Narrative medicine

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As Narrative Medicine ( "narrative medicine"; from Latin narrare "tell"; English narrative medicine (NM) or narrative based medicine (NBM)) refers to a methodical approach of medicine that deals with the importance of stories and stories for the patient Doctor relationship deals.

Theoretical framework

Narrative medicine, like narrative psychology , assumes that people give their lives meaning and meaning by reproducing experiences in the form of stories and narratives.

Individual life events are not viewed as connected with one another - for example, by themselves: connections and plausibility are rather created by the subject in the process of narration . Then narratives are not the result of a past of whatever kind , but rather the attempt of the narrator to formulate a coherent story - for the listener and for himself - from the perspective of the here and now . The story is told in three forms of time: the respective event comes from the past, it is linked to current conditions of the present and viewed in anticipation of the future .

According to Duden, the term narrativ only exists in adjectival form in the German language ; In technical jargon, however, it is sometimes also used as a substantive in the sense of narrative = experience report. The guideline on evidence-based health information defines patient narratives as follows: Narratives reflect individual experiences with illness, health or the need for care. They can be short quotations or longer reports on one or more aspects of a disease. Narratives often contain implicit or explicit descriptions of behavior, coping strategies or decision-making processes. Written in the first or third person, they often follow a plot, contain concrete examples, details and characters. They are understood as a component in health information. Depending on the medium, they can be in writing, as video or as audio recordings.

Formation

Narratives play an important role in medicine; Stories of illness, healing and death, of patients and of experiences in meeting them have always been told. However, the standing of these stories in medicine has changed over time. As recently as the late 1990s, there were complaints that patient narratives had been suppressed for a long time. That has changed again recently. Whereas in modern times the doctor's narrative in the form of an objective, scientific report was dominant in the medical narrative, the story of the patient is now increasingly coming into play; Narratives are increasingly seen as a useful resource in understanding the meaning of illness and being ill for patients.

The term narrative medicine was explicitly coined to delimit and complement evidence-based medicine , among others by Trisha Greenhalgh, who published her monograph on narrative based medicine shortly after her book on evidence-based medicine. Recently there has been an increasing effort to understand narrative medicine and evidence-based medicine as complementary .

Practice of Narrative Medicine

There are different forms of narratives in medicine: patient stories, doctor stories and narratives of encounters between doctor and patient.

Patient stories give (especially the doctor) an insight into the inner view of illness: they clarify the biographical and social context of being sick, e. B. also the concerns of the person concerned. In the patient-doctor relationship entered into with the doctor , patients use stories to bring their own individual assumptions, ideas and interpretations of their illness into account. Patient stories are said to have a therapeutic effect - even outside the patient-doctor relationship, for example in self-help - as they can help those affected to deal with their health problems. Disease narratives arise in large numbers outside of medicine - in the form of experience reports, e.g. B. in the chat rooms of the Internet.

Written reports on encounters between doctor and patient are seen as an important aid in medical training and practice for learning and deepening self-reflection on how to deal with the patient.

Limitation / risks

Patient stories are as unique as their authors. In contrast to reliable scientific studies on the effectiveness or ineffectiveness of medical measures, they cannot be generalized. Ana Luisa Rocha Mallet remarks very correctly in her essay Narrative Medicine: Beyond the Single Story : Single stories create stereotypes. This risk must always be considered: we cannot generalize the experience of an individual. What was effective for Maria (e.g. globules ) prevented Agnes from recovering because the therapy that was actually effective was dispensed with.

Patient stories can help people cope with illness by giving others access to personal experiences. But no statements about the effectiveness of medical measures can be derived from personal fates.

In addition, the risk of misuse of patient stories should not be underestimated. The healthcare industry likes to use patient stories as an advertising medium , often in the form of surreptitious advertising . Among other things, the statements of the German Heilmittelwerbegesetz , according to which drugs, procedures, treatments, objects or other means may not be advertised outside of the specialist circles ... with the reproduction of medical histories as well as with references to these in abusive, repulsive or misleading or can lead to a false self-diagnosis through a detailed description or representation (§ 11 Heilmittelwerbegesetz). In addition, advertising disguised as information is fundamentally prohibited under German law against unfair competition .

