Med-School Makeover

Dr. A. Scott Pearson's patient had a problem--two problems, actually, and only one of them seemed fixable by a surgeon. The patient, an elderly man, needed to have a tumor removed from his colon. He also didn't want to have the operation. Pearson, a surgical oncologist at Vanderbilt University, could have sent his reluctant patient home. Instead, he and his residents asked to hear the backstory. "He was the sole provider for his wife, who was an invalid," Pearson says. "He couldn't put her care in jeopardy while he got better." A team of doctors and social workers arranged temporary care for the patient's wife, and soon he lay recovering in a hospital bed.

Pearson may have exceptionally good instincts, but his technique is increasingly being taught in med schools. Known as narrative medicine, it's part of a new approach among physicians and medical educators to consider patients' personal stories as much as their test results in determining the course of treatment. Dr. Rita Charon of Columbia University, who coined the term and defined many of its tenets, says the practice has "really blossomed, sort of spontaneously." Her workshops have drawn doctors from Israel, England and Canada; more than 80 percent of med schools in the United States now offer courses with a narrative or literary bent. All of them are unified by one principle, says Charon: "If you take the stories out of medicine, there's little left."

Today many doctors enter highly specialized fields and are more pressed for time than ever, leading them to focus more heavily on data, says Jack Coulehan, professor of preventive medicine at Stony Brook University in New York. Charon teaches her students basic communication skills that force them to focus on patients instead: ask specific but open-ended questions, don't interrupt and, adds Pearson, "don't look at your chart or the computer--look at the person." Some narrative-medicine programs also require students to keep journals in the hope that understanding their feelings will help them empathize with patients'. Others have reading lists that include works by William Carlos Williams and Anton Chekhov.

The methods are deceptively simple, but they seem to work. Small studies have shown that med students with narrative training are "more skilled at doing interviews, more able to develop therapeutic relationships with patients and even better at doing procedures like a spinal tap," says Charon. They also can benefit from a taste of their own medicine: those who keep journals seem to cope with stress better and get along more smoothly with their colleagues. Narrative, it seems, may be just what the doctor ordered.