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Narrative Medicine and Healthcare Reform

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Abstract

Narrative medicine is one of medicine’s most important internal reforms, and it should be a critical dimension of healthcare debate. Healthcare reform must eventually ask not only how do we pay for healthcare and how do we distribute it, but more fundamentally, what kind of healthcare do we want? It must ask, in short, what are the goals of medicine? Yet, even though narrative medicine is crucial to answering these pivotal and inescapable questions, it is not easy to describe. Many of its core claims go against the grain of common sense thinking about medicine. This article argues that the best way to understand narrative medicine is to tell a story that puts its emergence in historical context.

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Notes

  1. For background on Flexner’s report see M. Hiatt, “Around the Continent in 180 Days: The Controversial Journey of Abraham Flexner;” Pharos, Winter 1999; and TN. Bonner, “Searching for Abraham Flexner;” Academic Medicine 93, No. 2; and P. Starr The Social Transformation of American Medicine (New York: Basic Books, 1982), 118–121.

  2. A. Flexner, Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Science (New York: Carnegie Foundation for the Advancement of Teaching, 1910), 23.

  3. Ibid., 25.

  4. C. Odegaard, Dear Doctor: A personal letter to a physician. (Menlo Park: Henry Kaiser Foundation, 1986), 12–14.

  5. See G. Engel, ” The Need for a New Medical Model: A Challenge for Biomedicine,” Science 196, No. 4286 and G. Engel, “The Clinical Application of the Biopsychosocial Model,” American Journal of Psychiatry, 137, No. 5 (1980).

  6. E. Cassel. “The Nature of Suffering and the Goals of Medicine,” New England Journal of Medicine 306, No. 11 (1982).

  7. I. McWhinney, “Are We on the Brink of a Major Transformation in Clinical Method?” Canadian Medical Association Journal 135 (1986): 873.

  8. E. Pellegrino, “Being Ill and Being Healed: Some Reflections on the Grounding of Medical Morality,” in V. Kestenbaum, ed., The Humanity of the Ill: Phenomenological Perspectives (Knoxville: University of Tennessee Press, 1982), 156.

  9. E. Husserl, “Philosophy and the Crisis of European Humanity,” in J. Wild, ed., The Crisis of European Sciences and Transcendental Phenomenology, (Evanston: Northwestern University Press, 1970), 299.

  10. K. Toombs, “Introduction: Phenomenology and Medicine,” In K. Toombs, ed. Handbook of Phenomenology and Medicine, (Netherlands: Kluwer Academic Publishers, 1998), 2.

  11. E. Pellegrino, Humanism and the Physician, (Knoxville: University of Tennessee Press, 1979), 9.

  12. R. Zaner, “Medicine and Dialogue.” Journal of Medicine and Philosophy 15 (1990): 303.

  13. Ibid.

  14. Ibid.

  15. E. Pellegrino, “Being Ill and Being Healed: Some Reflections on the Grounding of Medical Morality,” 157.

  16. Ibid., 156.

  17. E. Pellegrino, Humanism and the Physician, 127.

  18. E. Pellegrino, “Being Ill and Being Healed: Some Reflections on the Grounding of Medical Morality,” 157.

  19. A. Kleinman, The Illness Narratives: Suffering, Healing and the Human Condition, (New York: Basic Books 1988), 3.

  20. Ibid., 5.

  21. Ibid., 10.

  22. Ibid., 253.

  23. Ibid., 253.

  24. Ibid., 266.

  25. K. Charmaz, Good Days, Bad Days: The Self in Chronic Illness and Time (New Jersey: Rutgers University Press 1990).

  26. A. Frank, At the Will of the Body: Reflections on Illness (Boston: Houghton Mifflin, 1992).

  27. Ibid., 1.

  28. Ibid., 3.

  29. For a range of examples, see A. Hawkins and M. McEntyre, eds., Teaching Literature and Medicine (New York: Modern Language Association, 2000).

  30. H. Brody, Stories of Sickness (Oxford: Oxford University Press, 2003), 8.

  31. Ibid., 15.

  32. Ibid.

  33. KM. Hunter, Doctors’ Stories: The Narrative Structure of Medical Knowledge (Princeton: Princeton University Press, 1991).

  34. Ibid., 6.

  35. Ibid., 7.

  36. A. Hawkins, Reconstructing Illness: Studies in Pathography (Indiana: Purdue University Press, 1993), 21–22.

  37. Ibid., 4.

  38. Ibid., 6.

  39. Ibid., 6.

  40. Ibid., 9.

  41. R. Charon, “Narrative Medicine: Attention, Representation, Affiliation,” Narrative, 13, No. 3 (2005): 261.

  42. R. Charon, Narrative Medicine: Honoring the Stories of Illness (Oxford: Oxford University Press, 2006), vii.

  43. Ibid., 262.

  44. R. Charon, “Narrative and Medicine,” New England Journal of Medicine, 350, No. 9, 2004): 863.

  45. R. Charon, Narrative Medicine: Honoring the Stories of Illness, 108.

  46. Ibid., 113.

  47. Ibid., 155.

  48. Ibid., 182.

  49. M. Edson, Wit: A Play (New York: Faber and Faber, 1999).

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  1. Gallatin School of Individualized Study, New York University, 1 Washington Place #609, New York, NY, 10003, USA

    Bradley E. Lewis

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Lewis, B.E. Narrative Medicine and Healthcare Reform. J Med Humanit 32, 9–20 (2011). https://doi.org/10.1007/s10912-010-9123-3

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