When I enrolled in a narrative medicine program at a local university, my first homework assignment was to “write 800 words.” No topic was specified. I had the freedom to write about anything that could reasonably be construed as narrative medicine writing, which, according to Rita Charon, MD, PhD, a general internist who is synonymous with the narrative medicine movement, is medicine that incorporates writing with the clinical skills of recognizing, absorbing, interpreting, and being moved by the stories of patients’ illnesses.

Dr. Charon, who is the executive director of the narrative medicine program at Columbia University, considers narrative medicine a basic science mandatory for medical practice. Narrative-based practice works in two ways. First, it uses literary texts and storytelling to improve the empathic ability of students, teaching them to become better listeners. Second, by incorporating a narrative pedagogy into the medical school curriculum and helping students process their clinical experiences through writing assignments, narrative medicine fortifies clinical practice.

Excluding my two-year stint in an executive MBA program in the mid-1990s, I haven’t had a homework assignment since I graduated college nearly 50 years ago. I never considered reading assignments in medical school as “homework.” Medical school never offered me the option of picking and choosing a topic to study or, heaven forbid, figuring out ways to make education less stressful and somehow fun. Perhaps that is why narrative medicine writing has become so popular among medical students: It restores value to the subjective experience of suffering that is often lost in the objective way students are taught and trained.

Narrative medicine is now taught in some form at approximately 80 percent of medical schools in the U.S. in courses, seminars, workshops, and graduate degree programs. Programs are designed for students and seasoned practitioners alike. Some are led by physicians, some by journalists, and many by individuals with advanced degrees in creative writing. Practically all programs have mechanisms to improve clinical care through narratives.

Narrative medicine classes for medical students are not meant to replace lecture-based classes but instead supplement them, e.g., through elective courses or didactics interwoven longitudinally with traditional courses and clerkships. Narrative medicine programs have reported numerous benefits, including decreasing burnout in students. Narrative medicine claims to increase students’ confidence and instill a strong patient-centered focus. Early exposure to the principles and practice of narrative medicine – as early as the first semester of medical school – may enhance professional development by fostering self-awareness, competency building, mindfulness, and spiritualism and humanism. Research on this burgeoning field is ongoing.

The importance of writing narratives and the benefits that accrue to medical students in particular cannot be understated in light of the empathy and compassion fatigue that begin to set in halfway through medical school, precisely when students embark on their clinical rotations and emotional responsiveness is required to assist patients through difficult times. However, after two intense years of rigorous scientific studies, replete with courses that sap the life out of most medical students, it’s not easy to set them free in clinical settings and tell them to “be themselves” and “be attentive” to patients. Many students are already burned out, depressed – even suicidal, and feel like imposters. But that’s the hidden beauty of the narrative: reflection and writing not only helps students connect to their patients, it allows them to connect to themselves, fostering self-expression in genuine ways. Like ice caps melting, new identities emerge, long submerged under the weight of textbooks and the influence of med-speak. Writing can counter the trauma of the initial and subsequent years of medical education and training.

Medical students are not judged when they write – or at least they should not be judged. They are not critiqued, put down or pimped by attendings in authority. Students are allowed to take risks, and they can make mistakes in narrative health care programs. Medical practice, on the other hand, is unforgiving; it requires constant perfection. Any deviation from practice guidelines requires a thorough explanation, and even then, a novice engaging in the “art” of medicine – practice based on individual experience rather than peer-reviewed guidelines – is likely to be frowned upon. Practicing medicine tests your nerves and readily shakes your confidence; writing builds self-esteem and strengthens confidence.

My hope is that medical students, residents, and physicians will consider taking a course or two in narrative medicine. Given the virtually infinite number of options and arrangements to choose from, courses will accommodate the schedules and preferences of most applicants, ranging from medical students to busy practitioners. The program that interested me the most offered a “certificate” after completing three graduate-level courses. Each course occurred via distance learning – two hours, online – the same evening each week for a semester. If, for any reason, students missed a class, they could view a video of it at their leisure before the next class. The courses that personally appealed to me were:

• “Narrative as a Form of Knowledge” – Writing assignments and engagement with narrative prose and poems.
• “Narratives of Illness” – A study of illness narratives in poetry, short fiction, creative nonfiction, and novels.
• “Writing & Healing” – A study of narratives by doctors and other health care practitioners, with an emphasis on reflective writing skills.

The value of narrative medicine should be obvious: courses extend naturally to clinical practice and help physicians become better attuned to the contexts of their patients’ needs and distress. Integrating narratives into clinical practice also helps optimize physicians’ well-being and restore meaning in work.

What are your thoughts on narrative medicine? Share in the comments.

Arthur Lazarus, MD, MBA, is a former Doximity fellow, a member of the editorial board of the Physician Leadership Journal and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.

Image by Luciano Lozano / Getty