In a recently released issue of Pediatrics, you will have the opportunity to read a short yet very moving essay by trainee, Dr. Anoushka Sinha (10.1542/peds.2021-052723). She eloquently describes the mirroring of her medical experience in the NICU with twins whose clinical courses differed greatly, by her reading of Maggie O’Farrell’s novel, Hamnet, a fictional account of the death of Shakespeare’s child Hamnet, also a twin. Dr. Sinha connects the two experiences – the lived and the written – and shows us how narrative medicine has helped her become a physician who listens, cares, and embraces the stories of her patients and their families.
In Dr. Sinha’s essay we follow her daily work as a trainee in the NICU, not just calculating calories, but watching the decline of the one twin as the other makes slow progress toward homegoing. She shares with us the parents’ “pivot” toward comfort care for the failing twin, as well as the infant’s final moments with his family. Each clinical change is paralleled in her reading of Hamnet, with its lyrical prose that captures a family’s poignant grief as one twin lives, and one twin dies. Dr. Sinha shows us how the written narrative of Hamnet helped her empathically experience and come to terms with the clinical events that unfolded.
She includes a brief discussion of narrative medicine, which I am learning about through reviewing articles like this one, and from the Section on Pediatric Trainees Features Editorial Board team who have knowledge and expertise in this area. Narrative medicine can be defined as an interdisciplinary field that applies the skills used to analyze literature (e.g., in-depth reading and critical thinking) and the values used to understand literature (e.g., empathy and reflection) to interviewing and caring for patients.1 Fundamentally, each patient (parent or child or both) has a story or narrative to share with us. Physicians are generally well trained to elicit the objective facts of the story or “patient history,” such as the duration and specifics of symptoms, but are less well versed in appreciating the whole and the nuance of the patient narrative. It may be the patient’s narrative or “story”, rather than the objective history, that provides key clues to differential diagnosis or contributions to care.2 For the physician, the engagement of truly listening and appreciating the patient’s ideas and perspective has potential to deepen the doctor-patient relationship. As in Dr. Sinha’s essay, narrative medicine can serve many purposes, including (as it did for her), supporting patient care, and the physician’s ability to experience and process emotionally difficult events.
The field of narrative medicine is still young, and evidence for its use as a teaching, intervention, or assessment tool is still limited. Research that demonstrates a benefit for medical practice and patient outcomes is in its infancy, and systematic reviews support additional research in this intriguing area.3,4 After reading Dr. Sinha’s essay, though, I find myself convinced that this emerging field will be able to benefit patients and providers in many ways. I hope you enjoy her article as much as I do.
References:
- Charon R. The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001 Oct 17;286(15):1897-902. doi: 10.1001/jama.286.15.1897. PMID: 11597295.
- Pino Andrade R. Narrative medicine in medical diagnosis. Colomb Med (Cali). 2020;51(1):e4339. Published 2020 Mar 30. doi:10.25100/cm.v51i1.4339
- Fioretti C, Mazzocco K, Riva S, Oliveri S, Masiero M, Pravettoni G. Research studies on patients' illness experience using the Narrative Medicine approach: a systematic review. BMJ Open. 2016 Jul 14;6(7):e011220. doi: 10.1136/bmjopen-2016-011220. PMID: 27417197; PMCID: PMC4947803.
- Milota MM, van Thiel GJMW, van Delden JJM. Narrative medicine as a medical education tool: A systematic review. Med Teach. 2019 Jul;41(7):802-810. doi: 10.1080/0142159X.2019.1584274. Epub 2019 Apr 14. PMID: 30983460.
