A narrative approach to medicineA narrative approach to medicine

Aims and objectivesAims and objectives

What is narrative based medicine?What is narrative based medicine?

To consider narrative as a way of learning To consider narrative as a way of learning and understandingand understanding

To try some narrative of our ownTo try some narrative of our own

To consider if and how you might use this To consider if and how you might use this in your future learning and practicein your future learning and practice

Types of narrativeTypes of narrative

The patient’s storyThe patient’s storyNarrative provides meaning, context, and perspective Narrative provides meaning, context, and perspective

for the patient’s predicamentfor the patient’s predicament

Doctor’s narrativeDoctor’s narrative– Exploration of own feelings and reactionsExploration of own feelings and reactions

Anecdotes & fictional literatureAnecdotes & fictional literature– ““Anecdotes and fiction are a window onto the world”Anecdotes and fiction are a window onto the world”

Why use narrative?Why use narrative?

Understand a patient’s experienceUnderstand a patient’s experience

Encourages empathy and promotes Encourages empathy and promotes understanding between the clinician and patientunderstanding between the clinician and patient

Encourages a holistic approachEncourages a holistic approach

Facilitates reflective practiceFacilitates reflective practice

Enhances listening and interpretive skillsEnhances listening and interpretive skills

Gives meaning to the patient’s experience and Gives meaning to the patient’s experience and so can be therapeuticso can be therapeutic

MemorableMemorable

Medical usesMedical uses

Facilitating the traditional medical historyFacilitating the traditional medical history

CounsellingCounselling

PsychotherapyPsychotherapy

EducationEducation

Working in pairsWorking in pairs

What are some of the challenges to a What are some of the challenges to a narrative based approach?narrative based approach?

Challenges to a narrative based Challenges to a narrative based approachapproach

Video consultation skills teaching now Video consultation skills teaching now primarily based on COT competenciesprimarily based on COT competencies

A target based approach to WPBAA target based approach to WPBA

Time constraints of the 10 minute Time constraints of the 10 minute consultationconsultation

Fear of litigation and need to meet the Fear of litigation and need to meet the doctors agenda – red flags etcdoctors agenda – red flags etc

QOF, LQOFQOF, LQOF

Look closerLook closer

Time for you to have a go!Time for you to have a go!

Close your eyes and spend 2 minutes Close your eyes and spend 2 minutes reflection on an embarrassing, funny or reflection on an embarrassing, funny or memorable eventmemorable event

Working in pairs take it in turns to share Working in pairs take it in turns to share you experienceyou experience

Write your own storyWrite your own story

Over the next 10 minutes write a Over the next 10 minutes write a description of an experience that has description of an experience that has changed changed youryour practice practice

– A memorable patientA memorable patient– A memorable consultationA memorable consultation– A memorable meeting or lifetime eventA memorable meeting or lifetime event– Your experience as a patientYour experience as a patient

After coffee – small group work After coffee – small group work

Person APerson A - Tells their story - Tells their story

Person B - Listens without interrupting, then discusses it Person B - Listens without interrupting, then discusses it with person A to explore the story – its context, meaning with person A to explore the story – its context, meaning and implications for the individual.and implications for the individual.

Person C - Observes the process, this is a listening Person C - Observes the process, this is a listening exercise, watching and listening to how they story exercise, watching and listening to how they story unfolds; Language, emotion, details, body language etcunfolds; Language, emotion, details, body language etc

Final 5 minutes discuss the process between all of you Final 5 minutes discuss the process between all of you before changing placesbefore changing places

Trio workingTrio working

Person APerson A - Tells their story - Tells their story

Person B - Listens without interrupting, then discusses it Person B - Listens without interrupting, then discusses it with person A to explore the story – its context, meaning with person A to explore the story – its context, meaning and implications for the individual.and implications for the individual.

Person C - Observes the process, this is a listening Person C - Observes the process, this is a listening exercise, watching and listening to how they story exercise, watching and listening to how they story unfolds; Language, emotion, details, body language etcunfolds; Language, emotion, details, body language etc

Final 5 minutes discuss the process between all of you Final 5 minutes discuss the process between all of you before changing placesbefore changing places

Recommended readingRecommended reading

Ruth Picardie “Before I say goodbye: Ruth Picardie “Before I say goodbye: Recollections and observations from one Recollections and observations from one woman’s final year”woman’s final year”John Diamond “because cowards get John Diamond “because cowards get cancer too”cancer too”Jean-Dominique Bauby “The diving bell Jean-Dominique Bauby “The diving bell and the butterfly”and the butterfly”Narrative based medicine BMJ 1999 – a Narrative based medicine BMJ 1999 – a series of five articlesseries of five articles