.

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