LETTERS TO THE EDITOR

 

Narrative Medicine: an ally of the clinical method

 

Medicina Narrativa: una aliada del método clínico

 

 

Yasmany Salazar Rodríguez ^1*, https://orcid.org/0009-0002-0581-847X

 

Víctor Luis Rojas Moreno ², https://orcid.org/0000-0001-9501-4402

 

Ihosvany Ruíz Hernández ³, https://orcid.org/0000-0002-6635-5870

 

¹ University of Medical Sciences of the Revolutionary Armed Forces. Dr. Mario Muñoz Monroy Military Hospital “Orden Carlos Juan Finlay”. Matanzas. Cuba.

 

² University of Medical Sciences of Matanzas. Mario Muñoz Monroy Hospital “Carlos Juan Finlay Order”. Matanzas. Cuba.

 

³ Matanzas University of Medical Sciences. “Commander Faustino Pérez” Clinical Surgical Teaching Hospital. Matanzas, Cuba.

 

 

^* Corresponding author: yasmanyailen@gmail.com

 

 

Received: 23/03/2024

 

Accepted: 05/05/2024

 

How to cite this article: Salazar Rodríguez Y, Rojas Moreno VL. Narrative Medicine: an ally of the clinical method. Med. Es. [Internet]. 2024 [cited access date]; 4(3):e252. Available in:  https://revmedest.sld.cu/index.php/medest/article/view/252      

 

Dear Director:

 

As is known, the scientific method used in the development of teaching and medical practice is the clinical method. To conceptualize the clinical method, we resort to the statement of professors Ilizástegui Dupuy F and Rodríguez Rivera L, who point out that “this is nothing more than the scientific method applied to work with patients, with peculiarities that allow the study of the sick.” ⁽¹⁾

 

It is no less true that, with the advent of new technologies, the development of a market in private medical services and often the lack of motivation and empathy of doctors and medical students bring about the decline of the use of this important method, as highlighted by several researchers today such as Guillen León et al. ⁽²⁾

 

At the beginning of this century, a new proposal emerges to develop teaching and the development of the medical profession and, at the same time, a tool to support the development of the clinical method. This is nothing more than narrative medicine.

 

Narrative medicine is born from the benefits, reflections and experiences obtained by Dr. Rita Charon through the use of narrative skills in her sessions with patients. From its beginnings to the present, this tool has experienced a significant increase in its clinical application. Benefits have been described in the development of medical humanism and improvements in its interventions, diagnostic precision and personalized sessions, which favors comprehensive care, thanks to its use. ⁽³⁾

 

Narrative medicine is described as the execution of narrative skills by the health professional in users that allow them to interpret the person as a text full of information, ⁽³⁾ seeking to improve their quality of care and interpersonal treatment with a humanistic perspective in the doctor-patient relationship, favoring comprehensive care. Furthermore, it is not only a clinical intervention tool, but its application extends to the training of health professionals in some medical schools in the United States and Peru, with important results that have allowed students to develop a better approach to their patients, personal and attitudinal virtues and innovative proposals in their training, enhancing personal, professional, social and coexistence skills. ⁽⁴⁾

 

Narratives are important in medicine because they help build a bridge between modern biomedicine and the experiences lived by patients, between those who tell the story and those who listen to it. Narrative alters the usual ways in which medical professionals learn to practice, rediscovering the uniqueness of each person in the face of illness and focusing on the "knowledge of..." of the characters instead of simply their "knowledge of...", which can be provided by the experience of surviving.

 

Narrative medicine can be considered as a medicine that is practiced with "narrative capacity"; that is: the ability to receive, interpret and respond to stories. Does a narratively competent reader or listener find meaning in a story (novel, textbook, short story) and determine who tells it? Who will listen? Why and how do they tell it? These skills are told in collaboration with potentially conflicting sources, such as reader and author, observer and observed, doctor and patient. It is used to understand the meaning of the content. It is not a monolithic and hierarchically established understanding.

 

Higher medical education needs other ways of teaching, and interpreting patients' sufferings during medical practices;⁽⁵⁾ so that these medical students are able to provide patients with the ability to cope with the loss of health, find meaning in suffering and develop a fully affectionate and empathetic relationship between doctor and patient. Therefore, the teaching and practice of narrative medicine as an ally of the clinical method is necessary.

