Narrative Medicine: emphasis on narrative competence and counterbalance to evidence-based medicine – by John Launer

John Launer is a doctor, educator and award-winning writer.
He is lead for educational innovation in primary care for Health Education England in London, honorary associate clinical professor of primary care at University College London, honorary lifetime consultant at the Tavistock Clinic, associate editor of the Postgraduate Medical Journal, faculty member at ISTUD Business School in Milan and founding president of the Association of Narrative Practice in Healthcare.
Professor Launer was the originator, with Caroline Lindsey, of Conversations Inviting Change (CIC).
His most recent books are Reflective Practice in Medicine and Multiprofessional Healthcare (2022), Narrative-Based Practice in Health and Social Care: Conversations Inviting Change (2018), How Not To Be A Doctor: And Other Essays (2018).

What do you deal with and how did you happen to approach narrative medicine? 

I am a medical educator and I teach an approach to the practice of Narrative Medicine that is called “Conversations Inviting Change.” My background is firstly as a graduate in English literature followed by training as a doctor. I became a family physician but then did additional training as a family therapist.

I first learned about narrative ideas and skills through becoming a family therapist but I soon saw how relevant these could be to everyday medical practice. Together with a colleague I developed a form of training to apply a narrative approach to all medical and health care work including consultations with patients and their families as well as in teaching, supervision, management and leadership.

Over the past 25 years I have helped to build a team of trainers in this approach and together my colleagues and I have now taught the approach to doctors and health professionals around the UK and Europe and further afield in North America, Japan, Australia and elsewhere. 

Is there an official definition of narrative medicine where you work? If so what is it? 

No. There is no central organisation in the UK that co-ordinates training in Narrative Medicine or has the authority to determine what does and does not fit that description. I do not think the absence of a clear definition is such a bad thing, as I believe Narrative Medicine should be pluralistic and inclusive.

We have formed an organisation in the UK called the Association of Narrative Practice in Health Care, but this is for the purpose of providing accreditation and maintaining standards for trainers who teach “Conversations Inviting Change” . We make no attempt to set definitions for other forms of Narrative Medicine or approaches to the field.

I do not agree with making a distinction between Narrative Medicine and Narrative-Based Medicine as I think this is confusing for outsiders or people who are learning about the field for the first time. 

What is narrative medicine for you? 

Narrative Medicine for me is any approach to medical practice or research which puts stories and story-telling at the centre.

All forms of Narrative Medicine have two things in common. The first is an emphasis on narrative competence –  the capacity to listen to stories and to respond to them sensitively and helpfully.

The second is a commitment to providing a counterbalance to evidence-based medicine by introducing a more humanistic and compassionate perspective. There are some overlaps with other approaches to practice and research but the focus on stories and story-telling remains a unique feature of Narrative Medicine. 

What is the history of narrative medicine and the Medical Humanities? 

Medical humanities or health humanities have been around for a very long time. Many doctors and health professionals have always been interested in literature, the visual arts, cinema and theatre, and seen what these could contribute to an understanding of patients and the work of medicine.

Narrative medicine has its roots in the work of people in the 1980s including Eliot Mishler, Arthur Kleinman and Kathryn Montgomery Hunter but it really acquired a distinct identity with two seminal books. One was edited by Trish Greenhalgh and Brian Hurwitz in the UK. The other was written by Rita Charon who also set out a vision of medicine where stories and storytelling were at the centre.

Since then Narrative Medicine has diversified considerably around the world but generally focuses on the following questions:  

  • What kinds of stories do patients tell, and why?
  • What kinds of stories do health professions tell, and why?
  • How does medicine itself construct its stories?
  • Can people become better clinicians through studying and writing stories?
  • How can we help patients to tell their stories in ways that might make a difference to them?

My main interest has always been in the last of these questions: can we practise medicine in a way that helps others to tell alternative and evolving stories, or at least entertain the possibility of telling these? My belief is that this should always be the ultimate purpose of Narrative Medicine, however remotely from the patient its activities take place.

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