Narrative medicine

In 1910, the Carnegie Foundation for the Advancement of Teaching created the Flexner Report, which set out to redefine medical educational practices. In this report, it argued that the proper goal of medicine is "to attempt to fight the battle against disease." Flexner wrote that "the practitioner deals with facts of two categories. Chemistry, physics, biology enable him to apprehend one set; he needs a different apperceptive and appreciative apparatus to deal with the other more subtle elements. Specific preparation is in this direction much more difficult; one must rely for the requisite insight and sympathy on a varied and enlarging cultural experience."[2] In the late 20th century the emergence of narrative medicine came as an effort to re-emphasize an aspect of wider cultural elements in medicine.

One prominent medical school that first began a program on narrative medicine was Columbia University Medical Center with their opening of the first Program in Narrative Medicine. Built within their College of Physicians and Surgeons, they believe that narrative medicine can make profound changes to the way medical treatment is administered:

“Narrative Medicine fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness. Through narrative training, the Program in Narrative Medicine helps physicians, nurses, social workers, mental health professionals, chaplains, social workers, academics, and all those interested in the intersection between narrative and medicine improve the effectiveness of care by developing these skills with patients and colleagues. Our research and outreach missions are conceptualizing, evaluating, and spear-heading these ideas and practices nationally and internationally."[3]

Rita Charon[4] has been the executive director of this program and has published and lectured on the benefits of doctors receiving narrative training as a way to increase empathy and reflection in the medical professional field.

From the 1990s, physicians like Rachel Naomi Remen[5] and Rita Charon argued that medical practice should be structured around the narratives of patients.[6]

A number of schools in the United States offer advanced classes in narrative medicine.

• The Columbia University Medical Center has been the leading pioneer of developing educational programs for the field of narrative medicine. In addition to lectures and seminars given throughout the year, Columbia University created the Master of Science in Narrative Medicine program for graduate students in 2009, making it one of the first graduate programs devoted strictly to narrative medicine.[7]
• The Lewis Katz School of Medicine has a Narrative Medicine Program run by Mike Vitez, a Pulitzer-winning journalist, and Naomi Rosenberg, an Emergency Medicine physician. It launched in 2016. The program's goal is to protect, support, and nourish the humanism that brings physicians into the profession, and to teach the skills of narrative that help at the bedside and beyond. The program has curricular and extracurricular components. Reflective writing forms a significant component of the Professional Identity Formation thread in the MD curriculum. Electives in medical humanities range from exploration of narrative medicine to photo storytelling to improvisational acting. Students also conceive and complete individual or group projects for elective credit under the guidance of the faculty. Extracurricular activities include a wide array of writing and narrative medicine workshops—some led by students—for students, residents, and hospital staff. “Narrative Medicine Talks” is a regular speaker series, and the program hosts fall and spring Story Slams for the Lewis Katz School of Medicine and Temple Hospital Community. On December 7, 2019, LKSOM hosted its inaugural Narrative Medicine Conference.
• Montefiore Medical Center is the academic medical center and University Hospital for Albert Einstein College of Medicine. This medical center created a program in Narrative Medicine as a subset of the Department of Family and Social Medicine. Residents at this school attend programs where they learn how to use personal narrative to enhance empathy, as well as topics including stress, loss, and balance.
• The Ohio State University Humanities Institute is also supporting the multidisciplinary initiative of narrative medicine. This program runs concurrently with their other undergraduate and graduate programs, where students "strive to develop narrative competence that enables them to deliver care that is not only more empathetic and compassionate, but also more effective."
• The University of California Irvine College of Medicine has created an Integrative Medicine Program within the Department of Family Medicine. This program "strives to change the focus of healthcare and medical education for our residents, medical students and faculty to include a multidisciplinary, patient-centered approach that emphasizes wellness, prevention, and self-care skills, and the adoption of the principles for creating optimal healing environments."[8]

• In 2011, Western University created the Narrative Medicine Initiative (NMI) and has incorporated narrative medicine into the undergraduate, postgraduate, and continuing medical education departments. They work to answer questions such as "How does the art of storytelling improve health care education and the experience of patient care?". Western holds regular (at least annual) Narrative medicine rounds where local patients and physicians share their stories of disease and illness, with a focus on how the stories will improve physician's ability to handle future stories. [9]
• Lenoir-Rhyne University has established the Thomas Wolfe Center for Narrative, with the slogan "Heeding the call for narrative in a fragmented world." This program offers graduate-level and certification courses in several narrative training disciplines, one of which is narrative medicine.
• Saybrook University takes a broad approach to narrative medicine through their mind-body medicine program. This seeks to approve the mind-body approach to health and wellness as a way to improve quality of life for patients.

This growing field of narrative medicine extends beyond the United States:

• The British Medical Journal began adding their own writing seminars to promote this type of narrative in its emerging physicians.
• At University of Southern Denmark narrative medicine is a mandatory course to follow for all undergraduate medical students.[10]

• Slow medicine
• Medical humanities

• Charon, Rita (2008). Narrative Medicine: Honoring the Stories of Illness, Oxford University Press.
• Charon, Rita et al. (2016). The Principles and Practice of Narrative Medicine, Oxford University Press.
• Greenhalgh, Trisha; editor (1998). Narrative Based Medicine, BMJ books.
• Hunter, Kathryn Montgomery (1991). Doctors' Stories: The Narrative Structure of Medical Knowledge, Princeton University Press.
• Launer, John (2018). Narrative-Based Practice in Health and Social Care: Conversations Inviting Change, 2nd Edition, Routledge.
• Marini, Maria Giulia (2016). Narrative Medicine: Bridging the Gap between Evidence-Based Care and Medical Humanities, Springer.
• Marini, Maria Giulia (2019). Languages of Care in Narrative Medicine: Words, Space and Time in the Healthcare Ecosystem, Springer.
• Mehl-Madrona, Lewis (2007). Narrative Medicine: The Use of History and Story in the Healing Process, Bear & Company.
• Mehl-Madrona, Lewis (2010). Healing the Mind through the Power of Story: The Promise of Narrative Psychiatry, Bear & Company.
• Robertson, Colin; editor (2016). Storytelling in Medicine, Routledge.

• https://www.utne.com/mind-and-body/narrative-medicine-heals-bodies-and-souls
• https://www.npr.org/templates/story/story.php?storyId=1480863
• Intima: A Journal of Narrative Medicine
• Columbia | Narrative Medicine
• Northwest Narrative Medicine Collaborative - community of narrative medicine, medical humanities, and health humanities practitioners in the U.S. Pacific Northwest
• English language articles at Italian Narrative Medicine website