Telling a story and pioneering ‘narrative medicine’

Walking into Rita Charon’s studio, in a Jazz Age building in Greenwich Village, I get a quick glimpse of the white-walled space bathed in sunlight from two large windows that offer a panoramic view of the Lower Manhattan skyline. Everything in the room seems to have been thought out, from the Bach playing in the background to the paintings on the walls. One of them, “The Doctor”, is an appropriate Victorian portrait of a dedicated doctor working on a child while worried parents look on. It used to hang in Charon’s father’s office.

My meeting with Charon, founder of the “narrative medicine” organization that trains health professionals to use the power of storytelling in their work, is something I’ve been thinking about for 20 years. I’ve been wonder how such a humane approach can fit into the time- and money-constrained world of 21st century health care? And who is the woman, who sometimes goes unnamed, who has done so much to change the way we think about the doctor-patient relationship?

Now, as we sit down, I realize that I intend to tell the story of someone who is used to imitating other people’s stories. The essence of his work, he says, is “what really happens [moment of] two people sitting, meeting each other through language, through visible personality”. So we begin.

Charon graduated from Harvard Medical School in 1978 and began practicing general medicine. In the late 1980s, he began doctoral studies at Columbia University, focusing on Henry James and a section on medical literature. The task of the second half of his life was to unite these two opposing areas above. He believes that emotional and imaginative elements in literature, art and music can change the way health workers treat patients and others. Around 1990, he began teaching storytelling at Columbia and in 2009 launched a master’s degree in the subject, the first of its kind. Since then, his method has been used by health practitioners throughout the US and overseas, from Greece to China. Systematic reviews have shown that it improves participants’ ability to think, in one study and reduces racial bias.

Charon tells me that for decades doctors were taught to follow the model of ‘sideline involvement’.

His father, a physician in Providence, Rhode Island, was an important influence. At one point, he goes to a cupboard containing all his medical records, which he found after his death. This part of his life has always been closed to him; the close community in which they lived meant that secrecy was especially important. But it turned out that his files combined the usual medical descriptions with many personal references. It seemed to show the realization that diseases could not be divorced from the broader conditions of their patients’ lives. Inspired, Charon began to write detailed and interesting notes about his patients.

A trained narratologist, he says, can take in a lot in a short amount of time, even when there is pressure on doctors to keep the time as short as possible. “As you improve your care skills, you will notice other things about your patients. You will listen more loudly.” As doctors, he says the human body is “our things . . .” I’m sitting here watching you, I noticed how you’re sitting on the chair.”

Boldly, I ask what else he chose about me. He noticed that my outer coat was purple with the pink lining of my jacket: “You have taste because you can’t put water in olive green.” He saw my eyes: “Often this sentence is full of curiosity.” My impression of her, deepening over the next three and a half hours, is that of a woman with a great wellspring of compassion, ignited by righteous indignation at the inadequacy of health care for US. “In Yiddish, we call it Shanda, which is ‘shame’. The shame of the system,” he said. “More and more doctors . . . they feel that they are being used by their employers. They know they are doing a bad job. . . They get tired of saying, ‘I’m sorry, I can only listen to one complaint per show. Explain that next time.’”

He says that truly listening to patients can change them. “Patients generally know what they need.” He remembers a young woman with poorly controlled diabetes who came to his examination room angry and distraught. “I did my routine, which is to get off the computer, put my hands in my lap. Don’t write it down. Just say, ‘I’ll be your doctor. Tell me what you think I should know.’ ‘” The woman looked like she was going to cry but she looked around. “You really want to know what I need? I need a new set of teeth.”

It was then that Charon realized that he had closed his mouth as he spoke. He had no upper teeth. Instead of arguing with the woman’s insulin dosage, Charon arranged for her to be seen at the university’s dental clinic. He shows up after a few months, and he’s glowing. He started a [catering] business in his house. He [blood] sugar was better than it had been for a while. And she was more active – going to parties, dancing! It was such a lesson for me. Why on earth would you start anywhere but ‘Tell me where to start’?”

I am interested in how this approach requires a shift in the traditional power relationship between doctor and patient. He tells me that for decades doctors were taught to follow the model of “extreme anxiety”. In fact, “being concerned will get you further than worrying about isolation. Isolation looks like cold.” Instead, Charon believes in making room for imagination. “When the more you use your creativity, the better your medicine will be. It is jumping. . . I don’t like the word intuition because it sounds like magic. But the ability to see the known from the unknown – that’s what poetry does. “

In the early 2000s, Charon tried something new. After completing the consultation and taking notes like any doctor would, “I turned around the keyboard and the monitor and said, ‘I know what I saw. But please finish that letter.’ I would leave them alone for five minutes, and they wrote the most depressing things!”

One college professor wrote “that he knew he was a good teacher and that this made him very proud.” That thought surprised Charon because it did not come up during their conversation, which was dominated by the woman’s health problems and the difficult relationship with her daughter.

A thought occurs. As I end our conversation, I ask him to end this conversation. Is there anything else I should know? He says that after he left his practice in 2015 to focus on running his program at Columbia, he felt relieved that he was able to give responsibility to his patients. (“Somebody’s going to worry about Lucy.”) It was several weeks before she realized the gap in her life: “I was missing a lot of random acts of kindness. .”

As a doctor, the timing of giving is “intense”, he says, whether it’s calling a patient’s sister to update her, helping to put on someone’s socks after an examination or scrubbing a terminally ill patient’s feet. . There’s something poignant about the unbridled gratitude these initiatives generate, he says. I think their expectations of us are very low.

He suggests that storytelling medicine can give nurses the ability to see a problem from different perspectives, a power he likens to the “combined eye of a fly”. It can help them understand and appreciate those they care about in their uniqueness and complexity. He says: “We should treat each patient as a deep secret.”

Sarah Neville is the FT’s global health editor

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