Interview to Trish Greenhalgh

RCGP22-20141003111122171Trisha Greenhalgh is an internationally recognised academic in primary health care and a non-principal general practicioner in Oxford. She gained her first degree in Social and Political Sciences from Cambridge University in 1980 and qualified in Medicine from Oxford University in 1983. She began her research career in laboratory science but retrained as a GP and worked at UCL (University College London) for many years before transferring to Barts Medical School in 2010 and the University of Oxford in 2015. Her many awards and prizes include Order of the British Empire for Services to Medicine, National Institute for Health Research Senior Investigator Award, Royal College of General Practitioners Research Paper of the Year Award (twice) and European Health Management Association Baxter Prize for Outstanding Contribution to Research in Healthcare Management (twice).

Q. What are Humanities for Health and Narrative Medicine now, in 2015, in short?

T.G. I think the practice of medicine is at a very interesting phase in its evolution. There are some signs that the Humanities are making a comeback. Evidence-Based Medicine (EBM) has delivered much – but not as much as people expected it to 20 years ago (see http://www.bmj.com/content/348/bmj.g3725). Arguably, there is a turn back to Narrative Medicine in the areas where a strictly rationalist approach has failed. The rise of “patient centred” and “personalised” medicine offers the potential to bring EBM and Narrative Medicine closer together – if we can develop a closer dialogue with our epidemiologist colleagues.

Q. Do you think that Narrative Medicine practice it’s important?

T.G. Of course, but you always ask people who support Narrative Medicine to do this blog, so you have a skewed sample!  There is an excellent new summary of the history of Narrative Medicine by the Wellcome Trust, based on a “witness seminar” attended by some of the leading scholars in the field. See this link for a download: http://www.histmodbiomed.org/witsem/vol52.

Q. Is there an epistemological shift necessary to move from Evidence Based Medicine to Narrative Medicine?

T.G. Yes. EBM and Narrative Medicine are based on different sets of philosophical assumptions. But whilst they are two “competing” paradigms, they can be integrated pragmatically and using case-based reasoning to inform the care of individual patients.

Q. Why should patients tell about their illnesses? Must we believe that stories are always true? And how should we behave with patients’ narratives?

T.G. Some patients find it helpful to tell about their illness, others don’t, so I don’t think we should use the word “should” here. Narrative is a way of making sense of life experience and bodily symptoms. It gives those experiences and sensations social meaning and moral worth.

Q. Do you think that Medical Humanities and Narrative Medicine could be competence to learn already at the University?

T.G. Like others who have contributed to this blog previously, I like Rita Charon’s notion of “Narrative competence” – we clinicians should be able to elicit, value, respect and act on the stories that our patients tell about their illnesses and life choices.

Q. Could we think about moving from Narrative Medicine to a more “holistic” form of comprehension of illness, body-states, and health, so to come to Narrative Healthcare or Narrative Health Competence?

T.G. Yes sure. But I also think we need to move from the “told story” to the “enacted story” and hence make less use of individual narrative interviews and more use of ethnographic methods. In a recent study of tele health and telecare in older people, my team used ethnography in the home to build narrative summaries of how people live with complex co-morbidity, how they use technologies and why they sometimes don’t use those technologies. You can see the paper here http://www.sciencedirect.com/science/article/pii/S0277953613003304  and the narrative summaries here http://www.atheneproject.org/Case%20Studies.html.


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