What is your narrative medicine?

This is the first in a series of discussions with health professionals who use narrative medicine in their work. Together we hope to answer the question: What is narrative medicine? If you'd like to be included in this conversation, drop us an email!

Dr. David Schleich, PhD

President Emeritus, National University of Natural Medicine [Portland, Oregon]

How do you practice narrative medicine in your work today? 

Narrative medicine is really about creativity, mostly it's about the other, the what and the why, and the where. You have to keep listening. It’s about taking messages of fear, but also messages of hope, and converting them into action.

Hmm. So my job is as a catalyst and an organizer. And I happen to think that narrative medicine or the arts in medicine, are all different kinds of ways to go at it.  My job is to convert the fear and the hope into action items that are more about hope. That's creative spark.

 All I know is that you can show people around you how to go about taking creative ideas to make something happen for the patient--or in this case for the student or for the professional out there who needs continuing medical education. Whatever it is, you can take that creative spark and you nourish it.

I use narrative medicine techniques, but it's not only about medicine, it's really about healing. 

What challenges does narrative medicine help you with? 

The challenge of handing or giving back that agency or that power of feeling within yourself, right? Not only to create the space for it, but you have to then run with it or experience it.

You definitely have to carry it. It's a bit of passing the baton. If you think of a baton race and the beauty of it, the baton metaphor is that you have to have a baton. You have to have something to pass. You have to have something to give, to carry to the finish line. Right? And most often people can't even imagine having a baton.

Most patients can't even imagine being empowered to do anything, to carry anything. There's a baton. What's it look like? Wait a second. I don't like that baton. It's too short. It's too long. It's too heavy. Whatever kind of baton you have, you have to accept it.  And so that's when you listen.

Narrative medicine, especially close reading, helps you to hear what people are most afraid of, what challenges them.  

Some of the folks I've worked with become what they fight.  They absorb this identity. You know, a non-compliant patient or a patient caught up in jadedness from so much diagnosis and treatment. They just get tired of it and don't believe in it anymore, or they don't believe in themselves that they can heal, or they don't believe that what they're feeling is of interest to anyone but themselves, or they don't believe that there's any hope. This loss of hope is the challenge.

You have to really read closely what they're saying and give them examples of situations and people, and that's where literature is so powerful. You have been on a similar journey and you have a right to feel what you're feeling. You have a right to express it. You have a right to be clear about what's going on for you. You see, listening is another part of this close reading stuff. Narrative medicine gave me tools to help be more effective in communicating, listening, and diagnosing and treating in my case, organizational problems. By using language that was more healing than divisive,  that was more inclusive than exclusive, more invitational than prescriptive or directional, I was able to solve the issues at hand.  You drill down into it, with close reading, you drill down into what is really worrying that person. Narrative medicine frames helped me in my practice. 

 How do you explain narrative medicine? 

I would say to people, narrative medicine helps you get at the singular aspects of a patient's life. It helps in hearing what the patient is saying and shaping a therapeutic partnership. It becomes more personal, more real narrative medicine promotes an affiliation with patients.

It's highly give and take and it's highly interactive. It's not objective note-taking or rushing to a diagnosis. It's not like you fit this particular segment of the population from the research. It’s relational healing. Narrative medicine promotes relational healing. So really narrative medicine is about improving healthcare not about adding another layer of cost. Narrative medicine is helping to soften the impersonal and revenue greedy and revenue-hungry healthcare system. 

It aligns the clinician and the patient in a stronger kind of affiliation in my view. It's a better way of saying, I hear your concerns, let me understand them better. And when you have that kind of intensity in the connection, the effectiveness of what you do just rises.