What is it???

Outcomes

• Be able to describe what Narrative Based Medicine is

• Be aware of the advantages and disadvantages of Narrative Based Medicine

• Consider the role of Narrative Based Medicine in your practise as a GP trainee

http://www.bbc.co.uk/radio4/features/the-listening-project/conversation/p01lcw4m

“One day when Pooh Bear had nothing else to do, he

thought he would do something, so he went round to

Piglet's house to see what Piglet was doing. It wassnowing as he stumped over the white forest track, and he expected to find Piglet warming his toes in front of the fire, but to his surprise he saw that the door was open, and the more he looked inside the more Piglet wasn't there.”

Narrative as a linguistic form• It has a beginning, a series of unfolding events

and an end

• It has a narrator and a listener whose different viewpoints affect how the story is told

• The narrative is concerned with individuals; their feelings (not just facts) and how people feel about them

Narratives in Medicine

“episodes of sickness are important milestones in the narratives of patients’ lives”

• The narrative (verbal +/- written) provides meaning, context and perspective for the patient’s predicament

• Understanding the narrative provides a framework for approaching a patient’s problems holistically

BMJ 1999 Greenhalgh and Hurwitz

Emphasis on the Medical History replaces the “native ability” to elicit and appreciate patients’ narratives

1998 Kleiman

An Example of Narrative Medicine in Practise

• http://www.youtube.com/watch?v=24kHX2HtU3o

The CSA (http://www.rcgp.org.uk/gp-training-and-exams/mrcgp-exam-overview/~/media/Files/GP-training-and-exams/MRCGP-Clinical-Skills-Assessment-Jan-2012.ashx ):

– Being curious about the patient and trying to understand their perspective will help you to identify their views (Heading 12)– How is the problem affecting the patient? What changes have they had to make to their life because of this problem? Who else is affected by the problem? (Heading 14)

Promote empathy and understanding between patient and clinician

Encourage a holistic approach

“Questions some of the certainties of Medicine and Science”

Can be therapeutic

Facilitates traditional medical history

Enhances listening and interpretive skills

Time constraints especially with 10 minutes consultations

Fear of litigation driving the need to meet the doctor’s agenda i.e. red flags

Would get in the way of QOF and “box-ticking”

Patients seek “conventional medical explanations for their problems”

Narratives and Fiction

“we construct our view of reality by telling stories” Dr John Launer (gptraining.net)

Written Tasks