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The narrative medical write-up is a nontraditional patient work-up in which medical students narrate a patient's story. The purpose of the assignment is to help students gain skills necessary for "narrative competence," the ability to understand and act according to the larger narrative of a patient's life. More than a simple, empathetic retelling, the narrative medical write-up is a re-creation of the patient's story in which the student is both listener and teller, entering into a collaborative effort with the patient. This essay approaches the write-up from a narratological perspective, examining the complexities of plot construction, authorship, and fictionality within the write-up that make the work both difficult to define and truly powerful within medical education.