a Different Type of Patient History
| Dr. Rita Charon
Credit: Courtesy Rita Charon
| Charon, right, with two of her narrative
medicine students, Anne Rogness and George Stapleton.
Credit: C. H. Halporn
Oct. 28, 2003 -- At New York City's Columbia University,
students are experiencing a novel approach to medical training. Besides the scientific
charts they keep on patients, the students are writing about their encounters
and emotional reactions in ordinary language. This program in "narrative medicine"
includes lectures on medical ethics and guest lectures by writers such as Susan
Sontag, but the core of the program is writing and reading from these parallel
Dr. Rita Charon, professor of internal medicine, created the narrative medicine
program. The idea came to her as an internist, when she was struck with how sickness
unfolds in stories. Much of her job involves absorbing people's stories, deciphering
them and then taking action. Dr. Charon says she realized that this narrative
aspect of medicine was all around her students, but never openly discussed. NPR's
Margot Adler spent some time with Charon and her students to see how patients'
stories unfold, and what some doctors-in-training are doing with them.
Read an Excerpt
An essay by George Stapleton, a medical student in Dr. Charon's narrative medicine
One of the hardest days of my med school experience, the second anniversary of
Sept. 11, on which I was isolated from the friends I needed and compelled to work
an 18-hour shift, I fell in love with a very special new patient. Pleasant and
fun, never complaining even when she described symptoms that would send other
people into a constant fit, Mrs. V. possessed a rare charm and appreciation of
human kindness that reminded me of my very dear and deceased grandmother. I hated
the first 11 hours of that workday, because I was compelled to work on the demands
of the here and now, rather than find the space I needed to reflect on the past.
Yet, in the final 7 hours of that burdensome day, meeting and working with Mrs.
V. gave me something to look forward to and cherish, rather than regret. I would
relish every subsequent morning when I could tap her door -- though she wouldn't
hear the tap -- stride into her room happily, and sing a large, gentle, "good
morning, Mrs. V." Quickly answered, no matter her pains, with an equally enthusiastic,
"Good morning, George!"
Mrs. V., who came to us because of severe back pain and blood in the urine, asked
me several days later whether she had cancer. Based on our most recent test results
at the time, cancer was one of the possible causes of the symptoms. I didn't want
to worry my patient with the possibility of cancer, though it made me nervous.
I told her that I didn't think she had cancer, but that it was one of the things
we would look for and rule out in subsequent tests. I may have even told her to
let us worry about it for her. She was pleased.
Had she not said it first, I would not have used the word cancer in our conversation.
The word forced me to be more specific than I wanted to be with a paucity of information
at the time. In order to assure her, I offered my opinion on the most likely cause
of her symptoms. Later that day, a test result provided enough evidence to justify
my tone of confidence with my patient, but I am still anxious as I await her final
(Patient's initial and clinical information have been changed to protect the