See also

literature

  • ZF Meisel, J. Karlawish: Narrative vs evidence-based medicine – and, not or. In: Journal of the American Medical Association . Volume 306, Number 18, November 2011, pp. 2022-2023, doi: 10.1001 / jama.2011.1648 . PMID 22068995 .
  • JP Meza, DS Passerman: Integrating Narrative Medicine and Evidence-based Medicine: The Everyday Social Practice of Healing. Radcliffe Publishing, 2011. Link accessed August 28, 2018
  • DB Morris: Narrative medicines: challenge and resistance. In: The Permanente journal. Volume 12, Number 1, 2008, pp. 88-96. PMID 21369521 , PMC 3042348 (free full text).
  • B. Sundstrom, SJ Meier and others: Voices of the "99 Percent": The Role of Online Narrative to Improve Health Care. In: The Permanente journal. Volume 20, Number 4, 2016, pp. 49-55, doi: 10.7812 / TPP / 15-224 . PMID 27455070 , PMC 5101090 (free full text).
  • G. Zaharias: What is narrative-based medicine? Narrative-based medicine 1. In: Canadian family physician Medecin de famille canadien. Volume 64, Number 3, March 2018, pp. 176-180. PMID 29540381 , PMC 5851389 (free full text) (review).
  • G. Zaharias: Narrative-based medicine and the general practice consultation: Narrative-based medicine 2. In: Canadian family physician Medecin de famille canadien. Volume 64, Number 4, April 2018, pp. 286–290. PMID 29650604 , PMC 5897070 (free full text) (review).
  • G. Zaharias: What is narrative-based medicine? Narrative-based medicine 1. In: Canadian family physician Medecin de famille canadien. Volume 64, Number 3, March 2018, pp. 176-180. PMID 29540381 , PMC 5851389 (free full text) (review).

Web links

(Non-commercial internet portals with patient stories / illness experiences)

Individual evidence

  1. ↑ T. Greenhalgh, B. Hurwitz: Narrative based medicine: why study narrative? In: BMJ. Volume 318, Number 7175, January 1999, pp. 48-50. PMID 9872892 , PMC 1114541 (free full text) (review).
  2. ^ T. Greenhalgh, B. Hurwitz: Narrative-based Medicine - speaking medicine. Dialogue and discourse in everyday clinical practice. Huber, Bern 2005, ISBN 3-456-84110-8 .
  3. ^ Rita Charon: Narrative Medicine. In: JAMA. 286, 2001, p. 1897, doi: 10.1001 / jama.286.15.1897 .
  4. ↑ a b c P. F. Matthiessen, S. Wilm, V. Kalitzkus: Narrative Medicine - What is it, what is it, how do you implement it? In: ZFA magazine for general medicine. No. 2, 2009. doi: 10.3238 / zfa.2009.0060 .
  5. ↑ Narration. In: G. Wenninger: Lexicon of Psychology. Spektrum Akademischer Verlag, Heidelberg 2000. Link accessed on August 28, 2018.
  6. ↑ narrative. In: Duden .. Bibliographisches Institut, Berlin 2018. Link accessed on August 28, 2018.
  7. ↑ J. Lühnen, M. Albrecht, I. Mühlhauser, A. Steckel Berg: Guideline evidence-based health information. Hamburg 2017. Link accessed on August 28, 2018.
  8. ^ T. Greenhalgh: Narrative based medicine in an evidence based world. In: T. Greenhalgh, B. Hurwitz (Ed.): Narrative based Medicine. Dialogue and Discourse in Clinical Practice. BMJ Books, London 1998, pp. 247-265. [German. Translation: 2005]
  9. ^ T. Greenhalgh: How to Read a Paper: The Basics of Evidence Based Medicine. BMJ Books, London 1997.
  10. ^ R. Charon, P. Wyer, NEBM Working Group: Narrative evidence based medicine. In: Lancet. 371, 2008, pp. 296-297. Link accessed on August 28, 2018.
  11. ^ R. Charon: Narrative medicine as witness for the self-telling body. In: J Appl Commun Res. 37 (2), 2009, pp. 118-131.
  12. ↑ SL Arntfield, K. Slesar, J. Dickson, R. Charon: Narrative medicine as a Means of Training medical students toward residency competencies. In: Patient education and counseling. Volume 91, Number 3, June 2013, pp. 280-286, doi: 10.1016 / j.pec.2013.01.014 . PMID 23462070 , PMC 3992707 (free full text).
  13. ^ Ana Luisa Rocha Mallet, Luciana Andrade u. a .: Narrative Medicine: Beyond the Single Story. In: International Journal of Cardiovascular Sciences. 2016, Volume 29, Number 3, pp. 233-235. doi: 10.5935 / 2359-4802.20160037 .
  14. ↑ HJ Omsel: online commentary on the German Heilmittelwerbegesetz. Chapter medical histories. Link accessed on August 28, 2018.
  15. ^ Law against Unfair Competition . Version based on the second law amending the law against unfair competition of December 2nd, 2015, entered into force on December 10th, 2015. Appendix to Section 3 Paragraph 3.Link accessed on August 28, 2018.