Narrative medicine teaches doctors how to listen to patients’ stories

Although narrative medicine is now a broad field and widely taught both in the US and abroad, Charon founded it at Columbia and coined the term in a journal in 2000. At CUIMC, narrative medicine is a multidisciplinary program. designed to promulgate the uses of narrative practices in clinical care and medical education. The discipline sits at the intersection of the humanities, arts, clinical practice, and health care justice, and aims to improve doctor-patient relationships by training clinicians in reflective practice.

“Let me give you an example of how narrative medicine works,” said Charon, a petite, vibrant woman who speaks slowly and thoughtfully. She was sitting at a round table in her office on the Columbia University campus. The room, located at 15he NewYork-Presbyterian Hospital floor at West 168he Street, has a panoramic southward view of the sky, Manhattan, the Hudson River and New Jersey.

“An elderly lady comes in complaining of lower back pain,” Charon said. “A doctor asks: ‘Have you had an x-ray or are you taking any medication? Have you seen a neurologist? The woman says, ‘Well, I can tell you what makes my back hurt. It’s when I pick up my grandson that I get this feeling at the base of my spine. So the doctor might say, ‘What if he tries aspirin or Motrin? That helps?'”

“But another doctor, if he was trained by us,” Charon continued, “would say, ‘Tell me about your grandson.’ And the grandmother would say: ‘he is 18 years old and has autism, and I have been raising him since he was born, but now he is bigger than me, so it is very difficult to pick him up.’

“That’s an example of the difference some narrative skill can make in understanding even the barest parts of what’s bothering this patient,” Charon said. “Some doctors are not interested in social things and will send that patient to see a social worker. However, a physician trained in narrative medicine will have a desire to hear what patients really have to say.”

an activist at heart

Charon, of course, realizes the challenges of this approach to patient care in today’s world of healthcare with 15-minute doctor appointments and increasing corporatization. However, he maintains that listening to a patient’s entire history rather than simply listing various symptoms is possible, and much preferable.

“My practice isn’t going to generate big changes,” Charon said, “but a movement is growing because the current state of medicine is alarming. We train our students in activism and advocacy.”

Charon is an activist at heart. He grew up in Providence, Rhode Island, with a father and paternal grandfather who were general practitioners. “My father had six daughters, and he always assumed that one of us would be a doctor, it turned out to be me,” he said, adding that two of his sisters are nurses.

She came to New York to study pre-med at Fordham University in the 1960s. “I was very involved in the antiwar movement,” she said. “I became radicalized, I was arrested and I remember a lot of tear gas.” The next stop was Harvard Medical School, followed by a return to New York, where she trained as a primary care resident at Montefiore Medical Center, and then she came to Columbia as a fellow in general medicine.

“I’ve been here about 40 years,” he said. “I stayed not only because I became a professor of medicine and had my clinical practice here, but because I also got a Ph.D. in English here.”

Making connections between medicine and literature

Charon began working on her Ph.D. in 1989, receiving it in 1999. She was intrigued by professors in the Department of English and Comparative Literature who were making connections between things like psychoanalysis and literature. They, in turn, were interested in what Charon was doing: taking the critical analysis skills she was learning in her English classes and transforming her medical practice with them. “She was a radical back then,” she said. “By learning how stories work, I changed my interactions with patients. When I met a patient, I said that I needed to know a lot and then, without interrupting, I listened attentively and intently.”