On a Wednesday afternoon, eight oncology doctors, nurses, and social workers on 5 Garden South in the Milstein Hospital Building read to one another what they have written about their patients. Not chart notes or case presentations; these are poems about families, stories about loss, and imaginary letters to patients who have died. Twice a month, Narrative Oncology meets for an hour to develop health professionals skills to perceive, interpret, and face the suffering that surrounds them.
During our pilot year funded by the Kenneth B. Schwartz Center, we learned that narrative writing teaches us to honor, in a way nothing else could, what our patients go through and what we ourselves endure in their care. Oncologist Gwen Nichols and I have just submitted a proposal to the National Cancer Institute for funds to perform a rigorous outcomes study of our work, hypothesizing that this project is good for individual professionals, good for the health care team, and good for patients.
Sickness unfolds in stories. Whether in a patients chief complaint, a family members saga of surgery, an interns presentation at attending rounds, or a death note in a chart, the events of illness unfurl and accrue meaning by being told. Equipping health professionals with the wherewithal to recognize, absorb, and be moved by the stories patients tell and that professionals tell one another might go a long way toward fixing what doesnt yet work in medicine.
The Program in Narrative Medicine at Columbia, the first of its kind, has created and developed this new frame for clinical work. Narratively competent medicine or narrative medicine for short recognizes patients needs to tell of their illness in order to comprehend it. It recognizes the needs of doctors, nurses, and social workers to put into words what they slowly come to know by living their lives around sick and dying people. What we have learned in many projects like Narrative Oncology is that narrative skills help to bring us near patients in professional engagement instead of detached concern. The engaged doctor or nurse might suffer more with her patients, but she will reap the great rewards unknown in detachment of courage and of joy.
Based in the Division of General Medicine, the Program in Narrative Medicine provides narrative training to faculty and staff and students, directs research in the outcomes of narrative medicine, edits the scholarly journal Literature and Medicine, and sponsors seminars, readings, and conferences for the medical school community.
Our Narrative Medicine Seminars, required of second-year medical students, include graduate-level seminars in contemporary poetry, illness narratives, the philosophy of death, faith and illness, and figure drawing. Literature@Work is a faculty and staff literature seminar that meets twice a month for serious discussion of works of fiction and poetry. The Writer-in-Residence Program brought novelist Michael Ondaatje and poetry teacher Jeff Encke to the medical school; we are happy to be hosting Susan Sontag in residence for the upcoming fall semester. Professor of English and co-editor of Literature and Medicine Maura Spiegel, Associate Program Director Rebecca Garden, Program Coordinator Tara McGann, and I have been privileged to collaborate with faculty from many clinical and humanities departments of Columbia in the work of the program.
We introduced the Parallel Chart to third-year medical students as a place to write about critical aspects of their care of patients that cannot be recorded in the hospital chart. Students have written and read to one another astonishing prose about their deep attachments to patients, their grief on patients deaths, their shock at the random unfairness of disease, and the memories triggered by the care of the sick. In an outcomes study funded by the Fan Fox and Leslie R. Samuels Foundation, we demonstrated that Parallel Chart writing actually improved students clinical performance. With support from the National Endowment for the Humanities, the program is convening an intensive study group of faculty from medicine, pediatrics, psychiatry, English, philosophy, and writing to do the hard conceptual work of figuring out why such narrative training in medicine helps.
Our Narrative Medicine Colloquium in early May attracted more than 300 doctors, nurses, therapists, literary scholars, novelists, and poets to learn about narrative influences in medicine. To continue the work launched by the colloquium, we have inaugurated monthly Narrative Medicine Rounds. I invite you all to join us at 5 p.m. on the first Thursday of each month in amphitheatre A-1 on the first floor of P&S. Each month, two presenters discuss their works-in-progress in narrative methods in clinical practice, teaching, or scholarship. Said our first presenter, ethicist Nancy Berlinger, I didnt know there was a name for what I do.
For information on program activities (including schedules, presenters, current book for Literature@Work), please visit our Web site at www.narrativemedicine.org or e-mail us at firstname.lastname@example.org.
Rita Charon, M.D., Ph.D., is professor of clinical medicine and director of the Program in Narrative Medicine.