Models of medical practice

Narrative medicine

Human beings are first and foremost storytellers.

Telling stories is how we make sense of our lives and the world around us. As the philosopher Alistair McIntyre states:

We are never more (and sometimes less) than the co-authors of our own narratives¹.

Narrative medicine recognises this and aims to allow the patient’s story to emerge enabling the integration of the patient’s illness experience within their life story. We also know stories are one of the ways we interpret and gain new knowledge – a ‘patient history’ is a narrative form, after all. Understanding the centrality of narrative in medical practice can help us generate and create new knowledge. John Launer described this as ‘narrative medicine’².

Narrative medicine is about:

• Storytelling: the patient’s story, primarily, but also the doctor’s story and how these stories interweave in the clinical encounter to create a new story with new meaning and understanding and the possibilities for change
• Acknowledging the uniqueness of each patient, validating his or her ‘story,’ and empathising through genuine interest and concern. Acknowledging the healing power of telling their story and having their concerns recognised
• Recognising the divide that can exist between doctor and patient and attempting to build connections. For the doctor this entails listening closely; exploring fears, feelings, and emotions; and developing a deeper understanding, not only of the illness experience but also of the patient and of the self

Allowing the story to emerge entails doctors remaining curious, asking open questions and supporting conversations inviting change eg ‘what would be different if?’ ‘could you imagine doing things differently?’

Interpretative medicine

Interpretative medicine is another proposed framework attempting to bridge the gulf between evidence based medicine and real world general practice. We will return further to interpretive medicine in the next module. It addresses one of the key fears/barriers to generalist practice – how do we know we have done it well – by providing a framework by which we can judge our KW in practice.

Interpretive medicine means using knowledge and evidence in the clinical encounter as an exploratory space and finding creative solutions to support the patient in their everyday life. It means interpreting symptoms in the context surrounding the patient rather than following ‘tick box’ protocol orientated medicine. It addresses one of the key fears/barriers to generalist practice – how do we know we have done it well – by providing a framework by which we can judge our knowledge work in practice

References

1. MacIntyre, A. (2013). After virtue. A&C Black.
2. Launer, J. (2018). Narrative-based practice in health and social care: conversations inviting change. Routledge.