Program is second of its kind in the country

By Mollie Barnes

(Photo iStock)

Rate your pain from 1 to 10.

Most people who have been to the doctor have probably been asked to do this. But, narrative medicine argues that maybe this momentary question misses the point if it doesn’t include a background story.

“For human beings, life is meaningful because it is a story. A story has sense of a whole, and its arc is determined by the significant moments, the ones where something happens. Measurements of people’s minute-by-minute levels of pleasure and pain miss this fundamental aspect of human existence,” said Atul Gawande in his book Being Mortal: Medicine and What Matters in the End.

This is the problem narrative medicine hopes to solve. By focusing on patient’s stories, medical professionals can bear witness, absorb, make sense of, and act upon the stories and the traumas of others to enhance healing.

“A doctor may need to walk with a patient, and or his or her family, through suffering and ultimately death,” said Kathy Riley, a current student in the Narrative Medicine masters program at the Keck School of Medicine of the University of Southern California. “I think that our work in narrative medicine helps equip doctors, nurses and social workers in those difficult journeys that they have to take alongside their patients and their families.”

The Narrative Medicine program at USC welcomed its first 6 students in the fall of 2020. Students take classes in literary studies, creative writing, philosophy, anthropology, sociology, and qualitative research through a medical lens. Students in the program include working professionals like Riley, who works for a pediatric brain tumor foundation. It also includes medical students, and other graduates from various fields such as anthropology.

“These skills have already helped me in my work with families whose children are going through or have gone through treatment for a pediatric brain tumor,” Riley said. “I’ve been able to conduct narrative medicine workshops with those families to help them put words and meaning to their painful experiences. These discussions give them a way to talk indirectly about the struggles that they’ve been through by talking about a poem or a work of art.”

The program includes a teaching component, allowing students to learn how to put on workshops in narrative medicine practices for people interested in acquiring some of the skills from this relatively new field. The program at USC is the second in the country, in addition to Columbia University’s Narrative Medicine program. The first year of the USC program was online due to pandemic safety protocols, but this year began in person classes with a new cohort.

And what students learn in this program is more than just bedside manner, which they learn in the regular medical program, said Pamela Schaff, MD and director for the program at USC.

“If our students can learn what to do with stories, for instance through skills of close reading in a literature classroom, where students analyze details in a text, we believe that translates into improved clinical care for patients,” she said. “It adds another dimension.”

Students take courses in intersubjectivity, which is the relation or intersection between people’s cognitive perspectives, and can choose electives in narrative ethics, immigrant illness narratives, and health justice.

“The courses engage with theories of bearing witness, trauma studies, and philosophical foundations of intersubjectivity,” Schaff said. “How does one person really understand or gain access to the lived experience of another? We’re all existentially separate human beings, but we nevertheless continue to try to bridge that divide and understand and act on the stories that we receive from others. That’s the work that we believe is essential to effective health care.”

Schaff and Erika Wright, the Narrative Medicine program associate director, proposed the master’s program to help address disparities in health care. Schaff has a PhD in creative writing and literature, which she earned at the USC Dornsife College of Letters, Arts and Sciences, in addition to her MD.  After hearing narrative medicine’s founder, Rita Charon, speak at a conference about the new field, she was inspired to bring a similar program to USC.

“When the field was founded, it was really to address some of the issues that I think that patients and physicians alike are continuing to experience,” Schaff said. “You can have all of the scientific knowledge in the world, but if you can’t understand the story or be a good reader or interpreter of a story, you can’t really take care of patients the way I think patients want to be taken care of.”

Jennifer Li graduated from the narrative masters program in spring 2021, in between her second and third year of medical school. In addition to helping enhance healing for patients, she said the program also helps doctors to be able to better reflect on their experiences.

“It sort of protects against burnout, because you’re seeing patients as people and not just diagnoses to be treated,” she said. “I think that makes clinical practice so much more rewarding.” 

While doctors generally have a limited amount of time with a patient, Schaff said narrative medicine practices don’t waste time, they can actually save it. Narrative medical practices of close reading, observing, and listening can help health professionals hear stories more effectively from the start.  

“If we can learn to see the beauty, the pain, and the ambiguities of great literature or works of art as we closely examine them and reflect on them, then we just might be able to stop and notice that our patients are works of art, too, and deserving of our best attention,” Riley said.

For more information about the Keck School of Medicine narrative medicine masters program visit https://sites.usc.edu/narrativemedicine/