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/ 247 / 8 narrative and medicine Schemas of narration how shall i comprehend the life that is in me and around me? To do so, stories were constructed—and told, and remembered, and handed down over time, over the generations. Some stories—of persons, of places, of events—were called factual. Some stories were called “imaginative” or “fictional”: in them, words were assembled in such a way that readers were treated to a narration of events and introduced to individuals whose words and deeds—well, struck home, or, as some of my students with studied understatement have put it, made an impression that lasts “longer than a few hours.” “Longer” for [one of my students] Richard turned out to be longer than he had dared hope possible. Survival did not diminish his interest in the characters he’d met— [Thomas hardy’s] Jude and [ernest hemingway’s] “old man” and ivan ilych and [Tillie] olsen’s elderly couple [in Tell Me a Riddle]. on the contrary, their presence changed the shape of his life, prompted him . . . to keep certain texts at his side, stories that helped him as he (in his middle twenties) went through his own story with growing hope. —robert coles, The Call of Stories (1989: 189) Throughout Part 2 of this book, we were concerned with storytelling and narrative—with the patient-physician relationship growing out of the encounter of storytelling, the patient’s narrative itself, and a doctor’s ability in listening to narrative. Many experienced physicians develop types of understanding—phronesis, narrative knowledge, and logic of diagnosis— that, in their functional engagements with narrative and reality, are different from and complementary to the biomedical knowledge of scientific explanation . Such engagements with narrative are at the heart of humanistic understanding . This chapter reexamines the importance of narrative in the practice of medicine from the point of view of the ways in which the narrative knowledge we examined in Part 1 informs that practice. it then offers an account of everyday narrative and literary narrative that suggests, more fully than we did in chapter 3, how the development of systematic guidelines that grow out of an analysis of narrative focused on the agents and actions of narrative discourse can help physicians and other health care workers serve 248 / the chief concern of medicine their patients and profession with greater care and, perhaps, more fully discover on a daily basis the rewards of their engagement with patients. Practices of Medicine and Narrative as we have argued throughout The Chief Concern of Medicine, the particular information obtainable through narrative is of direct, practical usefulness to the physician. as many studies have shown and we have repeatedly mentioned , the history of Present illness (hPi) is the most powerful diagnostic information for the physician, and the ability to attend to the narrative information presented in the hPi is of great practical use in the treatment of patients . Dr. Rita Charon nicely describes this in terms of “honoring” a narrative in an interview. This interest we [medical educators pursuing “narrative medicine”] have in narrative knowledge and narrative methods is not an abstract, scholarly interest alone. it’s a very practical interest. There is a very concrete, direct relationship between narrative knowledge and clinical action. indeed, we are interested in helping our students and doctors understand things for their own purposes. We’re even interested in helping them reflect on their experience and feel better for it. i’m happy when my students or the doctors who study with us feel better by virtue of their narrative training, but that’s not enough. My goal in giving them narrative training is to enable them to act more effectively with their patients. So, the increase in the narrative skills of recognizing there’s a story to be heard, eliciting it, being curious about what’s unsaid, putting it together in some way, trying provisional hypotheses to see “Did i get this right?,” and being moved oneself by what’s heard, all of these things culminate in the doctor then being able to act on the patient’s behalf with more vigor, with more purpose, with more investment than they otherwise would. i talk sometimes about how we have to honor the narratives we hear, and this is a very active thing. People tell us very private, frightening things about themselves, and we, because we have skill and also because we have power, are privileged to hear these things. Sometimes they are things we don’t...

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