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Narrative Medicine: Form, Function, and Ethics
- Rita Charon, MD, PhD
- College of Physicians and Surgeons of Columbia University; New York, NY 10032 (Charon)
Sickness and healing are, in part, narrative acts. Patients write about their illnesses with increasing frequency, which suggests that finding the words to contain the chaos of illness enables the sufferer to endure it better (1-3). We physicians, too, write more and more frequently about ourselves and our practices (4, 5). In many forms of narrative writing, doctors are endorsing the hypothesis that writing about oneself and one's patients confers on medical practice a kind of understanding that is otherwise unobtainable (6).
What Is Narrative Medicine?
The growth in publication of patients' and physicians' stories is joined by other signs of the increasing importance accorded to narrative dimensions of sickness and medicine. Residing in what is called narrative knowledge, the human capacity to understand the meaning and significance of stories is being recognized as critical for effective medical practice (7, 8). Physicians are reaching to practice what I have come to call narrative medicine—that is, medicine practiced with the narrative competence to recognize, interpret, and be moved to action by the predicaments of others (9, 10).
Narrative conceptual frameworks have been advanced—and accepted with gratitude—for examining and understanding medical reasoning, clinical relationships, empathy, and medical ethics (11-13). The growing acceptance of and demand for qualitative clinical research to complement quantitative clinical research demonstrate physicians' realization that both the singular and the statistically significant must be comprehended in the study of disease or its treatment (14, 15). The rise of narrative medicine may signify fundamental changes in the experience of disease or of doctoring. It also suggests that medicine, as part of its culture, is responding to the forces propelling similar narrative turns in such fields as literary studies, history, qualitative social sciences, and ethics (16). Examining narrative medicine's practice of writing may help us to …
