In her 2006 article, Dr. Rita Charon makes a distinctive difference between treating patients as part of professional practice and taking a curative approach to patients as a calling. In doing so, she credibly and satisfactorily answers the critical question on how doctors should treat their patients through the concept of narrative medicine. Narrative medicine is a relational clinical practice approach where a doctor carefully listens to the patient with regard to what is going on in the patient’s life, then using the information to arrive at how to treat, and where possible, eventually cure the patient (Charon, 2006). Narrative medicine can be compared with the modern approach to clinical care, where it is possible for a patient to be under the care of a consultant, without the patient even meeting the consultant in person. Instead, the consultant will access the patient's records electronically, arrive at a treatment approach, then key in the treatment approach into the same computerized system for others to handle the patient (Oaklander, 2016). Modern healthcare is tending towards the computerized approach but Dr. Charon insists that the traditional narrative-based approach is the right way.
According to Charon (2006), under the narrative approach, listening to a patient goes beyond hearing “….. the content of his narrative but also for its form—its temporal course, its images, its associated subplots, its silences, where he chooses to begin in telling of himself, how he sequences symptoms with other life events ” (Charon, 2006, p. 177). Listening to a patient goes beyond what the patient is saying to include how it is being said, the tone of voice, the look in the face, and the areas a patient stammered or looked down. A bond is created between the patient and the clinician where the clinician seeks to enter the life of the patient and understand what is going in with the patient, beyond merely what the patients share. As outlined in Charon (2006), narrative medicine is not something that can be done remotely through reading records or listening to another colleague give a third person version of what the patient is going through. Instead, it is an experience that both the patient and the practitioner undergo. Dr. Chiron outlines an instance during a narrative medicine session that the patient Ignatio Ortiz begun to cry halfway during the narrative and stated that “ no one had ever let him tell of himself before ” (Charon, 2006, p. 185). Based on the above, narrative medicine itself has a curative effect on the patient, even before any diagnosis or prescription has been made.
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Based on a close reading and careful analysis of Charon (2006), and a comparison between narrative medicine and most comparative clinical practice approaches, I agree with Dr. Charon that this is how clinicians should treat patients. The basis for acquiescing regards both the patient and the doctor. Beginning with the latter, the practice of medicine has become a hard, rigorous, and thankless job leading to poor work-family balance, fatigue, and burnouts. The tired and stressed doctors have a higher propensity for making mistakes, leading to suffering of patients and civil liability for doctors (Alexander & Ballou, 2018). The relationship between the doctor and a patient has been replaced with the relationship between the doctor and a computer. The patient will give personal details based on a specialized format during triage and in many cases never get an opportunity to offer explanations about those details (Oaklander, 2016).
Under the modern computerized approach to clinical care, a patient might get the right diagnosis and treatment but the patient satisfaction that comes with interacting with a professional who cares, is missing. A system where both the doctor and the patient are struggling and where all parties involved neither enjoy the process nor realize satisfaction from it must be wrong and in urgent need of review, if not an overhaul. Dr. Charon’s approach as outlined in Charon (2006) is the solution to these problems.
References
Alexander, A. G., & Ballou, K. A. (2018). Work life balance, burnout, and the electronic health record. The American Journal of Medicine, 131 (8), 857–858 https://doi.org/10.1016/j.amjmed.2018.02.033 .
Charon, R. (2006). Narrative medicine: Honoring the stories of illness . Oxford: Oxford University Press
Oaklander, M. (2016, June 27). Electronic health records lead to doctor burnout and stress. Retrieved from http://time.com/4383979/doctor-burnout-electronic-health-records/
