Can Modern Medicine and Narrative Medicine Truly Coexist?
So far, I've given examples of how I envision narrative medicine. My argument is not to have narrative writing replace current communications about birth in medical centers, but rather supplement it.
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The current system of medicine involves leaving "medical notes" which are essentially recaps of each appointment that are, in current times, placed into a patient's online chart. An example of a medical note (not in labor and delivery) is provided below:
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76 y/o man with h/o HTN, DM, and sleep apnea who presented to the ED complaining of chest pain. He states that the pain began the day before and consisted of a sharp pain that lasted around 30 seconds, followed by a dull pain that would last around 2 minutes. The pain was located over his left chest area somewhat near his shoulder. The onset of pain came while the patient was walking in his home. He did not sit and rest during the pain, but continued to do household chores. Later on in the afternoon he went to the gym where he walked 1 mile on the treadmill, rode the bike for 5 minutes, and swam in the pool. After returning from the gym he did some work out in the yard, cutting back some vines. He did not have any recurrences of chest pain while at the gym or later in the evening. The following morning (of his presentation to the ED) he noticed the pain as he was getting out of bed. Once again it was a dull pain, preceded by a short interval of a sharp pain. The patient did experience some tingling in his right arm after the pain ceased. He continued to have several episodes of the pain throughout the morning, so his daughter-in-law decided to take him to the ED around 12:30pm. The painful episodes did not increase in intensity or severity during this time. At the ED the patient was given nitroglycerin, which he claims helped alleviate the pain somewhat. -- has not experienced any shortness of breath, nausea, or diaphoresis during these episodes of pain. He has never had chest pain in the past. He has been told “years ago” that he has a right bundle branch block and premature heart beats. I recommend continuation of present medical therapy with an increased dosage from 5mg to 10mg of amlodipine.
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Blood pressure 141/82, O2 96%, HR 73
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These medical notes can be accessed online by any provider who sees the patient in the future in order to stay up-to-date with medical visits. As seen in the example above, this is a very detailed note about a patient's presentation to the ER. However, it is missing any history, emotional information, or mental health indicators. In order to bring an increased level of empathy, I recommend that medical notes include narratives. Oftentimes, scribes will write a medical note. I believe the implementation of narrative-focused scribes will be ultimately beneficial in elevating the level of care provided today. These narratives will be available to future care providers, upon asking patients for consent to release narratives to future care providers in the OB/GYN realm. Narratives will support doctors notes with any narratives the patient is willing to provide so future MAs, nurses, doctors, etc. can see not ONLY look the patient's past physical medical history, but also their emotional history!
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So, yes. I do think narrative medicine and modern medicine can coexist. The lack of satisfaction in patient care in the United States speaks for itself. Patients want to feel heard, and narrative medicine can take a prominent role in alleviating the current level of ignorance in the medical field.