Over at The Guardian, Andrew Solomon has a worthy article called “Literature about medicine may be all that can save us: A new generation of doctor writers is investigating the mysteries of the medical profession, exploring the vital intersection between science and art.” Solomon notes that,
Language is integral to medicine. It is hard to cure a condition you cannot describe, and few treatments for those conditions go without names of their own. Even veterinarians, trained to diagnose animals who cannot put their complaints into words, begin by labelling the illness and proceed by specifying the treatment. The emerging field of narrative medicine proposes that patients can be treated correctly only when they can tell the story of their illness, often in the context of a more extensive autobiography. A doctor usually begins by getting the patient to describe their pain, and often arrives at diagnosis as much through that interaction as through anything he can observe. Illness is temporal, and language helps to chart its course, even when x-rays, MRIs, CAT scans and other images can represent its current state. A picture is not always worth a thousand words; sometimes, it is the words that tag the problem. You tell the doctor how you felt yesterday and how you feel today; the doctor tells you how you should feel tomorrow. That interaction is part of the cure; it is why a physician’s bedside manner can have such an enormous impact on his efficacy. We are embodied, but our minds order the brokenness around us by imposing vocabulary on it. In fact, there is some evidence that people who can speak more fluently receive better medical care; patients deprived of language are often subject to abuse.
This image shows a man in a blue dress shirt and striped blue tie, wearing a white coat. His mouth has a bandaid over it. He is standing next to a woman in a pink sweater and dress shirt. Her mouth also has a bandaid over it. Both are white. The man is raising one eyebrow much higher than the other as though confused or inquiring. The woman is raising both eyebrows. This is an add from the American Academy of Orthopaedic Surgeons. The text reads “Talk much with your doctor? Communication between doctors and patients can be powerful medicine. But too often, both parties come up short. Patients should come to appointments prepared with questions written down in advance and a list of all current medications and allergies. Doctors can do more, too, starting with listening better and using language patients don’t need a medical dictionary to understand…” IMAGE SOURCE: http://newsroom.aaos.org/PSA/print/Patient-Physician-Communication/patphyscomm2007.htm
Privileging narrative this way both centers (re-centers?) patient experience and testimony even in a world replete with clinical signs and markers–imaging, bloodwork, hands-on movement of limbs, blood pressure, heartbeat, skin discoloration, etc.–and highlights the bare fact that patients who cannot communicate in ways that doctors find effective may have worse outcomes.
Consider deaf-signing patients, patients for whom the doctor’s language of practice is a second language, patients who have communication disabilities, and patients who have received subpar public education. Medical student Hamsika Chandrasekar chronicles their experiences working with patients with whom Chandrasekar had difficulty communicating, over at the Stanford Medicine Scope blog. Chandrasekar highlights the importance of access to resources in achieving effective communication, an important point to keep in mind.
Solomon goes on to mention the work of physician-writers both past and present including Oliver Sacks, Siddartha Mukherjee, Danielle Offri, and Atul Gawande as well as many others. This is work by practitioners that attempts to describe and analyze the practice of medicine itself. Solomon’s Guardian piece is thus an excellent place to start for delving into such literature.
In addition, this editor is reminded of Tod Chambers’s excellent book The Fiction of Bioethics in which he critically examines case studies and medical records as narrative constructions, and of Hilde Lindemann’s very fine edited anthology Stories and Their Limits: Narrative Approaches to Bioethics. The links I’ve provided for each of these go to a precise and a review, respectively. Readers intrigued by Solomon’s discussion may want to check these out, as well.
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