The limitations of narrative medicine.

Abstract

Narrative medicine has emerged over the past few decades as an exciting approach to medical practice, interweaving the practice of medicine with the practices of literary analysis and reflective writing. It is often claimed that narrative medicine enables practitioners to understand and empathize with patient stories, effectively 'joining' patients in illness. However, I argue that there are reasons to be suspicious of narrative medicine's ability to promote patient-centered care. I begin by questioning the distinctiveness of narrative knowledge, suggesting that it is neither able to be propositional knowledge ('knowledge-that') nor phenomenal/experiential knowledge ('knowledge-what-it's-like'). Then, I consider an alternative reading of narrative medicine, by which narratives are simply ways to structure patient information so that a physician can more readily empathize with the patient. I dismiss this alternative as unsatisfactory given that it depends on either all patients building narratives or physicians imposing narrative structure(s) where one does not inherently exist, thus overriding patients. Finally, I provide possible supplements and alternatives to narrative medicine, proposing that active listening and the removal of systemic barriers to physicians' abilities to provide humanistic care (e.g., lower administrative, profit, and documentation burdens) may be a first step to putting empathetic patient care on the forefront. Ultimately, I think that these efforts (while their fruition may present difficulty), rather than sifting through patient information to construct and elevate narratives, present the opportunity to accurately refocus patient-centered care.