Categories of Narratives in Medicine ~~~~~~~~~~~~~~~~~~ Fostering Narratives in Clinical practice / Research ~~~~~~~~~~~~ Vera Kalitzkus

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1 Categories of Narratives in Medicine ~~~~~~~~~~~~~~~~~~ Fostering Narratives in Clinical practice / Research ~~~~~~~~~~~~ Vera Kalitzkus Institute of General Practice Medical Faculty of the University Düsseldorf

2 4 Genres of Narratives in the context of medicine / health care Illness narratives Narratives of physicians/caregivers Narratives in the interaction of physician/caregivers patients/clients Grand Stories / Metanarratives The all give insight into the personal/biographic, cultural and sociohistoric contextuality of medicine, health and illness

3 3 Areas of Application To learn more about the patient s perspective / patient s life world / subjective view medical practice, training, research To learn about the doctors/carers perspective training, research, self reflection Narrative approach in concrete medical practice (communication, interaction) Narrative as evidence

4 Illness Narratives What we can learn from them: Meaning of the illness/suffering for the patient How does it feel from the inside Biographical / social context of illness experience Coping strategies and potential for personal development What kind of doctors/caregivers do they need? Inside every patient there s a poet trying to get out My ideal doctor would read my poetry. (A. Broyard) I longed for healthcare professionals who would audit empathically the story that I could not tell unless they listened. (A. W. Frank)

5 Narratives of Physicians/Caregivers

6 Grand Stories / Metanarratives What we can learn from them: Medicine as cultural system underlying assumption, beliefs, values Connection between medical and social system Examples: Ayurveda, TCM, Biomedicine Sociohistoric context of health and illness the body as a canvas of culture and history Examples: The plague, history of pain, Susan Sontag illness as metaphor

7 Concepts of the body The subtle body (Ayurved) Modern image of the body

8 Narratives in todays Medicine 75% of the information leading to a correct diagnosis can be elicit by a thorough anamnestic dialogue with the patient (Alexander Lown 1996) If you listen to your patients they will tell you their diagnosis (Sir William Osler, ) Narratives do not necessarily require a lot of time Spontaneous talking time of patients in GP = 2 minutes enough for 85% of patients (Langewitz et al. 2002) Only 7 from 335 patients needed more than 5 minutes! Narrative approach not as new technique, but empathic witnessing (Kleinman), all encompassing attention (Rita Charon)

9 Applied Narrative Medicine FOSTERING NARRATIVES IN CLINICAL PRACTICE / RESEARCH

10 Microscene protocoll for practice observation Time Patient In Practice since Reason for Encounter History of the Illness History of the Patient History of Doctor- Patient-Relation Core intervention / attitude towards patient Subjectivity of GP To learn more about the black box consultation research A tool for self reflection

11 Applied Narrative Medicine FOSTERING NARRATIVES IN COMMUNICATION / INTERACTION

12 The Dont s: No when, what, where or why ( argumentation will follow) No suggestiv questions The Do s: How to elicit narratives 1. Ask open ended question! 2. Ask clear and simple questions! 3. Practice Active Listening (reflecting / mirroring ) 4. Acknowledge what you heard 5. Summarize what you heard (from motivational interviewing) Ask about the lived experience / perceptions (with all the senses) Ask about processes in time Ask about example

13 What for? to foster self-exploration The art of listening to foster change talk (counselling) or explication (interview) containment / confession /? A story needs a listener (A.W. Frank 1998) Listening is one of the most complicated and difficult of all instruments in a doctor s repertoire and one of the most potent ones. (A. Lown 1996) The story of Momo and the art of listening (M. Ende) With an open mind and heart!