Thursday Review: “Narrative Humility”

Healthcare work requires mastery. Writing in The Lancet, Sayantani DasGupta reminds us that the patient isn’t one of the things that can be mastered.

Mastery in healthcare means bringing knowledge and skill to a patient, but not using them as an excuse to ignore the patient as an individual. The way to do this, DasGupta writes, is narrative humility.

Narrative humility acknowledges that our patients’ stories are not objects that we can comprehend or master, but rather dynamic entities that we can approach and engage with, while simultaneously remaining open to their ambiguity and contradiction, and engaging in constant self-evaluation and self-critique about issues such as our own role in the story, our expectations of the story, our responsibilities to the story, and our identifications with the story—how the story attracts or repels us because it reminds us of any number of personal stories.

The author recommends shifting our perspectives from “narrative competency” to “narrative humility” for the same reason “cultural competency” is replaced with “cultural humility”.1 When we approach someone else, we can be competent in our own abilities. We can’t be competent in our foreknowledge of exactly where someone else is coming from.

In this way, narrative humility allows the exchange of stories in a clinical context. “Active listening” has long been a hallmark of medical interviews. Along these lines, DasGupta writes, the patient’s story, at least initially, belongs entirely to [the patient].

Clinical communication is simultaneously being on the inside and the outside. Healthcare is being intimately familiar with another person’s body and story, but never experiencing the illness. A patient arrives in a clinic to tell their story after someone says, “So, what brings you in today?” They’ve come to have their story told back to them from someone who has mastery of some discipline in healthcare.

Narrative humility is an approach to the fact that there must be a story told by the patient and a story told by the provider. Healthcare providers must intervene into the life of another, but the story of the patient must be altered, not domineered. If we approach one another with narrative humility, we become aware that we have a role to play changing another’s story. In the same way, the provider can become aware that the patient has a real effect on them.

DasGupta cites Alessandro Portelli’s2 comment on the etymology of the word “interview”: it is exchange between two subjects: literally a mutual sighting.

Sources

The article reviewed: DasGupta, Sayantani. 2008. “Narrative Humility”. The Lancet 371 (9617): 980–981. https://doi.org/10.1016/s0140-6736(08)60440-7.

1 Tervalon, Melanie, and Jann Murray-García. 1998. “Cultural Humility Versus Cultural Competence: A Critical Distinction In Defining Physician Training Outcomes In Multicultural Education”. Journal Of Health Care For The Poor And Underserved 9 (2): 117-125. https://doi.org/10.1353/hpu.2010.0233.

2 Portelli, Alessandro. 1991. The Death Of Luigi Trastulli, And Other Stories: Form And Meaning In Oral History. Albany, NY: State University of New York Press.

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