 

Narrative medicine includes aspects of the biopsychosocial-cultural and spiritual model, and person-centered medicine.

 

It facilitates the development of skills in the use of stories in diagnostic and therapeutic processes, as well as in the education of patients, professionals, and research. Similarly, it is complemented by an evidence-based approach to medical practice, which positively impacts health professionals by promoting spaces for self-reflection and self-knowledge. Therefore, the following question is suggested:

 

Why study patient narratives?

 

Diagnosis:

 

·         They point out the phenomenology of the experience of becoming ill.

·         They stimulate empathy between doctors and patients.

·         They allow the construction of meanings.

·         They provide keys and analytical categories of great clinical utility.

 

Therapy:

 

·         They facilitate a holistic approach to the patient.

·         They are intrinsically therapeutic (in themselves).

·         They can suggest additional and personalized options to the treatment.

 

Education:

 

·         They are very “memorable.”

·         They stimulate reflection.

·         They prevent the automation of behavior.

·         They are rich in experiences.

·         They facilitate the construction of a patient-centered agenda.

·         They allow the generation of novel hypotheses.⁽⁶⁾

 

By focusing on the stories behind the science, narrative medicine recalls the essential humanity of medical practice. It provides a valuable tool for professional and personal development, promoting more compassionate and connected healthcare. By expressing experiences, medical storytelling encourages us all, both doctors and patients, to be more aware, reflective and empathetic about our common journey towards health and wellbeing. However, its use is still a matter of research to determine the correct application as a teaching, learning and assessment method, so it is suggested to have it as a research topic.

 

BIBLIOGRAPHIC REFERENCES

 

1. Conde Fernández BD, Conde Pérez M, Conde Pérez YA. The clinical method and the scientific character of clinical medicine. Rev cubana med [Internet]. 2020 [cited 26/07/2024]; 59(4). Available in: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75232020000400010&tlng=en

 

2. Guillen-León Laura A, Campos-Sánchez Carlos M, Acosta-Escanaverino Isbetti. Consideraciones acerca de la crisis del método clínico ante el desarrollo tecnológico. FEM (Ed. impresa) [Internet]. 2021 [cited 26/07/2024]; 24(5): 271-273. Available in: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2014-98322021000500271

 

3. Reinoso González E, Yañez Baeza C, Pérez Galdavini V, Aguilera Eguia R. Medicina narrativa. Percepción de estudiantes de fisioterapia como herramienta en educación médica. FEM (Ed. impresa) [Internet]. 2023 [cited 26/07/2024]; 26(1): 29-36. Available in: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2014-98322023000100005

 

4. Urday Fernández D, Cuba Fuentes MS. Medicina narrativa. An. Fac. med.  [Internet]. 2019 [cited 26/07/2024]; 80(1): 109-113. Available in: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1025-55832019000100020

 

5. Salazar Rodríguez Y, Mondéjar Rodríguez JJ, Ruíz Hernández I. Enseñanza problémica, enfoque neuroeducativo y educación médica superior. Rev Cubana Med Milit [Internet]. 2024 [cited 26/07/2024];53(3). Available in: https://revmedmilitar.sld.cu/index.php/mil/article/view/67876

 

6. Tekiner H. Ethical Considerations Related to Narrative Medicine. In: Sayligil O. Patient Centered Medicine. IntechOpen. [Internet] 2016. [cited 26/07/2024]. Available in: www.scielo.org.pe/scielo.php?script=sci_nlinks&ref=200630&pid=S1025-558320

 

STATEMENT OF AUTHORSHIP

 

YSR: Conceptualization, formal analysis, investigation, methodology, visualization, writing - original draft, writing - review and editing.

 

VLRM: Conceptualization, formal analysis, investigation, methodology, visualization, writing - original draft, writing - review and editing.

 

IRH: Conceptualization, formal analysis, investigation, methodology, visualization, writing - original draft, writing - review and editing.

 

CONFLICTS OF INTEREST

 

The authors declare that there are no conflicts of interest.

 

SOURCES OF FINANCING

 

There were no sources of financing.