Narrative-Based Medicine: Potential, Pitfalls, and Practice

Abstract

Narratives have always been a vital part of medicine. Stories about patients, the experience of caring for them, and their recovery from illness have always been shared—among physicians as well as among patients and their relatives. With the evolution of “modern” medicine, narratives were increasingly neglected in favor of “facts and findings,” which were regarded as more scientific and objective. Now, in recent years medical narrative is changing—from the stories about patients and their illnesses, patient narratives and the unfolding and interwoven story between health care professionals and patients are both gaining momentum, leading to the creation or defining of narrative-based medicine (NBM). The term was coined deliberately to mark its distinction from evidence-based medicine (EBM); in fact, NBM was propagated to counteract the shortcomings of EBM.1,2 But what is NBM? Is it a specific therapeutic tool, a special form of physician-patient communication, a qualitative research tool, or does it simply signify a particular attitude towards patients and doctoring? It can be all of the above with different forms or genres of narrative or practical approach called for depending on the field of application. In this article we will give a systematic overview of NBM: a short historic background; the various narrative genres; and an analysis of how the genres can be effectively applied in theory, research, and practice in the medical field, with a focus on possibilities and limitations of a narrative approach. In medical practice, three different, though overlapping, areas can be distinguished: Learning the patient's and the caregiver's perspective for research and training. Classification of various narrative forms or genres will be included in this discussion. The narrative approach in medical practice, through understanding the narrative structure of medical knowledge, and narrative-oriented, physician-patient relations. Narratives as evidence—narratives from social science research and narratives derived from medical practice and patient encounters are a source of knowledge for evidence, beyond the gold standard of randomized controlled trials of evidence-based medicine.