What are narrative competencies and why are they important in healthcare?
In medicine, there are two main paradigms. The hard paradigm is a biotechnological approach in which health and disease are explained in biological terms, treatment is focused on disease as a disorder of the body, and where a strict, objective characterization of disease predominates. The soft paradigm, on the other hand, is based on the model of health and disease, which recognizes the need for narrative in medical practice and emphasizes the psychosocial and cultural determinants of human functioning in both health and disease. It focuses on the subjective experience of the disease and, in addition, the treatment of the person as a whole, including the environment. The second paradigm is the main focus of narrative medicine.
Defining narrative competencies
Narrative competence is a set of skills required to recognize, absorb, interpret, and experience the stories that we hear or read about in medical practice, according to Dr. Rita Charon, a professor at Columbia University in New York, an internist as well as a literary scholar. Because of this, developing narrative competencies requires a combination of textual analysis skills (such as examining a story from different angles and recognizing metaphors), creative skills (such as imagining various interpretations of a given story), and emotional skills that allow us to feel the emotions of the characters in the story.
Why are narrative competencies important?
Strictly scientific medicine cannot assist a patient in coping with health loss or finding meaning in suffering. Along with scientific skills, healthcare professionals must be able to listen to patients' narratives, understand and respect the meaning of their stories, and be moved by them to act on their behalf. They allow us to practice medicine with empathy, reflection, professionalism, and credibility. Health professionals with strong narrative skills can interpret what the patient is trying to say quickly and accurately. As a result, they make better use of clinical interaction time. They not only understand the patient, but they also understand the disease in a new, more holistic way.
Four situations in which we use narrative competencies
An interaction between a healthcare professional and a patient
If we imagine a conversation taking place in a doctor's office, the patient's story is frequently a complicated narrative of the illness communicated with words, gestures, and silence, containing information about both the disease itself and the fears associated with it. The doctor listens to the patient's story while following it, imagining the patient's circumstances (medical, familial, cultural), understanding the words used and the events described, and engaging memories, associations, and allusions to previously heard stories. By learning about the patient's experiences with the illness, the doctor can correctly interpret test results, develop empathy, and involve the patient more in receiving effective care. If the medical professional is incapable of carrying out these narrative tasks, the patient may not tell the whole story, may be reluctant to ask important questions, and may not feel heard. As a result, the therapeutic relationship becomes shallow and ineffective.
An internal monologue of a health professional
Medical staff learns compassion, respect, and humility through genuine patient care. Negative situations, such as suffering, injustice, or despair, that doctors and nurses see every day in their practice: have an impact on them as well. Reflective practitioners are better at identifying and interpreting their own emotional responses to patients' words. They are also better able to make sense of their own life experiences and learn to practice medicine with commitment, which requires constant reflection on their own practice.
Communicating with representatives of other medical professions
Without narrative competence, we seem to be isolated from each other and from our colleagues in other disciplines. Daily professional activities in medical practice and teaching strongly depend on narrative competencies, because these skills enable clinical cooperation and mutual reliance, as well as constructive criticism and mentoring.
An interaction between health professionals and society at large
Due to the high level of public trust in the health sector, we are involved in discussions about how to improve healthcare systems.
Further reading:
Charon R. (2001). Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA. 286(15):1897–1902.
