Understanding what a patient is trying to communicate is crucial to providing an accurate diagnosis and effective recommendations. But to glean those insights, clinicians need to learn how to listen.
The field of narrative medicine provides practitioners with tools to more powerfully and authentically understand what their patients are trying to tell them. Incorporating techniques used in literary analysis, the practice helps clinicians learn more from their patients, support more effective treatment, and strengthen patient-provider relationships. Created in the 1990s and early 2000s, the field is now embraced by practitioners and is required training in many medical schools around the world.
Rita Charon is a third-generation physician, professor of medicine, doctor of literature, and co-founder of the field of narrative medicine. In 2000, she coined the field’s name, and in 2009, she founded Columbia University’s Master of Science in Narrative Medicine, the first graduate program focused on the approach. By 2019, she was chair of Columbia’s Department of Medical Humanities and Ethics and faculty in its Division of Narrative Medicine. Rita’s 2001 Bellagio Center residency helped her to hone her ideas and develop her first book on the subject, Narrative Medicine: Honoring the Stories of Illness.
We spoke to her about the power of storytelling and listening, narrative medicine’s journey from idea to internationally recognized field, and what makes her hopeful for the future of narrative medicine.
It doesn't matter if the person you're talking to is very similar to you or very different. It's part of your job to leave yourself for a moment and see where the other person is. There’s joy in that.
Rita CharonChief, Columbia University Division of Narrative Medicine
How did you become interested in the connection between stories and healing?
I learned how to read when I was three or four, and since then, I was never without a book. After completing my internship and my residency in internal medicine, I became an assistant professor of medicine at Columbia University. My medical school training and all the late nights had kept me away from reading, so I told my supervisor I wanted to take an English literature course. He told me “Don’t take a course. Get a master’s.”
I ended up in a remarkable English department, reading fiction, poetry, and high-level theory and working with rigorous, demanding scholars. The idea of being a close reader — looking at every word, seeing how many different meanings you can get from a sentence, and examining the nuances — was exciting to me. So I started trying to use that same rigor in listening to my patients. Rather than starting with, “I see you’re 47 years old and you haven’t had a mammogram,” it became, “Please tell me what you think I should know about your situation in order to treat you.” Connecting in this way helped begin the relationship on a different footing, and I felt so much more alive in what I was trying to do.
How did narrative medicine go from an idea to a new field?
Using this approach made a huge difference with my patients, and I wanted to share it with colleagues. With funding from the Macy Foundation, the National Institutes of Health, and the National Endowment for the Humanities, we began training people on how the humanities and the arts could be helpful in a medical practice.
The original group included psychiatrists, pediatricians, social workers, and patient advocates, as well as writers and literary and cinema scholars. We would get together to read and write, and we taught one another from our own fields. The result was a cadre of clinicians who became well-trained in salient aspects of literary and philosophical knowledge. Twenty years later, that group is still working together.
From the beginning, I felt strongly that we needed to think internationally, because I knew this work was already spreading far. Different cultures and communities have different ways of thinking about health and illness, and their approaches to narrative medicine differ as well. But we work together. We don’t compete. People in the UK, France, Italy, and Portugal were doing work along these lines very early on, and today, Columbia’s Narrative Medicine International network includes people and groups from all over the world.
While I am often cited when people talk about the history of narrative medicine, it’s important to know that there were so many of us who built this together. The field was really co-founded.
How did your Bellagio Center residency help to hone your work on narrative medicine?
At the time, I wasn’t the chair of a department or the chief of a division. I was just a general internist who had this work brimming in my mind. I knew I was writing a book, and I knew what it was going to be about. My mission was to spend a month writing without being interrupted by “Mrs. X needs a prescription for Y,” which is what ordinary life was like. Having that space to think and explore was amazing. The stories just began to spool out. I didn’t realize that I could be as inventive a writer as I turned out to be.
It helped that I was surrounded by amazing scholars and thinkers. For example, Daniel Dennett, the philosopher, was there. He looked like Brahms, and he played piano like him, too. There were writers and poets, visual artists and musicians… We would have lunch with different people every day. And Dan would be playing his Brahms next door. It was conducive to thought.
What are your concerns for narrative medicine’s future, and what makes you hopeful?
It worries me to see funding decisions for health research becoming politicized. Last March, the National Institutes of Health eliminated more than $250 million in Columbia University research grants because of disagreements between the executive branch and the university’s administration. Funding was eventually restored, but damage was done. The growing corporatization of health care systems also prioritizes economic concerns, limiting the time that clinicians are allowed to spend with their patients and making care less individualized.
When it comes to what makes me hopeful, I just have to look at the amazing people who have come through our program. Our former students are starting programs and teaching about narrative medicine at institutions like Duke University, the University of Colorado, and Kaiser Permanente’s Bernard Tyson Medical School, just to name a few. We’re incredibly proud of the people we trained, and we can’t stop being excited, boastful parents.
To Charon, the power of narrative medicine is, in part, its ability to spark empathy and connection between clinician and patient. “It doesn’t matter if the person you’re talking to is very similar to you or very different,” Charon said. “It’s part of your job to leave yourself for a moment and see where the other person is. There’s joy in that.”
Learn More:
- Watch Rita Charon speak on how narrative connects to the core ideals of medicine in a visiting lecture at the University of Toledo.
- Listen to her talk about how the principles of narrative medicine can be used in other contexts on Sydney Finklestein’s Sydcast.
- Read an interview with Rita Charon in the official magazine of the National Endowment for the Humanities.
The opinions expressed in this article are those of the author. The Rockefeller Foundation is not responsible for and does not endorse its content.