Publications
APS Bulletin • Volume 16, Number 1, Winter 2006
Resource Reviews
John D. Loeser, MD, Department Editor
Medicine and Humanistic Understanding: The Significance of Narrative in Medical Practices
Reviewed by David B. Morris, PhD
J. Vannatta, R. Schleifer, and S. Crow (Eds.), Philadelphia, University of Pennsylvania Press, 2005. DVD-ROM, ISBN 0-8122-3851-6, $39.95.
Pain is notoriously difficult to reduce to a matter of nerves and neurotransmitters. In its psychological, social, and cultural dimensions, it draws health professionals into areas where biomedical knowledge alone will not suffice. Pain thus provides a test case for wider significance throughout medicine of what this new DVD-ROM describes as narrative knowledge and narrative skill.
“Narrative,” according to Oliver Sacks in Medicine and Humanistic Understanding, “is an essential part of medicine.” Narrative knowledge is offered here not as a substitute for biomedical knowledge but as its necessary complement. Sacks calls it not just desirable or even ideal but essential. Among the virtues of this beautifully designed, interactive DVD is that we see and hear Sacks describe the importance of narrative in his own animated, personal narrative style. Other video clips high-light the words and presence of such important contemporary physician-writers as Richard Selzer, Rafael Campo, John Stone, and Abraham Verghese. They are joined by clips of major humanities-based scholars working in the areas surrounding narrative medicine, such as Kathryn Montgomery, Anne Hunsaker Hawkins, and Anne Hudson Jones. It is, all told, a very impressive line up. The guiding spirit is physician Rita Charon, who, at Columbia University, founded the Program in Narrative Medicine. She asks us to consider, for example, what doctors learn from patients and how physicians might begin to articulate this form of mostly subterranean and unacknowledged but often essential knowledge.
The authors teach at the University of Oklahoma College of Medicine. They divide the text into six chapters: (1) the patient-physician relationship, (2) the patient’s story, (3) doctors listening to patients, (4) narrative and medicine, (5) narrative and the everyday ethical practices of medicine, and (6) reading The Death of Ivan Ilych. Pop-up boxes define key terms; hypertext links bring remote sections into dialogue; music, voice, and image supplement the written transcript of video clips. There is even an integrated CME exam. For a thorough, reliable introduction to narrative medicine or for a well-organized, challenging extension, there is no better resource. The publishers bill it as a complete course in medical humanities. It seems to me something far better and more inventive.
In a video clip, Kathryn Montgomery asks us to imagine a case in which the patient is a doctor. I will embellish her account slightly. The patient (Dr. B) grasps all the biomedical facts about her own condition, so that she knows exactly what her physician (Dr. A) knows. The asymmetries are clear. Dr. A’s story as physician cannot map exactly onto Dr. B’s story. The patient’s and doctor’s narrative overlap, but they never coincide. The question is whether Dr. A would make a more effective physician if he understood his patient’s story as well as he understands the biomedical facts. Would medicine—or pain medicine—be more effective?
“We think of how we can save time in medicine,” says physician-writer Rafael Campo describing the 5 minutes he spent with a patient over a poem about pain and chronic fatigue. “That,” he continues, “probably saved me 10 or 20 visits.”
Dr. Morris is a Professor at the University of Virginia in Charlottesville.
Dr. Loeser is Professor of Neurological Surgery and Anesthesiology at the University of Washington in Seattle.