Abstract
Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in the narrative are described. This view of narratives recognises that they can contribute knowledge of different kinds of connections between events: not just causal, and not just of patient’s perspectives. Additionally, narratives can add further epistemic value by suggesting potentially useful lines of inquiry. We take narrative approaches to healthcare to include clinicians considering both patients’ informational offerings and their own professional understandings as narratives. On this understanding, our account is able to overcome the major theoretical and practical criticisms that have been levelled against the use of narrative approaches in healthcare, and can help to explain why and how narrative approaches are consistent with PCH.
Highlights
Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH)
Several authors have argued that that clinical attention to narratives – that is, listening to the narratives of patients in the clinical encounter and/or recognising narrative structures in medical knowledge – can improve patient care in a number of ways
Many of the claims made about the benefits of attending to narratives overlap with features of person-centred healthcare (PCH)
Summary
Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). PCH has been formulated in a range of ways, but loosely, aims to counter problems in healthcare related to tendencies to reductive and dehumanising care of patients These tendencies have been linked to the enduring influence of the biomedical model (perpetuated by features of medical education [1, p.90], institutional traditions [2], and increasing emphasis on technologies [3;4;5]); and constraints in clinical practice, such as financial, time, and institutional pressures, that (allegedly) limit clinicians’ capacities to engage with patients as persons.. We focus on how narrative can help clinicians work in person-centred ways with patients
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