The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. Adopting methods such as close reading of literature and reflective writing allows narrative medicine to examine and illuminate 4 of medicine's central narrative situations: physician and patient, physician and self, physician and colleagues, and physicians and society. With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care. By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care.

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Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust

Narrative Inquiry is a research methodology that we adapted over the past two decades from Canadian higher education and curriculum studies to nursing research, education, and health-care practice. The Narrative Inquiry we use originated from Connelly and Clandinin in the 1990s, and rests on John Dewey's philosophy that experience is relational, temporal, and situational, and as such, if intentionally explored, has the potential to be educational. More specifically, it is only when experience is reflected upon and reconstructed that it has the potential to reveal the construction of identity, knowledge, and the humanness of care. Congruent with the expectation that nurses are reflective practitioners and knowledge-makers, Narrative Inquiry provides a means to enhance, not only quality of care, but quality of experience of those in our care: in education, our students, and in practice, our patients. In this article, we explicate how Narrative Inquiry may be lived in health-care education and practice, with a primary focus on nursing. We illuminate how we support our graduate students, the next generation of narrative inquirers, through a Narrative Inquiry Works-in-Progress group.

Narrative Inquiry Experience matters

The biopsychosocial model is both a philosophy of clinical care and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular. At the practical level, it is a way of understanding the patient’s subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care. In this article, we defend the biopsychosocial model as a necessary contribution to the scientific clinical method, while suggesting 3 clarifications: (1) the relationship between mental and physical aspects of health is complex—subjective experience depends on but is not reducible to laws of physiology; (2) models of circular causality must be tempered by linear approximations when considering treatment options; and (3) promoting a more participatory clinician-patient relationship is in keeping with current Western cultural tendencies, but may not be universally accepted. We propose a biopsychosocial-oriented clinical practice whose pillars include (1) self-awareness; (2) active cultivation of trust; (3) an emotional style characterized by empathic curiosity; (4) self-calibration as a way to reduce bias; (5) educating the emotions to assist with diagnosis and forming therapeutic relationships; (6) using informed intuition; and (7) communicating clinical evidence to foster dialogue, not just the mechanical application of protocol. In conclusion, the value of the biopsychosocial model has not been in the discovery of new scientific laws, as the term “new paradigm” would suggest, but rather in guiding parsimonious application of medical knowledge to the needs of each patient.

https://www.annfammed.org/content/annalsfm/2/6/576.full.pdf

The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry

Understanding others’ mental states is a crucial skill that enables the complex social relationships that characterize human societies. Yet little research has investigated what fosters this skill, which is known as Theory of Mind (ToM), in adults. We present five experiments showing that reading literary fiction led to better performance on tests of affective ToM (experiments 1 to 5) and cognitive ToM (experiments 4 and 5) compared with reading nonfiction (experiments 1), popular fiction (experiments 2 to 5), or nothing at all (experiments 2 and 5). Specifically, these results show that reading literary fiction temporarily enhances ToM. More broadly, they suggest that ToM may be influenced by engagement with works of art.

/pdf/reading-literary-fiction-improves-theory-of-mind-4sl9jat9n6.pdf

Reading Literary Fiction Improves Theory of Mind

This paper explicates the stigma of mental illness as it is experienced by four ethnic minority groups in the United States. Concerns about prejudice and discrimination among individuals who suffer burdens related to mental illness are delineated. It is proposed that ethnic minority groups, who already confront prejudice and discrimination because of their group affiliation, suffer double stigma when faced with the burdens of mental illness. The potency of the stigma of mental illness is one reason why some ethnic minority group members who would benefit from mental health services elect not to seek or adequately participate in treatment. The combination of stigma and membership in an ethnic minority group can impede treatment and well-being, creating preventable and treatable mortalities and morbidities. The article concludes with recommendations for research and health policy implications.

Stigma: barrier to mental health care among ethnic minorities

Introduced to US medical schools in 1972, the field of literature and medicine contributes methods and texts that help physicians develop skills in the human dimensions of medical practice Five broad goals are met by including the study of literature in medical education: 1) Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people; 2) great works of fiction about medicine enable physicians to recognize the power and implications of what they do; 3) through the study of narrative, the physician can better understand patients' stories of sickness and his or her own personal stake in medical practice; 4) literary study contributes to physicians' expertise in narrative ethics; and 5) literary theory offers new perspectives on the work and the genres of medicine Particular texts and methods have been found to be well suited to the fulfillment of each of these goals Chosen from the traditional literary canon and from among the works of contemporary and culturally diverse writers, novels, short stories, poetry, and drama can convey both the concrete particularity and the metaphorical richness of the predicaments of sick people and the challenges and rewards offered to their physicians In more than 20 years of teaching literature to medical students and physicians, practitioners of literature and medicine have clarified its conceptual frameworks and have identified the means by which its studies strengthen the human competencies of doctoring, which are a central feature of the art of medicine

Literature and medicine: contributions to clinical practice.

This is the fourth in a series of five articles on narrative based medicine

The contributions of narrative to medical ethics come primarily in two ways: firstly, from the use of stories (narratives) for their mimetic content—that is, for what they say; and secondly, from the methods of literary criticism and narrative theory for their analysis of diegetic form—that is, for their understanding of how stories are told and why it matters. Although narrative and narrative theory, like the form and content of a literary work, are inextricably bound up with each other, I will discuss them separately to help chart the evolving appreciation for the importance of narrative in the work of medical ethics.

#### Summary points

During the past two decades, stories have been important to medical ethics in at least three major ways: firstly, as case examples for the teaching of principle based professional ethics, which has been the dominant form of medical ethics in the Western world; secondly, as moral guides to living a good life, not just in the practice of medicine but in all aspects of one's life; and thirdly, as narratives of witness that, with their experiential truth and …

https://www.bmj.com/content/bmj/318/7178/253.full.pdf

Narrative in medical ethics

Why literature and medicine

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(97)03395-3.pdf

Literature and medicine: narrative ethics

The purpose of this article is to encourage and help inform active discussion of authorship policies among members of scientific societies. The article explains the history and rationale of the influential criteria for authorship developed by the International Committee of Medical Journal Editors, examines questions about those criteria that emerge from authorship policies adopted by several U.S. medical schools, and summarizes the arguments for replacing authorship with the contributorguarantor model. Finally, it concludes with a plea for scientific societies to play a prominent role in the ongoing debates about authorship and the alternatives as part of their efforts to encourage ethical conduct among their members. Whether or not scientific societies develop authorship policies of their own, they should undertake vigorous educational efforts to keep their new members adequately informed about the importance of authorship practices in ethical scientific research and publication.

Anne Hudson Jones

Papers

Literature and medicine: contributions to clinical practice.

Narrative in medical ethics

Why literature and medicine

Literature and medicine: narrative ethics

Can authorship policies help prevent scientific misconduct? What role for scientific societies?