By Michael Price

Dr. Schaff (top center) and Dr. Wright (top left) lead a narrative medicine workshop with interns in Keck’s Family Medicine Residency Program. (Photo/Alejandra Orozco)

On May 24, 2023, the Keck School of Medicine’s Narrative Medicine program convened its inaugural narrative medicine conference. The day-long event, “A Return to the Heart of Health Care,” brought together 30 community leaders from across Los Angeles united by their passion for health justice. Physicians, chaplains, social workers, advocates for unhoused individuals, English professors, and more assessed how narrative medicine’s methods can improve clinical interactions, assist communities in recovery, and mitigate burnout among the people who have been called to serve and care for others.

After initial presentations on the history of narrative medicine at Keck by program directors Pamela Schaff, MD, PhD and Erika Wright, PhD, and an overview of the field’s utility and methods, attendees broke into small groups to practice narrative medicine in action. The groups undertook close readings of a painting by local artist Eloy Torres and a poem by Ada Limón, reacting to these works, sharing their unique perspectives, engaging in prompted writing, and participating in facilitated discussions about the experience. It was a live demonstration that through thoughtful engagement with literature and the arts, health care professionals can enhance their capacity for perspective-taking and self-reflection. The process simultaneously demonstrated community-building through the shared experience of close reading, writing, and listening.

KSOM Narrative Medicine: The Keck-Dornsife Connection

Since its founding in 2000, narrative medicine has evolved into a vibrant field that honors the stories of individuals seeking and giving care in the clinic, the classroom, and the community. From its inception, narrative medicine has sought to address the dehumanizing aspects of medicine, asserting that the patient’s narrative—how they tell the story about who they are and what they’re going through—is not only essential but central to effective health care. Practitioners trained in narrative medicine develop the skills to appreciate a patient’s journey as a lived human experience informed by their background, beliefs, and values. Centering the patient experience allows them to more fully participate in their own care, and helps the provider find comfort in the challenges of witnessing pain—and joy in the collaborative process of care work.

Schaff, Director of the Narrative Medicine program, notes, “Both clinicians and the patients they serve are challenged by the corporatization of healthcare, by not enough time, by issues of limited access to care, by systemic inequities. We’ve seen that clinicians trained in narrative medicine methods are fortified and inspired to do their often difficult work, and are less likely to experience burn out.”

While narrative medicine initially focused on the clinical encounter, its value and appeal reach beyond a single setting or profession, as reflected by the professional journeys of Dr. Schaff and Dr. Wright, a literary scholar and Associate Director of the Narrative Medicine program. The field’s approach to stories, Wright notes, “has been shaped and guided by its affiliation with the reading methods, theories, and critical frameworks taught in English and other humanities, so it is not surprising that the KSOM Narrative Medicine program would have strong connections to Dornsife.”

Schaff and Wright met in the Department of English at USC when they were both doing doctoral work. Dr. Schaff, a pediatrician working on her PhD in Literature and Creative Writing, and Dr. Wright, a former secondary school teacher studying Victorian literature and medical practices, shared an interest in narrative theory, novels, and health care. They noticed the overlap in their concerns about patient/student wellness and clinician/teacher burnout and recognized that narrative medicine methods could provide a framework for grappling with these challenges.Dr. Schaff invited Dr. Wright to support the integration of humanities in medical education and to help create the second Master of Science in Narrative Medicine program in the country—and the only program of its kind on the west coast. Launched in 2020, the MS program appeals to both USC campuses, offering courses in creative writing, intersubjectivity, witnessing, narrative ethics, health justice, qualitative research methods and more.

“Because narrative medicine is defined by its relationship to English and other humanities,” Dr. Wright says, “strengthening our ties through formal collaborations, new alliances, and institutional support will allow our two campuses to learn from and enhance each other as we strive to center the stories of individuals and communities.”

Community Building is Scalable Work

A cornerstone of USC’s Narrative Medicine program is health care in action through outreach and community partnership. In tight alignment with Keck Medicine and university priorities, there is a direct line from the classes on campus to the productive workshops led by narrative medicine students, graduates, and faculty for social service organizations and their clients, as well as for Keck faculty and CHLA families and practitioners. Kathy Riley, a recent graduate of the MS program, earned a Visions and Voices Arts in Action grant to offer workshops for Cancer Support Community Los Angeles. As Dr. Schaff notes, “Patients and their families who have participated in narrative medicine workshops report feeling a sense of community with others who share common experiences with illness or in caring for loved ones.”

Keck master’s students design and facilitate a series of workshops as part of their teaching practicum requirement. In Spring 2023, students co-facilitated a series of readings and discussions about art, poetry, and music with Special Service for Groups/Alliance (SSG/Alliance), a non-profit consortium supporting vulnerable communities such as those with mental health challenges and/or suffering from addiction.

Leading workshops helps future health care professionals explore the value of patient stories. Kylie Leong-Bob, a current master’s student who completed the practicum last spring, says, “There’s this expectation that physicians remain entirely objective, but it’s also validating and okay to feel moved by our patients’ stories. For the physician, being able to find yourself represented in a patient story, feeling like you are a co-creator, can be therapeutic.”

Narrative medicine workshops can also be adapted for specific groups, including client organizations, physicians, medical staff, and mixed groups. The self-reflection promoted by the workshops can help organizations clarify or develop a shared mission statement.

Toward Greater Health Justice in LA and Beyond

As a community-building movement focused on action, the master’s program will continue to develop future leaders dedicated to health justice. Leong-Bob says, “[Drs. Schaff and Wright] always encourage us to lean into our own projects, into what we want to discover about narrative medicine. I just love the program because they make it feel like you’re not just a student. You’re a pioneer in narrative medicine.”

Drs. Schaff and Wright are grateful for the efforts of the inaugural conference planning committee—Aizita Magaña, Eve Makoff, Kathy Riley, Samantha Stewart, and Edgar Rivera Colón—and look forward to developing future workshops as a central part of the program’s community engagement work. A virtual reunion for the participants of the May workshop is planned for fall. Attendees will have a chance to reconnect and discuss plans for the future. The planning committee will gather information on what attendees felt was most valuable and refine future workshops and trainings.

Susan Slater, Associate Medical Director at AltaMed PACE, helps nursing home eligible seniors age in place within their communities. “Being with other leaders in healthcare who understand the value of stories to our work, ourselves, our patients,” she said, “was refreshing after the grind of the last few years with COVID piled on top of the sometimes demoralizing effect of our complicated, inefficient healthcare system.”

She left the conference with “a commitment to deeper, more engaged listening; remembering that the patient’s story is the text—with subtext—that can be ‘read’ as any other piece of text.” Dr. Slater was not alone in acknowledging the transformational experience: in a post-conference survey, 100% of  respondents said their work would change as a result of their experience.

As the Narrative Medicine program at Keck continues to develop community engagement and curricular content, it will also focus on forming tighter partnerships with professors in other humanities and social sciences departments, strengthening and sharing narrative medicine methods. “There’s something kind of natural,” Dr. Wright says, “in that anyone who is teaching is already doing attentive care work.”