Every Patient Tells a Story

Article Outline

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In today's health care system, enormous attention is given to the biomedical model of approaching the health aspects of the patients. The correct diagnosis is the key to prescribing the correct treatment, which aims to alleviate the patient's suffering. Targeted questioning, which leads to categorization of symptoms into specific syndromes provides the bulk of knowledge, which then allows for further clinical examination to verify our clinical suspicions.

Subsequently, to further consolidate our inkling, we order special investigations, such as blood tests and X-rays. However, along this path, the power of the patient's story becomes diluted. This psychosocial aspect tends to be relegated to second place in importance. This book describes in detail the profound influence that patients' stories may have on the way health care staff interpret the needs of patients and their environment, which includes caregivers. These narratives lead staff to assessments of needs and subsequent provision of services. These stories, therefore, play a very important role in the provision of overall care to the patient.

When working with patients with any chronic illness, the importance and the meaning that the disease brings to the patient and family should be part of the overall examination and assessment. This book describes the theory and logic as well as practical application. I am, therefore, confident in my recommendation that this timely compilation of chapters by the leaders in the field of narrative medicine will be both interesting and invaluable to all the readers of the Journal of Pain and Symptom Management. There are today a number of narrative medicine programs throughout the United States, and the research consistently shows improvement in patients care and outcomes for those patients who have been treated by physicians and nurses who are trained in narrative medicine.

This book is divided into three sections, which are recognizably different, yet connect very well together. This allows for further understanding of the whys and hows on the subject. The first section introduces the narrative as a technique and describes the many varied terms that are used by researchers. Clarification of the concepts and outcomes for the narrative are discussed. The differences between the story and the narrative are presented, with the latter spanning a wide spectrum from jokes to illness. Examples are given to demonstrate the impact a story may have. The evidence for use in the practice of palliative care is highlighted.

The second section focuses on the provision and use of the narrative in providing service, that is, practical application and clinical implications in the clinic. The importance of good listening is stressed as a professional tool in clinical practice. In addition, interpretation and analysis of the meaning and effects of the storytelling for the patient are discussed at length.

The third section focuses on patients and their caregivers; for example, the different meaning of pain and other symptoms in the narratives of different cultural groups. The use of metaphors and symbols require “committed attention” to better understand the patient.

Overall, the book is well written and the content flows well. The introductory chapters are difficult to follow, in that the jargon used is overwhelming, especially for someone with a narrow literature background, such as myself. This could have been condensed and made more succinct but is a minor criticism.

I can wholeheartedly recommend this book to any health care professional or student who interacts with patients and caregivers in the palliative care setting.