The Need to Diversify Narrative Medicine

Narrative medicine is a powerful storytelling tool that allows health care professionals and patients to humanize medical experiences. Rita Charon coined the term “narrative medicine,” which is defined as a form of medical practice based on “adopting methods such as close reading of literature and reflective writing.”1 Charon argues that these methods contribute to a “model for humane and effective medical practice.”1

Clinicians must be able to analyze, appreciate and respond to patients’ stories. This not only creates a deeper understanding of a medical presentation that can lead to an accurate diagnostic process, but it also fosters a strong physician-patient relationship. Much like taking a patient history, practicing narrative medicine creates a framework through which a medical story can be holistically communicated.

In its current state, narrative medicine is primarily practiced through artistic observation, literary analysis and writing. But these forms of expression are not common in all cultures. Most tools used in global narrative medicine pedagogy are created by artists and writers from the West, contributing to a teaching of medical expression that is rooted in Western ideology.2,3 Analysis of Western art allows for an appreciation of life, death and humanity in the context of Western culture. Similarly, literary analysis in narrative medicine curricula is primarily done with literature written only in the English language, further limiting the teachings of medical narratives to only those that fit Western frameworks.3 (In this article, “Western” is used to refer to the United States, the United Kingdom and Anglo-American culture.)

Despite these limitations, narrative medicine is an interdisciplinary, evolving field, and there are many solutions to diversify narrative medicine models. One possibility is to expand the tools used in narrative practices to include oral and participatory forms of expression instead of only those that are visual and written.4 Many non-Western cultures, particularly traditional and folk cultures of Asia and Africa, share cultural stories through oral and performance methods. These narratives are passed down through generations by direct teaching and often lack visual and written components that can be analyzed.4

There are many types of oral and performative forms of expression that narrative medicine can adopt, such as music, theater and fashion. One major form of oral tradition that is gaining popularity in narrative medicine is dance.5,6 Dance is a common form of celebration around the globe, and storytelling through dance has been an important component of multiple cultures. Traditional dance forms from Haiti and India have been used in narrative medicine to educate medical trainees on cultural humility.6 By using oral traditions such as dance, narrative medicine serves as a medium that gives people from various cultures more opportunities to express and participate in illness narratives.

A story is a primary overview of a medical experience. Therefore, stories are valuable tools for processing and communicating medical events. The way we tell stories in medicine must be diversified so medical experiences can be appreciated through the lenses of many different cultures and perspectives.

References:

1. Charon R. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. 2001;286(15):1897–1902
2. Hooker C, Noonan E. Medical Humanities as Expressive of Western Culture. Medical Humanities. 2011;37(2):79–81
3. Shankar R, Priyani R. Three Years of Medical Humanities at a New Nepalese Medical School. Education for Health. 2011;24(1):535
4. Baugh AD, Vanderbilt AA, Baugh RF. Communication Training Is Inadequate: The Role of Deception, Non-verbal communication, and Cultural Proficiency. Med Educ Online. Dec 2020;25(1):1820228
5. Shervzov-Zebrun N, Barchi E, Grogan K. “The Spirit Thickened”: Ma–king the Case for Dance in the Medical Humanities. J Med Humanit. Dec 2020;41(4)543–560
6. Darivemula S, Bhumi S, Chowdhury JP. Rehumanizing Clinical Language Through Classical Indian Dance. AMA J Ethics. March 1 2021;23(3):E276–280

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