Thursday Review: “Role of narrative-based medicine in proper patient assessment”

Pain management in cancer patients is a good opportunity to examine how medicine can be both humane and effective,1 writes Giovanni Rosti.

Rosti constantly balances medicine’s outcomes with its humanity. A medical outcome can easily skew towards numbers and raw data. That emphasis can quickly become efficacy to the point of ruthlessness. Medicine’s humanity constantly reminds us that individuals are being treated, and not just patients.

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Thursday Review: “Gesundheit und Krankheit als Bildungsprozess”, Health and Sickness as an Educational Process

A little more than a decade ago, there was a growing sense that the patient was missing from their own care. In Europe, the German-language Journal for Qualitative Education, Counseling, and Social Research called the idea of bringing patients’ biographies into academic study weitgehend brachliegend, “extensively fruitful”. In the US, Rita Charon published her groundbreaking book Narrative Medicine just over a year later.
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Thursday Review: “Restoring the Patient’s Voice: The Therapeutics of Illness Narratives”

The bulk of my work is wrapped up in teaching how stories can be useful in clinical situations. I believe that stories and storytelling make life better and more meaningful. I tend, though, to downplay narrative work that can’t explicitly help doctors, nurses, and administrators serve patients more effectively. I suppose that comes from a need to show healthcare professionals the value of medical humanities.

The way that Dr. Jurate A. Sakalys writes about the need to simply let patients talk, though, is a good challenge for me. Writing in the Journal of Holistic Nursing, Sakalys brings up several themes which have come up in the context of patient-provider communication. The focus of the article, though, is on why those narratives are healthy for the patient.

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Thursday Review: “Understanding the Person through Narrative”

Last week, examining Greg Mahr’s ideas about assessing a patient’s decision-making capacities, I found it odd that there is nearly no difference between the outcome of a traditional decision-making assessment and a proposed, new narrative assessment. Mahr does a wonderful job of explaining why narrative is important and how a narrative assessment is focused on the patient’s understanding, rather than a physician’s wishes. The question remains, though: if the outcomes of a narrative assessment don’t differ from what is currently in place, why is it necessary?

Writing in Nursing Research and Practice, Joanne M. Hall and Jill Powell examine some real differences between current medicine and narrative medicine. Their article presents a wide review of available scholarship on narrative in use, specifically as it relates to mental health nursing.
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Thursday Review: “Narrative Medicine and Decision-Making Capacity”

Greg Mahr’s article on using Narrative Medicine to evaluate the medical decision-making capacity of patients is a wonderful case study in the implementation of the medical humanities. Appearing in the Journal of Evaluation in Clinical Practice, the paper contains frequent, concise insights into the goals and possibilities of Narrative Medicine.

The article is well-written and presents the traditional model of assessing patients’ abilities, the issues inherent in it, Narrative Medicine’s viewpoint, and an alternative, narrative decision-making assessment. (The presentation is very much like a story!) Mahr says, and I agree, that Narrative medicine has been an effective and powerful tool in reshaping medical practice. It’s odd, then, that when contrasting the outcomes of the “traditional” assessment and the “narrative” assessment, narrative assessments should arrive at the same conclusions as traditional assessments, but without the ethical and philosophical difficulties embedded within the traditional assessment.

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