Narrative medicine weaves storytelling into health care

August 2, 2016

Illness is collaborative. It’s not just a list of symptoms and a diagnosis, but a story.

That’s the philosophy behind a new educational initiative at the Community‐University Health Care Center (CUHCC). It’s called narrative medicine.

“Stories are basic elements of humanity and an element of healing,” says EmmaLee Pallai, M.F.A., education manager for CUHCC.

Pallai is leading CUHCC students and patients in conversations, readings and writing exercises in poetry, fiction and personal essay, all centered on stories of illness. She brings a background in creative writing, which helps students and patients look at health from a more abstract perspective.

“Through writing and storytelling, we’re exploring how people make and interpret meanings. There are different ways that we use words, and that impacts the way we perceive and provide health care,” she said.

Pallai said those stories may be influenced by aspects like privilege, culture, and social determinants of health. Stories are personal, and understanding one’s story helps providers offer patient‐centered care.

Narrative medicine also examines the way society frames illnesses. For example, Alzheimer’s disease stories are often sad and tell a victim narrative. Stories about type 2 diabetes, on the other hand, often place blame and fixate on the lifestyle choices of that individual.

“Things that were once considered an illness are now an integral part of personal identities, such as homosexuality or disability,” she said.  “It’s important to recognize that a difference from an ever-changing norm does not equal pathology and the idea of illness is not concrete from one year to the next.  This recognition can help us talk with our patients instead of to them, and help free ourselves from biases.”

In CUHCC workshops, students and patients don’t need previous writing experience, and Pallai walks them through exercises to ease them into the process. They are not judged for writing merit; it’s about thinking and discussion. That attitude should carry over into clinical care and education, too, she says.

“It’s crucial that our students and providers have these conversations,” said Colleen McDonald Diouf, M.A., director of CUHCC. “Communication and how well providers can listen and support patients can shape the entire arc of healing. Using the lens of narrative medicine, CUHCC moves more towards person-centered care, viewing the person as a whole. Educating our students so that they can hear and share these perspectives will influence how they practice in the community when they enter the workforce.”

Right now, CUHCC offers the workshops regularly for all learners on rotation.  Patient and learner workshops have been tested, with positive results, and a regular schedule will begin in the fall.  Other sessions will be offered to all faculty and staff throughout the year. More importantly, it’s a care philosophy that CUHCC hopes to weave into practice.

“The way our health care system has developed really detaches feelings from the process,” Pallai said. “Instead, let’s listen and engage and with one another because we’re creating this story together.”