Sunday, August 9, 2009

The Patient's Story

Medicine and health care have never really been about the science. They have always used science but the real essence of medicine has always been in each person's story. An illness is never just an illness but it occurs within a person's entire life. The social, financial, spiritual, emotional and intellectual aspects of each person affects the illness and the illness affects all of these factors as well. More and more medical journals have understood this and more have been publishing first person accounts of these "stories" often written by doctors and occasionally by their patients, in order to give voice to the individual's unique story. The granddaddy of them all is the Narrative Matters section in Health Affairs which is perhaps the most prominent and widely read of the health policy journals. In honor of the tenth anniversary of Narrative Matters, Health Affairs in the latest issue has four narratives by wonderful authors including Abraham Verghese, Julia Alvarez, Alexander McCall Smith and Fitzhugh Mullen who was the original editor of Narrative Matters. As Ellen Ficklen, the current editor writes in her introduction to these four stories, "The peer-reviewed personal essays link a health care–related story or anecdote to the bigger picture. In doing so, underlying all of the undeniably important statistics and data involved in policy, they demonstrate the basic truth that health policy has human consequences." Not only does health policy have human consequences but medical care is always best when it understands the human being behind the disease. A strong narrative communicates this better than any medical text. Unfortunately, in todays world we have often left these narratives behind in the care for the patient. In a world in which we have ten minutes to see a patient and half of that time is spent looking at a computer instead of listening, finding a true unique person behind the symptom becomes next to impossible. I can only hope that the trend to communicate the story is part of a larger trend to bring true care and understanding back into healthcare.