"What patients bring to their clinicians is their stories," writes behavioural scientist Thomas Egnew. It is through these stories that clinicians try to understand and treat patients' health. In his article published in Annals of Family Medicine, the author highlights the importance of "narrative medicine" in managing patient suffering resulting from the travails of chronic illness.
Narrative medicine is to the management of suffering as biomedicine is to the management of disease. It is medicine practised with the narrative skills of “recognising, absorbing, interpreting, and being moved by the stories of illness,” the author says.
When patients experience chronic or life-threatening illness and their suffering increases, clinicians can take on the role of holistic healer by addressing the inevitable existential conflicts in patients' narratives and helping them edit their stories to promote acceptance and meaning. In this guiding role, Egnew explains, clinicians can help patients transcend suffering, "assume the mantle of their heritage as healers," and find meaning in their work.
Relieving suffering is the ethical core of medicine. However, with its quest to cure disease and extend life, modern medicine often fails to address the need to relieve suffering. In addition, the medical service delivery system is poorly designed to meet the needs of chronically ill patients.
The author cites two management approaches recommended by Epstein and Back to relieve suffering. The first, diagnosing and treating disease to remove the source of suffering, remains paramount in medical efforts to alleviate suffering. The second, “turning towards” suffering, involves being open to the patient’s experience in order to enter the patient’s world. By so doing, Egnew notes, clinicians can help patients to refocus and reclaim important, meaningful, and generative aspects of their lives that foster growth through connection, transcendence, and healing.
“Turning towards” broadens the focus of medical service delivery to include the patient’s illness experience and suffering in management decisions, according to Egnew.
The travails of chronic illness exacerbate patient suffering. Patients can be supported through the degradations of chronic and terminal illness by a thoughtful exploration of their suffering. As the author explains:
"Suffering is conveyed as a story which inevitably involves the existential aspects of a patient’s life. Clinicians skilled in the nuances of narrative medicine can help patients edit their stories, which often involves engaging patients on levels relatively uninformed by medical education. Along the way, patients may be guided to find holistic healing."
Source: American Academy of Family Physicians
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