Narrative medicine in veterinary practice

Abstract

With the rise of medical humanities, narrative medicine is becoming established in the human medical field, but there has been scant literature on narrative veterinary medicine. In this book, Karen Fine, a holistic, integrative practitioner, argues that narrative veterinary medicine will not only improve communication with clients, but also the care of veterinary patients and the wellbeing of veterinary team members. The first section provides an overview of narrative medicine, drawing primarily on medical literature to explain the emergence and conceptual basis of this field. In short, in veterinary practice, the client presents a patient or patients, and brings to the consultation a particular narrative. The client narrative yields insights into the client’s world view, which impacts the nature of the human-animal relationship, the decisions made on behalf of that animal, who they trust with the animal’s care, their expectations and “problems in parantheses” (deeper concerns that clients may struggle to articulate). With the veterinary team, a new narrative (including a plan) is co-created with the client. Fine explains how the stories we tell ourselves can impact our own perceptions and approaches to clients, and even our wellbeing. I was reminded of the work of Alf Wight, better known by his pen-name James Herriot. According to the biography written by his son Jim, Wight struggled with mental illness and often worked in difficult circumstances. Were Herriot’s stories an attempt to reframe his work and professional identity? The second section is structured around the veterinary consultation, including narratives of veterinary team members, obtaining a history, making a plan and recording the narrative. To paraphrase Rachel Naomi Remen, veterinarians cure with their expertise but heal with their experience and attention. The third section highlights issues Fine identifies as “unique” to the veterinary profession, including euthanasia, while the fourth focuses on the stories of veterinary team members. It introduces tools for reflective practice, including parallel charts (the story of the patient that isn’t included in medical records, but enables the clinician to develop their own narrative), and personal loss timelines (documentation of our own losses, and how these may inform our interaction with clients and patients). It incorporates narrative case studies throughout. Fine claims that burnout can be decreased by emphasising the unique stories of patients and clients rather than just focusing on diagnosis and treatment, while compassion fatigue can be reduced through reflective practice, and narrative boundary-setting. Whether and how this is the case remains to be seen, as there is a dearth of research in this field. It may be that narrative veterinary medicine reduces burnout and compassion fatigue by increasing engagement and interest. Given concerns about the wellbeing of veterinary team members, it is important that such questions are explored through well-designed studies. Clinicians used to reading veterinary textbooks may find the relative lack of evidence a “hard sell”. Fine’s work is certainly based on key published texts in veterinary narrative medicine, and points to additional sources including narrative medicine journals. It provides a highly accessible, enjoyable introduction to a field which will no doubt grow. The book can be read from cover to cover in a few sittings, or dipped into. My copy is dog-eared and tagged in sections I want to revisit and explore in more depth. The book will appeal most to those already comfortable with the concept of reflective practice, and those willing to make time to listen to and engage with client narratives. Those who aren’t may still find some of the tools described useful to refine their consultations. It demands that we consider the way we construct stories about our work and our patients, the way we respond to stories from clients, and how those stories influence our reasoning, interaction with patients and clients, professional identities and even clinical outcomes. As someone who does not identify as an integrative practitioner, but is a fan of reflective practice, I found this book fascinating. It will be of interest to veterinarians, nurses, technicians, students, educators (particulary those teaching clinical communication) and social workers.