Shirah Vollmer MD

The Musings of Dr. Vollmer

Did Medicine Lose The Narrative?

Posted by Dr. Vollmer on May 8, 2013

Gene Beresin MD, Harvard Medical School faculty, wants to bring back the narrative to medical education. He made the point yesterday that coherent narratives help both patients understand themselves, and medical trainees understand their field. Narratives, he argued, creates attachment, and attachment creates security and comfort-crucial elements of a healing process. I am sorry, Dr. Beresin, as much as I fully support your mission, I am afraid that despite all of the advantages of electronic medical records, the major downside is the loss of the narrative. The stories are becoming much less important, replaced by symptom checklists and automated responses. I am not saying that medical care will get worse without the narrative, but I am saying that without the narrative, the practice of medicine changes its lure. Some folks, Ā like myself, are drawn to narratives. We love stories, be that in our patients, in books, in film or in theatre. The stories create a richness of life’s experiences which deepen one’s sense of oneself, as one begins to see a wider perspective of the world. So, maybe if I were coming of age today, I would be drawn to Eastern medicine, where the narrative still matters. Dr. Beresin, a man, I would guess, in his sixties, holds the old torch, making me nostalgic. He volunteered that he is also a musician, a man of the arts. That’s cool. Yet, despite his Ivy League credentials, I am afraid no mover or shaker in our health care system is going to listen. The value of the narrative is slipping away from the health sciences. It is too bad, but it is our future.

4 Responses to “Did Medicine Lose The Narrative?”

  1. Jon said

    Did medicine lose the narrative? Perhaps. You tell us that the good Dr. Beresin wants to bring it bac to medical education. Good. You also tell us that for the future of medicine, the narrative is slipping away from the health sciences. Perhaps with enough voices (Drs. Beresin and Vollmer as examples) indeed the narrative could be brought back to medical education. I understand your all-too-jaded concern of symptom checklists and automated responses; however, keep fighting the good fight. That is the way to keep medical education, and perhaps even medicine, more human.

    • Hi Jon,
      Thanks. I want to be clear that the lack of narrative in medicine, is a shame, perhaps more from the doctor’s perspective than from the patient’s. Good, efficient medical care can be had without a narrative, but the fun in providing that care changes. Sometimes that narrative is important to diagnosis, but most of the time, especially in today’s day of superior imaging techniques, the nuances of that narrative are becoming less critical to solving mysterious ailments. I am not sure about the concept of “jaded” as electronic medical records are here to stay, and by definition, they eliminate the narrative.

  2. Shelly said

    Yes, definitely, the narrative is super important, especially in your field. Nowhere is it more important than in psychiatry. The EMR may be magic at the bedside and in the 15-minute med check system, but without the narrative, there is little hope for your patients. We all know that meds alone don’t help. It is like someone trying to lose weight: it’s a losing battle if one only restricts calories. To effectively lose the pounds, one also needs to exercise and make it a lifelong habit. So too with psychiatry–meds alone will not change behaviors; talk therapy with continuous education and enforcement by a therapist is key.

    • Yes, Shelly, but the issue here is who is going to provide the “coaching” or the listening to the narrative. Physicians may be losing ground, but this might create new opportunities for non-MD providers. Thanks.

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