For instance, Charon recalled a patient who had high cholesterol and chest pain. During their first meeting, she recounts, "he started his story with the death of his father when he was a boy." By not restricting the conversation and treatment to his cholesterol and physical pain, Charon and her patient began to talk about his own challenges as a father. "It made for a very productive alliance," she says. "And his chest pains went away."
Many experts concur that such careful listening can lead to better diagnoses and approaches. Ron B. Loewe, an anthropologist and authority on narrative medicine at Mississippi State University, recalls interviewing doctors and patients at Cook County Hospital in Chicago about diabetes because few patients were complying with their doctor's orders and many were doing poorly. Loewe found that patients thought the doctors had given them diabetes when administering shots of prednisone, commonly used to treat inflammation. "What are the issues for compliance if your patient thinks you caused the disease?" asks Loewe, adding that many doctors remain uninterested in eliciting such stories. "They are under such pressure to see lots of patients in a very short period."
In addition, some doctors remain critical of medical school curricula that include humanities and communication skills, arguing that time is better spent on scientific subjects. "As with any change to an establishment as solid as medicine, there is skepticism," says Kelly Caverzagie of the University of Nebraska Medical Center and a member of the American Medical Association's Council on Medical Education. The old guard may harbor skepticism, but, Caverzagie points out, "the students themselves are embracing this movement."
Charon's own involvement with new movements is long-standing. In 1966 she entered Fordham University and quickly joined an experimental education project in which 30 students and six teachers designed their own curriculum. She tackled various jobs, among them teaching at a newly established progressive elementary school, before becoming a medical student at Harvard University in 1974. Her interest in narration and medicine formed during a lecture by Elliot Mishler, a Harvard social psychologist renowned for bringing narrative theory to sociology. "I was riveted," she says. She studied with Mishler, developing what she describes as a way of seeing patients as whole people, not as cases, and using her mentor's attention to the patterns of speech to hone her listening skills.
Her engagement with narrative ultimately led to a doctoral dissertation at Columbia on Henry James's late works, including The Wings of the Dove, in which one of the three central characters is a very ill woman; the creation of a writer-in-residence program at Columbia's medical school, in which visitors, including Susan Sontag and Michael Ondaatje, have shared their perceptions of illness with medical students and faculty; and a practice called "parallel charts," in which residents write about their patients in a nonmedical format. Charon is now designing studies to assess the impact of parallel charts and of groups such as the one in narrative oncology. Charon and oncologist Gwen L. Nichols say the readings have improved relationships among the oncology staff, prevented burnout and, therefore, led to better care.
"When a very junior nurse is in a position to give comfort and sustenance to the service chief, and when the head doctor of oncology finds himself weeping to hear what this junior nurse has written, that does something you don't do on rounds," Charon declares. "We have team meetings, we go on rounds. But it doesn't happen there because--well, that is what we are trying to learn."
This article was originally published with the title When Medicine Meets Literature.