Dr. Margaret KayMBBS(Hons),FRACGP, Dip.RACOG

The University of Queensland

TRANSFORMATIVE NARRATIVES

IN DOCTORS’ HEALTH: POSITIVE

REPRESENTATIONS OF THE

WOUNDED HEALER

Defining narratives• “ method of recapitulating past experience by matching a verbal sequence of clauses to the sequence of events that actually occurred”

(Labov)• constructed• orientation, complication, evaluation, resolution (coda)

•Stories are dialogic • Bakhtin - Co-construction

troublewhere/when unfolding sorted out

Wounded Healer• Ancient mythology

• Chiron• Teacher /Healer– Asklepios• Arrow wound – poison of the hydra

• Jungian – analytical psychology – archetypal images• Mental health

Narratives included:• Authored by the doctor with the illness• Published in a medical journal• Or anthology of ‘articles’ on doctors’ health• Excluded – memoire/biographies for lay community• 160 narratives (>250)• Saturation

MedlineCinahlPsychinfoGrey literatureAnthologies

•Typologies - Arthur Frank• Restitution

• being sick getting treatment and being healed

• Chaos• no meaningful response to illness

• Quest• ill person finds meaning in illness, • works with illness• move forward in life

Illness Narratives

Themes

“aversion to the hospital that embodies the "faustian soul of modern technology".”

"I have lived most of my life with the certainty

that a "big illness" was waiting for me. Not an

ordinary illness, but something obscure...”

Themes

•Becoming a patient

•Care received

•Effect of the illness

Becoming a patient•Crossing the ‘thin red line’ • Crossing the border, ‘changing hats’

•Want to be a normal patient / a good patient

“Although I had passed the examinations put out by the American Board of

Internal Medicine, she [the patient in the next bed

with [Hodgkin's disease] seemed to know a lot more about being sick and being

a patient than I did...”

Care received•Disappointment•Changed doctor / Self-treatment

•Shared-decision making•Need for hope•Rapport /empathy / trust

Effect of illness•Blow to omnipotence

•Altered outlook on life• Positive work-life balance

•Altered outlook on medical practice• Better doctor• Value the art

“Suffering had sensitized me to

the human condition.”

“I am sure my illness has made me a better physician”“given me confidence

that caring and encouragement can

go a long way in helping”

Narratives guide to our listeningorientation, complication, evaluation, resolution (coda)

• Content • Construction • How it is told – the emplotment• Association, Causation• Meaning

Narratives guide to our listening • Professional stories – Restitution• being sick, getting treatment, and being healed

• Chaos – Avoid

• Personal stories – Quest• Healing lies in finding the meaning

Transformation •We can choose our narrative

•Reflection – enables the writing of the narrative

•Chaos can be transformed

•Assist through Co-construction • rapport / trust / relationship• enables shared-decision making• allows the patient to be a good patient

Transformation •We can choose our narrative

•Reflection – enables the writing of the narrative

•Chaos can be transformed

•Assist through Co-construction • rapport / trust / relationship• enables shared-decision making• allows the patient to be a good patient

Transformation •We can choose our narrative

•Reflection – enables the writing of the narrative

•Chaos can be transformed

•Assist through Co-construction • rapport / trust / relationship• enables shared-decision making• allows the patient to be a good patient

Transformation •We can choose our narrative

•Reflection – enables the writing of the narrative

•Chaos can be transformed

•Assist through Co-construction • Treating-doctor / Doctor-patient• rapport / trust / relationship• Patient-centred medicine