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Elements of Medical Narratives

The basic elements of a narrative include:

• characters and settings (the who, what and where)
• plot (the sequence of events); and
• voice or point of view (often accessible by identifying the significance of those events to the person telling the story).

Questions that access these elements can be included in the general course of conducting a history and physical. The object is to encourage the patient to reconstruct a mini-drama that situates and contextualizes an illness, symptom, or other medical concern in their day-to-day life, thus assisting the physician in building a narrative picture of the patient's situation.

A word of caution: Just as there can be several interpretations of any story, physicians should be careful when attempting to interpret the patient's narrative (Charon). Rather, it is useful to construct the patient's story in collaboration with the patient. Repeating back to the patient the story that the physician has heard, and then asking the patient to correct any misinterpretations can insure greater reliability (or repeatability) of the narrative information obtained.