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Narrative medicine puts focus back on patient
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For those of you who read Primary Care Optometry News regularly, you know my view on health care reform remains steadfast. If we are ever to expand access, improve quality and control health care costs in this country, it is going to require a concerted effort by all stakeholders.
It will most assuredly not come from government mandates. Nor will it magically emerge from health care insurers’ data mining. Heck, it will not even come from technology advances and the relentless pursuit of providers. While each is an essential component, the solution largely hinges on patient participation. Simply put, we need patients to buy in.
So, we often discuss the importance of patient education on all things health related. We frequently debate the most effective ways to enhance patient compliance. But one thing we do not always do is listen and consider – yes, listen intently to and consider the patient’s perspective. Fortunately, there is a movement underway to change this, and it comes in the form of narrative medicine.
The concept of narrative medicine is not a new one. Dating back more than a decade, advocates such as Charon theorized, “The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret and act on the stories and plights of others. By bridging the divides that separate physicians from patients, themselves, colleagues and society, narrative medicine offers fresh opportunities for respectful, empathic and nourishing medical care.”
Charon’s comments, while both simplistic and intuitive, are not always easy to abide by. Long gone are the days in which providers had ample time to spend with their patients. Cumbersome and ineffective electronic health records, insurer-driven coding requirements and intrusive government reporting mandates sap valuable time and energy from patient visits. Add the complexities of integrating technologies, and it is understandable why we find it increasingly difficult to solicit our patients’ input. That being said, the importance of patient input is undeniable. And every once in a while a patient reminds us of such.
A few months ago I referred a long-standing patient for cataract surgery. At the time, her best-corrected visual acuity was 20/30 OD and 20/100 OS. Given her symptoms and clinical findings, I felt cataract surgery in the left eye was the most plausible course.
After a brief discussion, she consented to proceed with a surgical consult ... only to return having decided against the surgery. When asked why, her answer was both pragmatic and compelling. While the cataract remained somewhat debilitating, she was no longer driving and actually functioning fairly well. Additionally, worsening chronic obstructive pulmonary disease and declining overall health factored in her decision. Finally, a new high deductible insurance plan added a significant unanticipated cost to the procedure. She reasoned that the money saved by foregoing cataract surgery would be better spent on a new smart phone, thereby providing her the pleasure of texting and talking with family members daily. She commented, “I figured the phone will provide me with more joy during what time I have left with my family.” I told her I could not disagree.
In this month’s Primary Care Optometry News, we take a closer look at this trend in our feature article, “Narrative medicine empowers patients, improves care”. For some, it will conjure up memories of a simpler time in health care. For others, it will provide a fresh, less “data-driven” perspective on patient care. In either case, the real value of narrative medicine is that it puts the patient front and center – exactly where they belong.
- Reference:
- Charon R. JAMA. 2001;286(15):1897-1902. doi:10.1001/jama.286.15.1897.