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Narrative based medicine represents one of several patient-centered approaches to the practice of medicine that can give the physician access to the lived experience of their patients. As an enhanced form of history taking, narrative approaches can assist the physician in formulating more appropriate diagnostic and treatment options as well as improve doctor-patient relationships (Adler; Greenhalgh 1999). Patients feel known by their doctors, and in turn, physicians can better assess the effectiveness of their interventions.
Central to narrative based medicine is the phenomenon of constructing stories out of life circumstances. Real life events do not have plots, but it is a common human experience to construct meaning from otherwise seemingly disparate life events. These constructions are narratives--stories we tell ourselves and others that provide coherence for our lived experiences. These stories are not fixed but rather evolve over time as new events occur or new insights arise.
Narrative events imposed by the experience of sickness and disease, be they chronic or acute, have a tremendous impact on patients, families and communities. Illnesses do not occur in an isolated vacuum, but are situated in day-to-day experiences. As they play a part in the interactions among patient's family, work, and community environments, illnesses act to reconstruct the patient's life story. As individuals and groups live through their illnesses, larger existential questions about meaning and purpose often arise. The form of such questions will undoubtedly vary, but each version will be some contemplation on the course of events in one's life story. Physicians who have access to these stories may better assist patients in finding greater meaning, even in the face of adversity.
Narrative based approaches to medical care are not new to the practice of medicine. Learning a patient's family, work and personal situations is often a part of primary care practice. In today's managed care climate, or where patient contact is episodic or sporadic, the lack of continuity of care can impede the opportunity to build narrative knowledge over time. Strategies that can enhance narrative knowledge, however, need not be time consuming.
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