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Going through the article of Drs Elwyn and Gwyn1 we were inspired to take it as a project in undergraduate medical education with a few interested students as participants. The problems, which we encountered, were predominantly because of it being a neglected topic for ages to come although all of us in the teaching fraternity are aware of its significance. The biggest impediment to listening to patients is a busy schedule, which doesn’t allow any time for it. An average faculty in our institution has to apart from taking lecture classes and clinics attend busy OPDs and inpatients. While one is on inpatient rounds with a herd of other consultants and residents in the unit it becomes very difficult to talk and listen to the patient then and there. The listening can be performed in OPD but in busy days with a large queue of patients breathing down our necks it can become very difficult. Procedures, clinics or academic meetings also take up the afternoons. This I am sure would be a pattern across most academic institutions.
However we wanted to record most of our patient’s precious stories.2This is where our undergraduate students came to the rescue.
It is common practice for us to give difficult cases where we are stumped to the undergraduate students, as long cases for discussion. A meticulous history by them would more often than not bring out newer insights into the diagnosis. Thus assured of their good track record of handling patient stories we gave them cases to probe further. Our aims were to get an interesting insight to the patient’s life style before the onset of the disease and follow up the changes in their life patterns brought on by the disease.
It was difficult to start with as:
1) These students were volunteering without any obvious rewards in sight.
2) Our university doesn’t provide for narrative medicine in its syllabi and so these projects involving students have to be undertaken only during their holidays with a few enthusiastic students.
However as soon as we started we became aware of its benefits as the first student picked up a missed history of thyrotoxic periodic paralyis(3 dramatic episodes) appearing prior to other symptoms in an other wise straight forward case of thyrotoxicosis. We also realized that getting the stories had its difficulties apart from time devotion. Some patients would need considerable amount of tactful handling in bringing them onto their life contents as otherwise our training makes us more used to a superficial structure of the history. This is where the minds of fresh undergraduates unbiased with knowledge come in handy inventing newer techniques to tackle the challenges. We were helped by the present article in discovering concepts of discourse analysis, event time (in which patients tend to think) as opposed to real time, which hovers around the clinician’s thought processes, “voice of the life world” as opposed to the “voice of medicine.”
We framed a strategy of starting the story taking as a normal questionnaire of enquiry into the distressing symptoms at present and gently ask where the patient resides. As soon as the place of residence is mentioned we ask them whether they were there from childhood. The questions can proceed gently into the patient’s childhood and various phases of their life and then concentrate on the changes in life pattern as the disease arrives insidiously.
We plan to archive similar narratives for various diseases and use them further in undergraduate lectures as case situations with a difference where the social, ethical and philosophical dimensions of a patient help to paint a better picture of him or her as an individual than just a disease.
Acknowledgements:
All the 5th semester MBBS students involved in data collection, for preparing the narratives on each patient.
1) Padam Hirachan
2) Hari KC
3) Rajesh Adhikari
4) Nirmal Thapa
5) Deepak P Koirala
6) Krishna Dhungana
7) Daman Raj Paudel
References:
1) Elwyn G, Gwyn R, Narrative based medicine: Stories we hear and stories we tell: analysing talk in clinical practice, BMJ 1999; 318: 186-188.
2) Elwyn G, So many precious stories: a reflective narrative of patient based medicine in general practice, Christmas 1996,BMJ 1997;315:1659-1663.
Using patient narrative for medical education:
Going through the article of Drs Elwyn and Gwyn1 we were inspired to take it as a project in undergraduate medical education with a few interested students as participants. The problems, which we encountered, were predominantly because of it being a neglected topic for ages to come although all of us in the teaching fraternity are aware of its significance. The biggest impediment to listening to patients is a busy schedule, which doesn’t allow any time for it. An average faculty in our institution has to apart from taking lecture classes and clinics attend busy OPDs and inpatients. While one is on inpatient rounds with a herd of other consultants and residents in the unit it becomes very difficult to talk and listen to the patient then and there. The listening can be performed in OPD but in busy days with a large queue of patients breathing down our necks it can become very difficult. Procedures, clinics or academic meetings also take up the afternoons. This I am sure would be a pattern across most academic institutions.
However we wanted to record most of our patient’s precious stories.2This is where our undergraduate students came to the rescue.
It is common practice for us to give difficult cases where we are stumped to the undergraduate students, as long cases for discussion. A meticulous history by them would more often than not bring out newer insights into the diagnosis. Thus assured of their good track record of handling patient stories we gave them cases to probe further. Our aims were to get an interesting insight to the patient’s life style before the onset of the disease and follow up the changes in their life patterns brought on by the disease.
It was difficult to start with as:
1) These students were volunteering without any obvious rewards in sight.
2) Our university doesn’t provide for narrative medicine in its syllabi and so these projects involving students have to be undertaken only during their holidays with a few enthusiastic students.
However as soon as we started we became aware of its benefits as the first student picked up a missed history of thyrotoxic periodic paralyis(3 dramatic episodes) appearing prior to other symptoms in an other wise straight forward case of thyrotoxicosis. We also realized that getting the stories had its difficulties apart from time devotion. Some patients would need considerable amount of tactful handling in bringing them onto their life contents as otherwise our training makes us more used to a superficial structure of the history. This is where the minds of fresh undergraduates unbiased with knowledge come in handy inventing newer techniques to tackle the challenges. We were helped by the present article in discovering concepts of discourse analysis, event time (in which patients tend to think) as opposed to real time, which hovers around the clinician’s thought processes, “voice of the life world” as opposed to the “voice of medicine.”
We framed a strategy of starting the story taking as a normal questionnaire of enquiry into the distressing symptoms at present and gently ask where the patient resides. As soon as the place of residence is mentioned we ask them whether they were there from childhood. The questions can proceed gently into the patient’s childhood and various phases of their life and then concentrate on the changes in life pattern as the disease arrives insidiously.
We plan to archive similar narratives for various diseases and use them further in undergraduate lectures as case situations with a difference where the social, ethical and philosophical dimensions of a patient help to paint a better picture of him or her as an individual than just a disease.
Acknowledgements:
All the 5th semester MBBS students involved in data collection, for preparing the narratives on each patient.
1) Padam Hirachan
2) Hari KC
3) Rajesh Adhikari
4) Nirmal Thapa
5) Deepak P Koirala
6) Krishna Dhungana
7) Daman Raj Paudel
References:
1) Elwyn G, Gwyn R, Narrative based medicine: Stories we hear and stories we tell: analysing talk in clinical practice, BMJ 1999; 318: 186-188.
2) Elwyn G, So many precious stories: a reflective narrative of patient based medicine in general practice, Christmas 1996,BMJ 1997;315:1659-1663.
Competing interests: No competing interests