Narrative medicine tools: parallel charts
Parallel charts are one of the tools that help develop narrative competencies and enable a more comprehensive examination of the experience of illness. I first became aware of this tool through Anna Quindlen's Write for Your Life.
The parallel charts method was created in 1993 by Dr. Rita Charon, an internist and professor at Columbia University in New York. It asks medical staff and students to write in plain language about what they see, what their patients go through, and what it's like to care for the sick. As a result, we record information in this exercise that isn't part of the patient's chart but should be recorded nonetheless.
Instead of writing about the patient's current state, test results, medications used, and treatment plan, in parallel charts, we write about the emotions that come with caring for the patient, such as a sense of helplessness or guilt in the face of illness, rage at the unfairness of illness, admiration for his or her courage, or feelings of attachment when the patient is dealing with the same illness as a loved one.
In a classroom setting, this exercise is most effective when it is combined with frequent meetings where students can present their writing to their peers and the instructor. Students who use this method report finding solace in the knowledge that they are not the only ones experiencing loss, sadness, or guilt. Students naturally write a lot about themselves while writing about patients, which helps them learn how to identify and manage their emotions. According to ongoing research at Columbia University, medical students who use parallel charts are rated by their instructors as being more proficient in conducting medical interviews and procedures, as well as in communicating with patients.
We can use auxiliary sentences like these in parallel charts (Banfi et al., 2018):
“The first encounter with the patient was […] The patient seemed […] and he/she told me […] So I had […]. During the communication of the diagnosis I think the patient felt […] and so I felt […] I thought […] and I had […]
During the following visits […] The patient told me that at home […] Inside the family […] And outside […] His/her activities […] I thought […] And I had […] I felt […]
Today, taking care of this person is […] From the patient I’m learning that […] For the future I wish […] For the future, I hope that he/she […] Thanks for your time, energy, and thoughts. The last question: how did you feel about writing the parallel chart? […]”
The ability to shift perspective to see events from the patient's point of view is one of the most important and often missing skills for healthcare professionals - but one that can be learned.
Further reading:
Charon R. (2001). Narrative Medicine: A model for empathy, reflection, profession, and trust. JAMA;286(15):1897–1902.
Charon, R. (2008). Narrative medicine: Honoring the stories of illness. Oxford University Press.
Banfi, P., Cappuccio, A., Latella, M. E., Reale, L., Muscianisi, E., & Marini, M. G. (2018). Narrative medicine to improve the management and quality of life of patients with COPD: the first experience applying parallel chart in Italy. International Journal of Chronic Obstructive Pulmonary Disease, 13, 287–297.
