115th Annual Conference - Honolulu, Hawaii
Friday, November 10 - Sunday, November 12, 2017

The Embodied Patient: Illness Narratives in Writing in the Health Professions

Amy Clarke, University of California, Davis

The author, who teaches an upper-division writing seminar for pre-health professionals, applies tenets of narrative medicine to a standard assignment in this course: the pathography. As illustrated in representative student models, such a pathography should make the patient’s lived experience of illness “visible” to the reader. Students are coached in interviewing techniques, especially in attentive listening and informed inquiry to elicit detail and to help the interviewee identify the narrative arc of their illness experience.

Proposal: 

Evidence-based medicine (the gold standard of current health professions training) favors treatment decisions based on meta-analytic mining of the peer-reviewed literature. In our upper-division Writing in the Health Professions course at UC Davis, we address this professional competence by assigning a literature review. This capstone project forces students to grapple with the clinical trials, experimental reports and systematic reviews that underpin evidence-based treatment. But how do we prepare students on the cusp of entering professional training for the very personal nature of medicine? After all, most will spend their careers in direct relationship with people at the worst juncture of their lives: the moment their bodies fail. Diagnosing these patients requires eliciting the story of their illness: Healing them requires helping patients rewrite their life stories now that illness has become part of the narrative.

A specific approach for training students to do this kind of work is found in narrative medicine, a humanities-based subfield of medical training developed by Rita Charon and colleagues at the Columbia University School of Surgeons and Physicians. Narrative medicine positions the patient’s experience of illness as an essential component in evidence-based treatment decisions. As Charon puts it, “The care of the sick unfolds in stories. The effective practice of healthcare requires the ability to recognize, absorb, interpret, and act on the stories and plights of others.”

While my students Writing in the Health Professions have spent many hours in medical environments, most are inexperienced in interviewing patients. In particular they need training in how to listen attentively, prod gently for details, and help patients identify the “chief complaint,” of their illness story. Narrative medicine, as articulated by Sayantani DasGupta (and which builds on the work of bell hooks), provides structured training in engagement, being present with the patient and helping build the story without overtaking it.

To teach this kind of engagement and to illustrate the power of story, I assign a pathography based on an interview with someone the student knows who has undergone treatment for an illness. As always, I provide models of exceptional student responses to this assignment culled from the University Writing Program’s database of prize-winning essays, all of which are open source and accessible to anyone attending the session. In particular, we focus on the story of Sarah Sumpter, a national caliber collegiate runner whose description of the moment of learning she had a brain tumor is told in such clear, chilling detail that the reader is unlikely to forget it. Sarah’s narrative powerfully illustrates the effect of bringing the patient “into the room,” showing the personal toll of an experience the pre-health professional can’t usually begin to imagine. More essentially, the narrative is really about how Sarah rearranged her personal narrative, her sense of the meaning of her life, to accommodate the reality of a life-threatening disease: such integration is where the healing really begins.

Works Cited

Charon, Rita. Narrative Medicine: Honoring the Stories of Illness. Oxford UP, 2006.

DasGupta, Sayantani. “The Politics of the Pedagogy: Cripping, Queering and Un- homing the Pedagogy.” The Principles and Practices of Narrative Medicine, edited by Rita Charon, et al., Oxford UP, 2016, pp. 137-156.

hooks, bell. Teaching to Transgress. Routledge, 1994.