Illustration: Anna Godeassi.

Going beyond the diagnosis, narrative medicine can transform patient care

Narrative medicine uses humanities tools to train medical students to be better listeners — and as a result, better doctors.
ByMeredith McGroarty

When Pamela Schaff ’19, director of USC’s Master of Science in Narrative Medicine Program, was working toward her PhD in literature and creative writing at USC Dornsife, she studied the complex ways in which Henry James depicted relationships between characters in his novels. Schaff says the close reading of such texts during her doctoral research enhanced her clinical skills, as well as her ability to interpret the joys and struggles of her patients, and to act on their behalf — two key areas of practice that narrative medicine aims to bolster.

Students in the Narrative Medicine Program learn that the ancient medical tradition of beginning an examination by “taking a history” to understand a patient’s story does not account for what happens during the clinical encounter. There is a key distinguishing factor when practicing narrative medicine called “narrative humility.”  The concept recognizes that a patient’s story is not one that can be mastered but instead is dynamic and requires listeners to reflect on what they bring to an encounter. It also requires them to be open to the transformation that occurs when we hear another’s story.

The Narrative Medicine Program builds on this foundational practice by equipping students — future physicians, social workers, psychologists, nurses and those aspiring to work with health-related nonprofits — with a comprehensive range of humanities-based skills to engage with patients. These tools are designed to help graduates gain a more holistic understanding of an illness, including the contextual life circumstances and patient anxieties related to it.

While the program is housed at the Keck School of Medicine of USC, courses are taught by faculty with appointments at USC Dornsife and with specialties outside of biomedicine and clinical work. By drawing from such disciplines as creative writing, sociology, philosophy and anthropology, students learn how to “read” a patient’s account of their illness, appreciate their fears regarding prognosis or treatment, and communicate news and information in a manner that is most effective for patient well-being.

Students immerse themselves in diverse works of poetry, film, fiction and theatre that invite them to grapple with the uncertainty and complexity of the human condition. Works such as Claudia Rankine’s Citizen: An American Lyric, Ocean Vuong’s On Earth We’re Briefly Gorgeous and Alison Bechdel’s graphic memoir Fun Home invite students to reflect on individual and community identity.

“Close attention builds trust. It opens a space where patients, perhaps initially hesitant about vaccinating their kids or worried about developmental issues, will truly feel seen and cared for — an experience that’s rare in the rush of a standard 15-minute appointment,” says Schaff, professor of medical education, family medicine and pediatrics and director of Keck School of Medicine’s Humanities, Ethics, Art, and Law (HEAL) Program.

One recent graduate of the Narrative Medicine Program, Kathy Riley, is now associate director of programs at Cancer Support Community Los Angeles. She attributes her proficiency in addressing the complexities of grief and loss — a significant part of her work with caregivers — to the skills cultivated through the program. She notes caregivers are often overlooked in the context of illness and treatment and helping them address their feelings is vital for their well-being.

The field of narrative medicine is now widening far beyond the doctor’s office. Using stories to better understand subtexts and perspectives is also proving useful in the realms of social justice, law and myriad other areas, notes Erika Wright ’09, associate director of the Narrative Medicine Program.

Wright, assistant professor of clinical medical education and English, earned a PhD in English from USC Dornsife and also serves as an instructor in the Narrative Medicine Program. She says, “Learning how to understand complex community narratives, as well as recognizing that each individual within a particular community has their own story, is key to being able to best help an individual — whether in the doctor’s office or beyond.”