Narrative medicineBMJ 2012; 344 doi: https://doi.org/10.1136/sbmj.e2743 (Published 09 May 2012) Cite this as: BMJ 2012;344:e2743
- Brian Hurwitz, professor of medicine and the arts1,
- Annie Cushing, head of Clinical and Communication Skills Unit2,
- Ben Chisnall, first year medical student3
- 1Centre for the Humanities and Health, King’s College London, Strand, London WC2R 2LS, UK
- 2Centre for Medical Education, IHSE, Bart’s and The London School of Medicine and Dentistry, London
- 3GKT School of Medicine, King’s College London
Medical students and doctors use narrative skills on a daily basis. Taking a history from a patient, summarising a case for senior colleagues, and recording or reading a patient’s notes all require the construction of a meaningful chronological sequence, with important events included and less important ones omitted. Similarly, when doctors compare and contrast clinical presentations and cases from their own experiences, write up case reports, or document patients’ own accounts, they rely on narrative to structure their thoughts and conclusions.12345 Narrative medicine is the name given to the practice of medicine with an awareness of the centrality of narrative. From this focus, students and doctors are able to benefit from understanding the various ways in which narratives are structured and used in clinical settings.
Why is narrative important?
Narrative is the form in which concerns about health are framed by patients, relatives, and healthcare staff in clinical conversations, presentations, and medical case reports. Narratives arise when someone tells someone else that something happened in a way shaped by the order, gaps, and rhythms of the language that organises its content. 6 The contents may concern feelings, sensations, thoughts, and moods from a subjective viewpoint, or be about external and tangible matters, such as alterations in bodily function and personal circumstances.
Just as much as content, the tone, the tense that is used, and the mood all contribute to the feel of a medical narrative, as the history below, from the British Journal of General Practice, illustrates.7
Mrs B was 84 years old when her general practitioner, who had known her for a decade and a half, was asked to see her. Mrs B had been widowed for five years, after the sudden death of her husband, Jack. Her …