narrative medicine
Photo: Mauricio Alejo
In the early '80S, a few years into her career treating patients in a cramped clinic in New York City's Washington Heights, Rita Charon felt overtaxed. Every case was a puzzle, and more often than not, at least one of the pieces didn't seem to fit. But the Harvard-educated internist, now 62, says her problem wasn't a lack of scientific knowledge: "I wasn't a good enough listener."

Charon realized that the clues she needed weren't confined to lab results and diagnostic scans. They were hidden in her patients' habits, fears, beliefs, family circumstances, even their insurance battles. Determined to gather those threads and weave them together, Charon signed up for an English class at Columbia University to see what she could discover about the art of storytelling.

Over the next few years, her part-time coursework snowballed into a PhD in literature. ("As I studied, I realized I was enjoying the process of interacting with patients tremendously more.") And ever since, she has been teaching aspiring doctors what she didn't learn in medical school. Charon is the founding director of the Program in Narrative Medicine at Columbia University, where future MDs participate in writing workshops and examine texts by authors like Camus, Tolstoy, and Walt Whitman (who was a nurse during the Civil War). The idea is that these literary exercises will enhance the students' ability to interpret stories—and to take the imaginative leap into a world other than their own. "When doctors can see illness from their patients' eyes," says Ronald Drusin, MD, vice dean for education at Columbia's College of Physicians and Surgeons, "they become better doctors."

Research suggests Drusin is right: A study published last year in Academic Medicine assessed the empathy levels of 29 family physicians using a standardized scale, then followed 891 of their diabetic patients for three years. The patients of the doctors who'd scored high on the empathy scale were far more successful at managing their blood sugar levels than the other patients.

Charon's effort to restore the human elements of medicine seems to be resonating with her colleagues around the globe. She has won grants from the National Institutes of Health and the National Endowment for the Humanities; and a fellowship from the Guggenheim Foundation. At least eight more medical schools (from Paris Descartes to McGill to the University of Southern California) now offer coursework in narrative medicine. Healthcare providers worldwide flock to workshops. And soon physicians will be able to enroll in a certificate program through Columbia. "It's hard to keep up," Charon says, happily amazed by the audiences she greets on her busy lecture tours.

Next: How she listens now
But in the exam room, Charon doesn't do much talking at all these days. "I'll start an appointment with a new patient by saying something like 'I need to learn a lot about your body, your health, and your life. Please share with me what you think I need to know.'" Then she sits with her hands in her lap—no notes, no typing—and lets the patient tell her story.

The details your physician should know—but might not think to ask.

Sayantani Dasgupta, MD, who teaches narrative medicine at Columbia University, says the key to sharing your health history is thinking of it as a story:

Choose the turning points that you want to highlight—the ups and downs you've experienced over time. Who are the main characters? A supportive partner? An unsupportive boss?

Mention the dramatic tensions. You might be concerned about meeting work deadlines, or caring for a sick parent. These details will help your doctor treat your illness in the context of your life. Finally, spill your fears. Maybe your mother died of a brain tumor and you're afraid you will, too. Your worries offer insight into your hesitancies and motivations.

How to Listen to Your Body


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