Eliciting a Narrative

Although some patients may be natural storytellers, weaving intricate tales around even around the most mundane activities, not all persons will respond accordingly, particularly in dialogue with their physician. Instead, they may provide a reportage or “laundry list” of events. While this format may still yield useful data, it may lack the animated quality of narrative information.

In general, narratives can be elicited by asking patients to speak about specific events that have occurred, as well as the significance of those events. The following questions are provided as suggestions for ways to encourage narrative information. They are not meant as a checklist, but rather as guidelines that can be modified and used within a variety of medical encounters and practice settings to elicit the basic elements of narrative. Those patients who might find it useful to write about their illnesses or problems may be given these questions in the form of a narrative questionnaire.

Eliciting character and setting information Encourage the patient to use sensory descriptors - sounds, smells, colors, kinesthetic feelings, etc., which often trigger narrative memories. It may also be useful to ask about other “characters” in the patient's life.

“Can you give an example of a time when your personal/family/work life was affected by this problem/symptom/concern?”
“Describe the incident in terms of time, place, situation, and participants involved.”
“Does this problem or concern affect other individuals? If so, can you give me an example of the time when they have demonstrated or revealed how they are affected?”

Eliciting action and plot:

“In the incident elicited above, what was the sequence of events? What happened first?”
“What happened next?” “Then what happened?”
“What happened finally?”

Eliciting point of view: The particular events that the patient chooses to share, as well as the order in which they are told, reveal something of their significance to the patient.

“What significance did the incident have at the time it was occurring? What did it mean to you at the time?
What is the significance of the incident in your life now?

These questions can be posed to elicit narrative information related to illness states or symptoms, psychosocial issues, health maintenance or prevention concerns, or family history. With modification, they can also be used when discussing diagnostic or treatment interventions. For example, to better understand how a patient deals with their medication regimen, the opening question can be restated as: “Can you give an example of a time when your personal/family/work life was affected by this medication?” Follow-up questions would similarly probe for narrative information regarding characters, setting, action, plot and points of view.