Medicine: What’s Narrative Got To Do With It?

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In the 1891 painting, “The Doctor,” by Sir Samuel Luke Fildes, a physician leans toward the bed of a sick child.  He appears deep in thought, watching.  The child’s mother, distraught, is being consoled by the father.  A cup holding a spoon, and perhaps a medicinal ointment, sits on the table.  We know now that a physician at that time could do little as far as medical treatment. 

This is the narrative in the painting: a sick child, worried parents, the family doctor present, bearing witness to their story.  Over one hundred years ago, there was little more than the patient’s story.  At that time, Fleming was thirty-eight years from discovering penicillin, in 1929, which is not that long ago, really.  Before that, poultice, salves, and compresses were the medical mainstay.  Yet the doctor in Fildes’ painting remains present, holding vigil.

Now, fortunately, we have treatments galore: targeted therapies, stents, even robots that participate in operations.  And here I am writing about the patient’s story?  What kind of antiquated concept is that?

At Vanderbilt, I teach an undergraduate course called Narrative Medicine: Stories of Illness and the Doctor-Patient Relationship.  We study classic and contemporary illness narratives written by both doctors and patients.  I find that the students have an inherent sense of the importance of the patient’s story, that is, who the patient is in the context of illness.  I emphasize to the students that narrative-based medicine is how evidence-based medicine is applied to the individual patient.  The key is to have them hold on to this patient-centered concept when they enter the fast-paced, technological race that defines today’s medicine. 

I think Fildes got it right in his painting.  And indeed, he too had a story.  Fildes’ son died of tuberculosis in 1877, no doubt attended by a doctor holding vigil at the bedside.