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Stories in Medicine
Doctors-in-Training Record a Different Type of Patient History

Dr. Rita Charon
Dr. Rita Charon
Credit: Courtesy Rita Charon

Charon, right, with two of her narrative medicine students, Anne Rogness and George Stapleton.
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 charts.

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 class:

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 biopsy result.

(Patient's initial and clinical information have been changed to protect the patient's privacy.)