Narrative medicine and narrative practice: partners in the creation of meaning

Miriam Colleran, C. Donohoe, Anna Beug, Corina Bruekel, John Launer
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Abstract

Background Narrative medicine has emerged as an approach to whole person care and to support the clinician-patient therapeutic relationship. Although training in narrative medicine is usually based on the study of literary or artistic works, the same attitude of close reading can also be applied in conversations with patients or learners.MethodWe held a two-day narrative medicine workshop, incorporating two approaches: 'Conversations Inviting Change' (CIC) and humanities-based narrative medicine as taught by Columbia University. The workshop was primarily experiential, with theoretical components of both approaches. Participants brought active concerns for confidential breakout sessions and engaged in text-based and reflective writing exercises. Participants generated metaphors to describe these approaches to narrative medicine.Results Participants included a mix of community and hospital-based practitioners, pre-dominantly doctors. Participants considered the two approaches to be compatible and enhance each other. One metaphor generated was that Columbia style narrative medicine is ’like an individual lens which allows you to see things clearer’, it allows practitioners a different perspective on their patients and that CIC teaching ‘is a frame of glasses in which the lenses could be placed to enhance the ease of use’. Another metaphor was that the former ‘is like learning from a cadaver in the anatomy lab’, while the latter ‘is like running a clinical simulation’.Conclusion We believe this was the first workshop integrating these approaches to narrative medicine. They appear to be highly complementary. Both approaches lead to enhanced attention to narratives which has clear applicability to clinical practice.
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叙事医学和叙事实践:创造意义的伙伴
背景叙事医学作为一种全人护理方法和支持临床医生与患者之间治疗关系的方法而出现。尽管叙事医学的培训通常基于对文学或艺术作品的研究,但同样的细读态度也可应用于与患者或学习者的对话中:我们举办了为期两天的叙事医学工作坊,融合了两种方法:"邀请改变的对话"(Conversations Inviting Change,CIC)和哥伦比亚大学教授的以人文为基础的叙事医学。工作坊以体验为主,同时包含两种方法的理论内容。与会者为保密分组讨论带来了积极关注的问题,并参与了基于文本和反思的写作练习。结果 参加者中既有社区医生,也有医院医生,其中以医生为主。参与者认为这两种方法相互兼容、相互促进。其中一个比喻是,哥伦比亚式叙事医学 "就像一个独立的镜片,让你看事情更清晰",它让从业者从不同的角度看待病人,而 CIC 教学 "就像一个眼镜框,可以把镜片放在里面,以提高易用性"。另一个比喻是,前者 "就像在解剖实验室向尸体学习",而后者 "就像在进行临床模拟"。它们似乎是高度互补的。这两种方法都能加强对叙事的关注,这对临床实践具有明显的适用性。
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